RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

KARNATAKA, BANGALORE
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1.

Name of the candidate and address

(in block letters)

BINDU MARIAM MATHEW

UNITY COLLEGE OF NURSING, SHEDIGURI
DAMBEL ROAD
ASHOK NAGAR POST
MANGALORE-575006

2.

Name of the Institution

UNITY ACADEMY OF EDUCTION

COLLEGE OF NURSING, SHEDIGURI
DAMBEL ROAD
ASHOK NAGAR POST
MANGALORE-575006

3.

Course of Study and Subject

M. Sc. NURSING
OBSTETRICS AND GYNAECOLOGICAL
NURSING

4.

Date of Admission to the Course

27.06.2011

5.

Title of the study

A STUDY TO EVALUATE THE EFFECTIVENESS OF LEARNING

PACKAGE

ON

OVARIAN

SYNDROME

ADOLESCENT

KNOWLEDGE

GIRLS

(PCOS)
IN

AMONG

SELECTED

MANGALORE.

6.

REGARDING

Brief resume of the intended work

POLYCYSTIC

MOTHERS

OF

RURAL AREA

OF

6.1

Introduction
Adolescence is a period having the sense of identity and the sense of intimacy. It is

the transition from childhood to adulthood and so it is not a smooth one. In addition to this
intellectual and emotional upheaval, rapid body growth causes them anxiety and cultural
pressures of todays world add further stress to their uncertainty1. 10 to 20% of the world
population comprises adolescents and their problems have not been fully appreciated and
addressed until recent times2.
Gynaecological problems of adolescents occupy a special space in the spectrum of
gynaecological disorders of all ages. Menstrual abnormalities are the common problems of
adolescents. Menstrual disorders (58.06%) were found to be the commonest gynaecological
problem3.
Polycystic ovarian syndrome (PCOS) is a group of recognizable patterns of
symptoms or abnormalities which requires the presence of two of the following three
conditions. i) Oligo and /or anovolution ii) polycystic ovaries iii) hyperandrogenism 4.
6.2

Need for the study

Polycystic ovarian syndrome is a heterogeneous endocrine disorder that affects one

in 15 women worldwide .It is the most frequent cause of hyperandrogenism and oligoanovulation which have substantial psychological, social and economic consequences.
Immigrant populations from the Indian subcontinent to the UK and Australian women of
aboriginal heritage also have a higher prevalence of PCOS5.
It was first described by Stein and Leventhal in 1935 with significant clinical
implications like menstrual irregularities, hirsutism, infertility, suboptimal obstetrical
outcome and long term complications like impaired glucose tolerance, diabetes mellitus type
2, dyslipidaemia, coronary artery disease and endometrial hyperplasia6.

Studies in first-degree relatives of patients with PCOS shows that 24% of mothers
and 32% of sisters are affected, suggesting a major genetic association. Screening of an
unselected population in the south-western United states showed 4% incidence of PCOS7.

In women of Indian subcontinent, prevalence rates of PCOS are as high as 50% have
been detected. It is responsible for 18% of infertility and 40% of hirsutism cases in a study
conducted at Srinagar. Metabolic syndrome was diagnosed in 46% womens with PCOS in a
study done in Kolkota8. Women diagnosed as having PCOS before pregnancy have an
increased risk of developing gestational diabetes. PCOS is a genetic disorder that each child
has a 50% of inheriting the disorder from a parent who carries the gene9.
Obesity is an important pathogenic factor in the development of hyper-androgenism
in women with PCOS thereby affects ovulation, pregnancy rates and outcomes. Obesity and
PCOS increases the risk for infertility10.
A comprehensive community-based study among 3443 adolescent girls (15-18 years)
done to find out the prevalence of PCOS from 10 schools, Trivandrum. Among them, 339
girls are with the symptoms of PCOS and they were under-nourished (37.6%), normal
weight (51.2%), overweight (8.6%) and obese (2.6%)11. Lack of awareness and lifestyle
changes are considered to be the major factor leading to this phenomena.
A retrospective study done in 58 preadolescent and adolescent girls to study the age
at diagnosis of PCOS and to compare risk factors involved in causing PCOS highlighted that
PCOS may occur at a younger age in girls who develop early pubarche and thelarche.
Therefore, the diagnosis and workup should be considered in young girls with risk factors
suggestive of PCOS12.
PCOS is the most common endocrinologic disorders during adolescence, so there is
always a need to investigate all new relevant data. Early recognition and prompt treatment of
PCOS in adolescents is important to prevent long term complications 13. From all the above
studies the researcher found that mothers of adolescent girls have to obtain adequate
knowledge regarding PCOS because mothers are there with the children around the clock
and are well positioned to be valid reporters about their childs health needs.

