RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE,KARNATAKA

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION.

Ms.BRIGHTY SARA MATHEW

IST YEAR MSc NURSING

(OBSTETRIC AND GYNAECOLOGY)

VARALAKSHMI COLLEGE OF NURSING,#19 KIADB ROAD,CHOKKASANDRA,T.DASARAHALLI,

BANGALORE-57------------

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION.

1.NAME OF THE

CANDIDATEAND ADDRESS

Ms. BRIGHTY SARA MATHEWIST YEAR MSc NURSING, VARALAKSHMI COLLEGE OF NURSING#19 KIADB ROAD,CHOKKASANDRA,T.DASARAHALLI,BANGALORE-57

2 NAME OF THE INSTITUTION

VARALAKSHMI COLLEGE OF NURSING

3 COURSE OF STUDY ANDSUBJECT

DEGREE OF MASTER OF NURSING OBSTETRICS AND GYNAECOLOGICAL NURSING

4 DATE OF ADMISSION TO COURSE 30-06-2008

5 TITLE OF THE STUDY

EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING COMMON CAUSES OF INFERTILITY AMONG WOMEN UNDER THE REPRODUCTIVE AGE GROUP STUDYING IN A SELECTED IT COLLEGE, BANGALORE.

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

“A woman’s health is her total well-being, not determined solely by

biological factors and reproduction, but also by effects of work load, nutrition,

stress, war and migration, among others” -van der Kwaak, 1991.1

Childbirth is viewed as an important life event for women. It is a natural

and normal physiological phenomenon which introduces new experiences in

women's reproductive life. Reproductive health is a crucial part of general health and

a central feature of human development. It is a reflection of health crucial during

adolescence and adult hood, sets the stage for health beyond the reproductive years

for women, and affects the health of the next generation.

Reproductive health is a universal concern, but is of special importance for

women particularly during the reproductive years since, child birth events got great

physiological, emotional and social impact to the women and her family. Women

reproductive health is important because woman bears the risk of infertility due to

biological inability and typically due to medical problems experienced by one or the

other partner. 2

Most experts define infertility as not being able to get pregnant after at least

one year of trying. Women who are able to get pregnant but then have repeat

miscarriages are also said to be infertile. Lack of uniform definitions has

characterised research on infertility. It is accepted that the terms infertility,

childlessness or sterility all refer to the incapacity of couples to conceive or bear

children when desired. Primary infertility refers the couple had never conceived

despite cohabitation and exposure to the risk of pregnancy (absence of

contraception) for a period of 2 years. Secondary infertility refers the couple failed to

conceive following a previous pregnancy, despite cohabitation and exposure to the

risk of pregnancy (in the absence of contraception, breastfeeding or postpartum

amenorrhoea) for a period of 2 years. 3

The common causes of fertility problems in women include: blocked

fallopian tubes due to pelvic inflammatory disease, endometriosis, physical problems

with the uterus, uterine fibroids and many things can affect a woman's ability to have

a baby such as age, stress, poor diet, being over weight or under weight, tobacco

chewing, smoking, alcohol, sexually transmitted diseases and health problems that

cause hormonal changes. 4

Infertility is not always a woman's problem. In only about one-third of cases

is infertility due to the woman (female factors). In another one third of cases,

infertility is due to the man (male factors). The remaining cases are caused by a

mixture of male and female factors or by unknown factors. Infertility may have

profound psychological effects. Partners may become more anxious to conceive,

ironically increasing sexual dysfunction. 5 Marital discord often develops in infertile

couples, especially when they are under pressure to make medical decisions. Women

trying to conceive often have clinical depression rates similar to women who have

heart disease or cancer. 6 Emotional stress and marital difficulties are greater in

couples where the infertility lies with the man. 7

In many cultures, inability to conceive bears a stigma. In closed social

groups, a degree of rejection or a sense of being rejected by the couple may cause

considerable anxiety and disappointment. Some respond by actively avoiding the

issue altogether; middle-class men are the most likely to respond in this way. 8

Infertility has begun to gain more exposure to legal domains to care of parent or

spouse, or because of their own personal illness. 9

6.1 NEED FOR THE STUDY

Generally, worldwide it is estimated that one in seven couples have problems

of conceiving, with the incidence similar in most countries independent of the level

of the country's development.

Infertility is a global health issue, affecting approximately 8-10% of couples

worldwide11. The 1981 census of India estimated infertility to be in the range of 4-

6%13. A global review of infertility from the World Fertility Survey and others

estimated similar rates of infertility in other settings in South Asia, such as 4% in

Bangladesh, 6% in Nepal, 5% in Pakistan and 4% in Sri Lanka14. One estimate of

overall primary and secondary infertility in South Asia, on the basis of women at the

end of their reproductive lives in the age group 45-49 years, suggests an infertility

rate of approximately 10%: 8% in India, 10% in Pakistan, 11% in Sri Lanka, 12% in

Nepal and 15% in Bangladesh15.

Infertility is not merely a health problem; it is also a matter of social injustice

and inequality. Tribal populations in India have high levels of morbidity arising from

poor nutrition, and coupled with high infant, child and maternal mortality, and they

also have low levels of literacy. 16, 17

. Infertility also complicates marital dynamics, sometimes leading to marital

instability, and occasionally divorce, polygamy or remarriage. Because motherhood

is considered a mandatory status, infertile women may be harassed and tormented.

