RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES.
BANGALORE. KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1 / NAME OF THE CANDIDATEADDRESS / MR. ARUN.C.KURIAN
GAYATHRI COLLEGE OF NURSING. KOTTIGEPALYA, BANGALORE - 91
2 / NAME OF THE INSTITUTION / GAYATHRI COLLEGE OF NURSING.
3 / COURSE
SUBJECT / M.SC. NURSING.
COMMUNITY HEALTH NURSING
4 / DATE OF ADMISSION TO COURSE / 08.06.2011
5 / TITLE OF THE TOPIC / “A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME (STP) ON REPRODUCTIVE HEALTH HAZARDS AND SEXUAL AWARENESS AMONG ADOLESCENTS IN A SELECTED COMMUNITY AREA, BANGALORE.”
6. BRIEF RESUME OF THE INTENDED WORK:
INTRODUCTION
World Health Organization (1948) states “Health is a state of complete physical, mental and social wellbeing and not merely an absence of disease or infirmity”. Health is multidimensional. Reproductive health is a major and crucial component of general health.1
Reproductive health can be defined as a state in which “People have the ability to reproduce and regulate their fertility; are able to go through pregnancy and childbirth; the outcome of pregnancy is successful in terms of maternal and infant survival and well-being; and couples are able to have sexual relations free of fear of pregnancy and of contracting diseases.” 2
Sexual awareness is the awareness regarding safe sex practices which helps in the prevention of sexually transmitted diseases.
Components of reproductive health include Safe motherhood, Family planning, Early detection of cancers of the reproductive system for women and men, Sterility prevention, Approach the most disfavored categories especially youth and teenagers, Prevent unwanted pregnancies and Treat abortion complications and Promote male involvement in reproductive health. It also includes Safe sexual health and Prevention from transmitted diseases.3
Health education is indispensable in achieving individual and community health. The education of health behaviors brings an individual to a state of health awareness.1 Pre-marriage counseling is highly beneficial for couples to step in to marriage with proper knowledge and preparation. Getting married without pre-marriage preparation is like starting an important venture without preparing. 6 On receiving a healthy & complete understanding of all the aspects of the reproductive and sexual health the youngsters will definitely be able to tie the nuptial knot with more confidence and start their new relationship on a more sound footing. 4
6.1 NEED FOR THE STUDY
Reproductive health is the most important component of general health. In order to achieve and maintain a complete state of reproductive health, the knowledge regarding basic and crucial aspects of reproductive and sexual health is necessary. These basic aspects, the knowledge of which plays an important role in maintaining reproductive and sexual health are usually fertility awareness, abortion and its health hazards, planning for pregnancy, early identification of reproductive tract diseases, Sexually Transmitted Diseases and its prevention by using safe sex practices which can than further determine the couple’s sexual behavior to a greater extent.
It is estimated that 2-3% of the world’s reproductive age population relies on periodic abstinence to avoid pregnancy. Many adolescents do not understand the concept of fertile period so in some cases accidental pregnancies occur and in others delays in getting pregnant. 5
Pregnancy planning is not given much importance by many people. Unplanned pregnancies are those that occur when adolescents has not made a decision to conceive, or when pregnancy occurs in spite of using contraceptive measures.80 million unintended pregnancies occur worldwide each year. These pregnancies result in 42 million induced abortions and 34 million unintended births.6
NACO 2008 report states that 30 million populations residing in India are affected with STI’s. It also states that around 2.3 million people in India are living with HIV, of which 39% are female and 3.5% are children. STD clinic HIV prevalence in Karnataka is 8.4%. 10 The goal of primary prevention of STI is to keep infections from ever happening. Therefore primary prevention must be thought not only to the persons who are already sexually active but also to those who expect to become sexually active.