As a nurse, the researcher has a pivotal role in creating awareness among mothers of
adolescent girls about how to identify the symptoms and modification to be brought in order
to prevent further complications of PCOS. Hence the researcher felt that learning package
will be an effective teaching strategy to impart knowledge to mothers of adolescent girls

regarding polycystic ovarian syndrome.

6.3

Review of literature

a.

Studies related to effectiveness of learning package as a teaching module

b.

Studies related to prevalence of PCOS

c.

Studies related to knowledge on PCOS

d.

Studies related to clinical manifestations of PCOS

e.

Studies related to diagnosis of PCOS

f.

Studies related to quality of life in patients with PCOS

a.

Studies related to effectiveness of learning package as a teaching module

A Study done in the outpatient department of Apollo hospital to find the effectiveness

of teaching on home care management of diabetes mellitus among 50 samples selected using
purposive sampling technique. The structured questionnaire used and found that 60% of
participants had inadequate knowledge, 40% of them had moderate knowledge and none of
them had adequate knowledge in the pre-test. In the post-test it is found that 70% of the
participants gained adequate knowledge, 30% had gained moderate knowledge and none of
them had inadequate knowledge. The overall mean and standard deviation increased in posttest (M=30.06, SD=3.45) when compared with pre-test (M=19.30, SD=4.67)14.
b.

Studies related to prevalence of PCOS

A study of 460 girls aged 15 to 18 years conducted in Andhra Pradesh, to find the

prevalence of PCOS in Indian adolescents. 72 girls with oligomenorrhea and hirsutism were

invited for diagnosis of PCOS by Rotterdam criteria. Out of 460 girls, one had
oligo/amenorrhea with clinical hyperandrogenism, 29 had oligomenorrhea with polycystic
ovaries, one had polycystic ovaries with clinical hyperandrogenism and 11 had
oligomenorrhea with polycystic ovaries in the presence of clinical hyperandrogenism. Thus

42 girls satisfied Rotterdam's criteria for PCOS, which increased to 50.46(10.97%) when
imputed data were included. The study draws attention to the issue of early diagnosis of
PCOS in adolescent girls because the prevalence of PCOS in Indian adolescents is 9.13%16
c.

Studies related to knowledge on PCOS

A descriptive study done in New York to describe patient perception and awareness

of the PCOS among 657 women of age group of 26-34 years. A questionnaire was used and
the study revealed that patients emotions associated with the diagnosis of PCOS include
frustration (67%), anxiety (16%), sadness (10%), and indifference (2%). Therefore, the
awareness regarding PCOS can be achieved through wide public service announcements or
other structured media exposure, as they would be helpful15
d.

Studies related to clinical manifestations of PCOS

A Study conducted in New Delhi to study the prevalence of clinical manifestations in

obese and lean PCOS women and their health hazards. The women were diagnosed to have
PCOS by the Rotterdam 2003 criteria. Group A included overweight and obese, Group B
included normal weight and lean and were further divided into two groups according to their
body mass index. The result is found that the prevalence of menstrual irregularities, clinical
hyperandrogenism, endometrial hyperplasia (EH), and type 2 diabetes mellitus was
significantly higher in the obese group, whereas android central obesity was similar in both
groups. The study highlighted that diabetes and EH appears to be more prevalent in the
obese, putting a greater risk of morbid problems at a much younger age than the lean ones 17
e.

Studies related to diagnosis of PCOS

A descriptive study conducted in Brazil in 29 adolescent patients, aged 12-20 years,

to evaluate menstrual irregularities with Pelvic ultrasound and hormonal studies. Patients
were divided in three groups according to ultrasound ovarian volumes: group I (n = 16) both
ovaries <10 cm3; group II (n = 8) one of the ovaries
ovaries

10cm3; and group III (n = 5) both

10 cm3. The result showed that Serum levels of LH, LH: FSH ratio, testosterone,

and androstenedione were significantly higher in group III. Positive predictive value of both
ovarian volumes

10 cm3 in terms of polycystic ovary syndrome (PCOS) was 100%,

negative predictive value was 81%, sensitivity was 63%, and specificity was 100%. This

study concluded that in adolescent patients with menstrual disorders, bilateral ovarian
volumes of higher than 10 cm3 are correlated with the diagnosis of PCOS18
f.

Studies related to quality of life in patients with PCOS

A Cross-sectional study conducted on Quality of life in adolescent girls with PCOS at

an urban hospital with 97 adolescent girls with PCOS and 186 healthy controls. Health
related quality life (HRQL) scores as determine by the child health questionnaire-child self
report form. The study says that adolescents with PCOS experience lower HRQL compared
with healthy adolescents19.
6.4

Statement of the problem

A study to evaluate the effectiveness of learning package on knowledge regarding

polycystic ovarian syndrome (PCOS) among mothers of adolescent girls in selected rural
area of Mangalore.
6.5

Objectives of the study

Objectives of the study are to:

1.

assess the pre-test knowledge score regarding polycystic ovarian syndrome among
the mothers of adolescent girls using structured questionnaire.

2.

evaluate the effectiveness of learning package on knowledge regarding polycystic

ovarian syndrome among mothers of adolescent girls using structured questionnaire.

3.

find out the association between the pre-test knowledge scores and selected baseline
variables of mothers.

6.6

Operational definitions

Effectiveness: In this study, effectiveness refers to the extent to which learning package has
achieved the desired effect on increase in the knowledge among the mothers of adolescent
girls as assessed by the structured knowledge questionnaire.
Learning package: The learning package consists of a planned instructional programme on

PCOS which includes an interactive teaching session and a booklet on PCOS.

Knowledge: In this study, it refers to the correct responses by the mothers of adolescent girls
regarding polycystic ovarian syndrome using structured knowledge questionnaire.
Mothers: In this study, it refers to the mothers of adolescent girls, within the age group of
11-17 years.
Adolescent girls: In this study, it refers to girls within the age group of 11-17 years.
Polycystic ovarian syndrome: Polycystic ovarian syndrome (PCOS) is a condition
characterized by the accumulation of numerous cysts (fluid-filled sacs) on the ovaries
associated with high male hormone levels, chronic anovulation (absent ovulation), and other
metabolic disturbances. Classic symptoms include excess facial and body hair, acne, obesity,
irregular menstrual cycles, and infertility.
6.7

Assumptions
The study assumes that

mothers of adolescent girls may have inadequate knowledge regarding polycystic

ovarian syndrome.

mothers of adolescent girls may have the interest to participate in the study

learning package may help the mothers of adolescent girls to improve the knowledge
on polycystic ovarian syndrome.

6.8

Delimitations
The study will be delimited to:

mothers of adolescent girls in selected rural area of Mangalore

mothers of adolescent girls, available at the time of data collection.

6.9

Hypotheses

All hypotheses will be tested at 0.05 level of significance.

H1:

The mean post- test knowledge scores of the mothers of adolescent girls regarding
polycystic ovarian syndrome will be significantly higher than the mean pre-test
knowledge scores.

H2:

There will be significant association between pre-test knowledge scores on

polycystic ovarian syndrome and selected baseline variables of mothers of adolescent
girls.

7.

Material and methods

7.1

Source of data
Data will be collected from mothers of adolescent girls in selected rural area of

Mangalore.
7.1.1

Research design

Pre- experimental, one group pre-test post-test design.

E - O1 X O2
E:

Experimental group

O1:

Pre-test knowledge regarding polycystic ovarian syndrome

X:

Learning package

O2:

Post-test knowledge regarding polycystic ovarian syndrome 7 days after the learning
package.

7.1.2

Setting
The study will be conducted at Surathkal, rural area of Mangalore.

7.1.3

Population
In this study, mothers of adolescent girls aged within 11-17 years, residing at selected

rural area of Mangalore will be selected.

7.2

Method of data collection

7.2.1

Sampling procedure
For this study, non-probability purposive sampling technique will be used.

7.2.2

Sample size
Sample size for the present study will be 50 mothers of adolescent girls.

7.2.3

Inclusion criteria for sampling

Mothers of adolescent girls who are:

able to read and write in Kannada or English

willing to participate in the study

7.2.4

Exclusion criteria for samplings

Mothers of adolescent girls who are:

suffering from mental disability.

working in medical departments.

7.2.5

Instruments intended to be used

Tool 1:
PART I: Baseline pro-forma
PART II: Structured knowledge questionnaire
7.2.6

Data collection method

Prior to the data collection, the investigator will obtain permission from the

concerned authority of the particular rural area. The purpose of the study will be explained to
the participants. Informed consent will be obtained from the participants. The pre-test will be
conducted using structured knowledge questionnaire this will be followed by administering
the learning package. The post-test will be conducted using the same structured knowledge
9

questionnaire on the seventh day.

7.2.7

Plan for data analysis

Data will be analysed using descriptive and inferential statistics

7.3

Does the study require any investigations or interventions to be conducted on

patients, or other animals? If so please describe briefly.
Yes, learning package will be provided to the mothers of adolescent girls with the

aim to improve knowledge on polycystic ovarian syndrome.

7.4.