WHO, 2003 world cancer report, describes the global burden of cancer incidence and mortality in the year 2000, according to which the breast cancer incidence in the year 2000 was found to be 1,050 thousands and that of cancer of the cervix was 470 thousands. In men the incidence of prostate cancer was 542 thousands. In India cancer of cervix and breast accounts for nearly 60% of all cancers. One of the main objectives of National Cancer Control Programme 2004 is “primary prevention of cancer by health education”. 1
6.2 REVIEW OF LITERATURE
A study was conducted on Reproductive health awareness of school-going, unmarried, rural adolescents. The Study was planned to test the awareness level of adolescents regarding various reproductive health issues. It was a multicentre study, done in rural co-education/higher secondary schools of 22 districts located in 14 states through Human Reproductive Research Centre (HRRC's) of the Indian Council of Medical Research (ICMR). A sample of 8453 school going adolescents (aged 10-19 years) was surveyed by means of open ended, self-administered questionnaires maintaining confidentiality and the finding of the study revealed that the awareness of at least one method of immunization was present in three-fifth (60.1%) of students. It was least for DPT (13.5%) and most (55%) were aware of polio only. Awareness of all Reproductive Health matters was more in boys than girls and more in late teens (15-19) than earlier teens (10-14).The study concluded that there is a need for evolving information, education, and communication strategies to focus on raising awareness on RH and gender related issues. A socio-cultural research is needed to find the right kind of sexual health services for young girls and boys.10
Researchers rarely conduct research in an intellectual vacuum; their studies are undertaken within the context of an existing base of knowledge. Researchers usually undertake a thorough literature review to familiarize themselves with the knowledge base. A research literature review is a written summary of the state of evidence on a research problem.
“Review of literature is a systematic identification, location, scrutiny and summary of written material that contains information on research problem.” 8
The research reviews are organized under the following headings;
Ø Importance of reproductive health and sexual awareness in among youth.
Ø Education Regarding Reproductive Health and Sexual Awareness among youth.
Ø Effectiveness of Premarital Education and Reproductive Health Education.
· Importance of reproductive health and sexual awareness in among youth.
Roy S Nandan conducted a study to obtain information to support the provision of quality reproductive health services and appropriate behavioral change communication that would improve the health and wellbeing of the young, adolescet students by tahseen/catalyst project. The data was collected with the clinic data sheets, interviews and focus group discussions with adolescent students. The data from focus group discussions found that knowledge of sexually transmitted disease symptoms and knowledge among adolescent youth. It was also found that almost all adolescent males and females indicate that if premarital counseling services had been provided at health clinics they would have attended to become more knowledgeable. The study concluded saying that not all youth have a clear understanding of what the concept of reproductive health hazards and sexual awareness. It was also suggested that Ministry of Health and Population should address the need of adolescent students for reproductive health, and sexual awareness.9
A study was conducted to determine the factors which predict adolescent students’ participation in sexual awareness. Adolescents’ beliefs and attitudes about premarital counseling were assessed at least six months before their wedding, and participation was assessed after their wedding. Results indicate that the strongest predictors of couples’ participation were couples’ perceptions of barriers to counseling and whether they had counseling recommended to them. Recommendations for recruiting engaged couples for premarital counseling are made based on the findings. 10
Sullivan K.T, Pasch LA Cornelius T, Cirigliano E. conducted a study to assess reproductive health care awareness among 250 college girls of Other Backward Classes of Jabalpur city, Madhya Pradesh. The study revealed that 38.4 per cent had information regarding premarital counseling. Of this, 65.6 per cent girls accepted that guidance and counseling before marriage is necessary; 46.4 per cent felt free to discuss their sexual queries; and 94.4 per cent girls were in favour of sex education. 51.2% students accepted that female reproductive girls desired more information, and 66 % on conception and pregnancy. Only 9.2 % girls knew about male reproductive organs, and 15.2% had ever heard about STD. 44% were aware of the unsafe period of pregnancy, it was noticed that students desired to update their knowledge of reproductive health. They also advocate pre-marital counseling. 22 health was the most important segment of reproductive health, and 98.4 % girls desired more information and 66% on conception and pregnancy.Only9.2%girls knew about male reproductive organs and 15.2%had ever heard about STD.11
· Education Regarding Reproductive Health and Sexual Awareness among youth.
Nema A, Sharma KKN, conducted a cross sectional study among 624 women aged 13-49 years from 532 households in North Tamilnadu to examine the level of awareness and the different factors affecting the awareness on reproductive health issues. The questionnaire was orally administered. Results revealed that 92% women know at least one method of family planning. Awareness was highest for female sterilization i.e. 79.1%, IUCD was known to 55.7%, oral pill was 37.0%, condom was 21.7% and male sterilization was 16% knowledge on natural methods like rhythm and withdrawal was only 1%. 3.8% of women reported that bearing child before the age of 18 years as safe. About 8% reported that they don’t know about the safe age for bearing a child. Among 613 women only 15.8% had knowledge about RTI and of those who knew about RTI 81.4% said that it could be prevented. Only 9.5% adolescents had knowledge or had heard about safe sex. 7.4% identified safe sex as taking steps to avoid STD. A significant and positive association between educational level, family type and standard of living with the level of knowledge about the safe sex was observed. 12
Vinitha CT, Singh S, Rajendran AK conducted an explorative quantitative research design to explore and describe the reproductive health needs and the reproductive health behavior of the youth in Mangaung. A purposive non-probability sampling method was utilized and a sample of 250 was drawn from the youth. The data collected by means of a structured questionnaire found that the youth received insufficient reproductive health information to be able to prevent pregnancy and HIV/AIDS. The special needs of youth were indicated by 92% who requested that the clinic should accommodate both boys and girls and 96% of the respondents requested sessions for discussions facilitated by a professional person. 13
Seekoe E. conducted a survey by exploring the attitudes and perceptions of university students in Shanghai, China, toward reproductive health including knowledge on sexual health and sexually transmitted infections and AIDS. Of the 5,243 students, 5,067 students provided valid answer sheets, 50.05% were female and 49.95% were male. A total of 38.4% of respondents had received reproductive health education previously. Although 83.7% knew how HIV is transmitted, only 55.7% knew when to use a condom and 57.8% knew that the use of condoms could reduce the risk of HIV infection. The study concluded that student’s knowledge about reproductive health and STIs/AIDS is still limited. It is therefore necessary to provide effective and confidential reproductive health services to young people. 14
Chen B, Lu YN, Wang HX, Ma QL, Zhao XM, Guo JH et al conducted a household survey to measure reproductive health knowledge among 1973 single and married women aged 15-24 and 936 single men aged 15-19 years in Dakar, Senegal. Two focus groups and a simulated client study were also conducted. The survey and focus groups noted gaps in knowledge of family planning methods and reproductive health. There were misconceptions about methods and only one-third of men and women aged 15-19 correctly identified the time of the menstrual cycle when a woman is most likely to get pregnant. 15
Katz K, Nare C. conducted a study to assess the knowledge of reproductive health hazards and the opinions of Ataturk university students, Erzurum, Turkey towards reproductive health education and family planning services. A questionnaire of 39 questions was administered to 673 systematically and randomly selected students. The results showed that the level of reproductive health knowledge was below the theoretical mean value. Most of the students approved of formal reproductive health education (88.4%). The percentage of men who support family planning services and reproductive health education was lower than that of women. The study concluded that University students lack knowledge about reproductive health.16
Inandi T, Tosum A, Guraksin a conducted a cross sectional descriptive study to assess the level of awareness and practice of family planning methods among 200 women of reproductive age attending gynecology outpatient department of Nepal Medical College Teaching Hospital from 14th May 2008 to 14 the July 2008. 93.0% of the respondents were aware of at least one of family planning methods. The best known method of temporary contraception was depo provera (78.0%) followed by oral contraceptive pills (74.0%) and condom (71%). Least known methods were vaginal foam tablets/jelly (34.0%) and natural methods (16.0%). 27.0% reported awareness that condoms protect from HIV/AIDS and sexually transmitted diseases while knowledge about various adverse effects was widespread (52.5%). This study also observed that with increase in level of education awareness also increased. 17
· Effectiveness of Premarital Education and Reproductive Health Education.
Tuladhar H, Marahatta R conducted a study to evaluate the efficiency of premarital marriage education among 330 couples, who applied to Yzmir-Bornova Municipality Camdibi and Altyndag Branches to marry between the dates of 01.11.2007-23.05.2008 and accepted to take part in the research. The data have been gathered with the technique of face to face interview using a question form and an information evaluation form concerning premarital health. First the question forms have been carried out, and then the couples have been educated about premarital reproductive and mental health. After that education, information form has been carried out one more time. The analysis of the research data has been evaluated by SPSS 16.0 pocket program. The results revealed that the average score of information after education (=57.53 + or - 5.18) is found to be higher than the average score of information before education (=46.39 + or - 6.22) and the distinction between the two averages has been confirmed to be statistically significant. (t=-30.225, p=0.000). According to the result of the research; it has been confirmed that marital education before marriage is effective and that the studies on the premarital education carried out by trained health personnel will help couples to have a healthy family life and prevent them from having problems related to reproductive and mental health. 18