Has ethical consideration been obtained from the institution in case of the
above?
Yes, ethical clearance will be obtained from the ethical committee of the institution.

8.

References
1.

Marlow RD, Redding AB. Textbook of paediatric nursing. 6th ed. New Delhi:
Elsevier; 2002.

2.

Padubidri GV, Daftary NS. Hawkins & Bourne Shaws textbook of gynaecology. 13 th
ed. New Delhi: Elsevier; 2004.

3.

Sebanti G, Rekha D, Sibani S. A profile of adolescent girls with gynaecological

problems. J Obstet Gynecol India 2005 Jul/Aug;55(4):353-5.

4.

Stankiewicz M, Norman R. Diagnosis and Management of polycystic ovary

syndrome: a practical guide. Drugs 2006;66(7):903-12.

5.

Norman JR, Deiwally D, Legro SR, Hickey ET. Polycystic ovary syndrome. The
Lancet 2007 Aug;370(9588):685-97.

6.

Puri M, Sharma G. Insulin Sensitisers in PCOS. Obs & Gynaec 2004 Mar;9(3):1813.

10

7.

Pteifer MS, Kives S. Polycystic ovary syndrome in the adolescent. Obstet Gynaecol
Clin North Am 2009 Mar;36(1):129-52.

8.

Gagan. Pcos The Hidden epidemic Aug 2009. [online]. Available from:
URL:http://www.whereincity.com/ medical/ topic/ women-health/ articles/ 704.htm.

9.

Delhi IVF Fertility Research Centre. [online]. Available from:

URL:http://www.delhi-ivf.com/PCOD.html.

10.

Sharma N. Obesity: A risk factor for infertility. Obs & Gynae 2001 Sep;6(9):539-43.

11.

Nair MKC, Pappachan P, Balakrishnan S, Leena ML, George B, Russell SP.

Menstrual irregularity and poly cystic ovarian syndrome among adolescent girls-A 2
year follow-up study. Indian J Pediatr 2011 Jul.

12.

Bronstein J, Tawdekar S, Liu Y, Pawelczak M, David R, Shah B. Age of onset of

polycystic ovarian syndrome in girls may be earlier than previously thought. J Pediatr
Adolesc Gynecol 2011 Feb;24(1):15-20.

13.

Creatsas G, Deligeoroglou E. Polycystic ovarian syndrome in adolescents. Curr Opin

Obstet Gynecol Greece;2007 Oct;19(5):420-6.

14.

Shaini GS, Venkatesan L, Ben A. Effectiveness of structured teaching on home care

management of diabetes mellitus. The Nursing Journal of India. 2007 Sep;98(9):1979.

15.

Nidhi R, Padmalatha V, Nagarathna R, Amritanshu R. Prevalence of polycystic

ovarian syndrome in Indian adolescents. J Pediatr Adolesc Gynecol 2011
Aug;24(4):223.

16.

Sills SE, Perloe M, Tucker JM, Kaplan RC, Genton GM, Schattman LG. Diagnostic
and

treatment

characteristics

of

polycystic

ovary

syndrome:

descriptive

measurements of patient perception and awareness from 657 confidential self-report.

11

BMC Women's Health 2001 Aug;1(3).

17.

Majumdar A, Singh AT. Comparison of clinical features and health manifestations in

lean vs. obese Indian women with polycystic ovarian syndrome. Comparison of
clinical features and health manifestations in lean vs. obese Indian women with
polycystic ovarian syndrome. J Hum Repod Sci 2009 Jan;(1):12-7.

18.

Herter DL, Magathaes AJ, Spritzer MP. Relevance of the determination of ovarian
volume in adolescent girls with menstrual disorders. Journal of Clinical Ultrasound
1996 Jun;24(5):243-8.

19.

Trent ME, Rich M, Austin SB, Gordon CM. Quality of life in adolescent girls with
polycystic ovary syndrome. Arch Pediatr Adolesc Med 2002 Jun;156(6):556-60.

12

9.

Signature of the candidate

10.

Remarks of the guide

11.

Name and designation of (in block letters)

11.2 Guide

MS. LYGIA V. HALDER

ASSOCIATE PROFESSOR
HOD, OBSTETRICS AND
GYNAECOLOGICAL NURSING
UNITY COLLEGE OF NURSING
MANGALORE.

11.2 Signature
11.3 Co-guide (if any)

11.4 Signature
12

12.1 Head of the department

MS. LYGIA V. HALDER

ASSOCIATE PROFESSOR
OBSTETRICS AND GYNAECOLOGICAL
NURSING
UNITY COLLEGE OF NURSING
MANGALORE.

12.2 Signature

13.

13.1

Remarks of the Chairman and Principal

13.2

Signature

13