Infertile women suffer most profoundly in their relationship with their in-laws and

other community members. Social, cultural and economic factors continue to inhibit

women from gaining adequate access to the health delivery system. 18

Infertility is of public health importance in many developing nations because

of its high prevalence and especially due to its serious social implications. A review

of the epidemiology of infertility in Nigeria and other parts of Sub-Saharan Africa is

presented and socio-cultural issues including the social impact on couples are

discussed. The study evidenced that infertility causes marital disharmony, which

often leads to divorce. Women are often blamed for the infertility and men engage in

polygamy in an attempt to have children. The couple can also suffer stress from the

management of the infertility. Adoption is not popular and assisted reproduction has

medico-legal implications. Preventive measures are suggested, including counseling

at every stage of the management. 19

Recent scientific nursing literature and clinical practice yielded important

information regarding women's varied responses to the diagnosis and treatment of

infertility, as well as the multiple pathways women take through the infertility

experience. In this article, it examined infertility through women's eyes, explore the

influence of the social context on women's infertility experiences, and present ideas

for clinical approaches to working with infertile women. Three approaches for

nursing practice are suggested: (a) preserving self-esteem, (b) promoting access to

social resources, and (c) facilitating use of coping methods to reduce distress. 20

The investigator in her experience found that there is lack of knowledge

regarding common causes of infertility among women under reproductive age group

so, the investigator interested to administer a structured teaching programme and

planned to examine its effectiveness on imparting the knowledge regarding infertility

among target population of female adults studying in selected IT colleges at

Bangalore

6.2 REVIEW OF LITERATURE

1 Prevalence of infertility and common causes

Dhital et al conducted an experimental study to examine the knowledge of

girls on reproductive health among 200 students in Dharan town of Nepal.The

pretest score of the experimental group was 39.83 (+/- 16.89) and of control group

was 39.47(+/- 0.08).After the study the score was (84.60+/- 10.60) and of control

group with (43.93+/-10.08) was statistical significant (p<0.001) and post-test score

were better.

Shanmugasundaram S conducted an experimental study to assess the

knowledge on sex awareness by collecting data from 80 randomly selected samples.

The over all knowledge mean value in experimental design was 48.69 with the

standard deviation of 17.41 where as in control group the mean value was only 5.36

with the standard deviation of 11.94.after structured teaching programme the paired

‘t’ value was 17.69 with the p<0.001 which is highly significant.

R.J.Norman et al conducted a literature –randomized controlled trials

(RCTs), investigating the effects of insulin sensitizing drugs on weight loss

compared with diet or a life style modification programme .The main outcome was

change in body mass index (BMI).

Sobek AM conducted study on the age of women treated for infertility

increases among 4689 infertility women. The study investigated the age of the

patient, FSH levels, E2 levels, number of FSH units needed for ovarian stimulation,

number of oocytes and embryos. The study demonstrated that the increasing age was

accompanied by a decrease in ovarian function. It evidenced that women older than

32 years should be informed about the decreased ability to conceive. The treatment

of women for infertility is complicated by the growing age of patients in coming

decades. 22

Pasquali R et al summarized major factors affecting fertility in obesity.

Fertility can be negatively affected by obesity. In women, early onset of obesity

favours the development of menses irregularities, chronic oligo-anovulation and

infertility in the adult age. Obesity in women can also increase risk of miscarriages

and impair the outcomes of assisted reproductive technologies and pregnancy, when

the body mass index exceeds 30 kg/m. The adverse effects of obesity are specifically

evident in polycystic ovary syndrome. It concluded that much more attention should

be paid to the impact of obesity on fertility in women before assisted reproductive

technologies are used. 23

Goldstein.I conducted study on sexual dysfunction in women and infertility

reviewed some pioneering, resourceful, creative, and novel contributions that

urologists have made to enhance the understanding of sexual dysfunction in women.

It evidenced that as is obvious in infertility treatment, sexual medicine health care

requires biologic and psychologic attention to both members of the couple. The goal

of all sexual medicine health care providers is to provide the best health care

delivery to women and men with sexual health concerns. 25

II Knowledge regarding infertility

Mitchell A et al conducted a survey of nurses who practice in infertility

settings was conducted to obtain information about the educational level, clinical

activities, knowledge base, and skills of nurses involved with in vitro fertilization.

No differences were found with regard to educational level or perceived level of

proficiency with regard to the practice setting. It revealed that assisted reproductive

nursing currently does not meet the standards for classification as an advanced

practice nursing group. Action to further the area of reproductive nursing to a

specialty in nursing or an advanced practice level is worth consideration for this

highly specialized and unique group of nurses. 31

Wimberly YH et al conducted study on adolescent beliefs about infertility.

The results evidenced that most adolescents generally understood fertility as the

ability to become pregnant. Ten themes emerged as causes of infertility.

Anatomic/gynecologic causes generated the most responses and most detailed

discussion. Other commonly mentioned causes were male factors sexually

transmitted infections, genetics and substance use. Less commonly mentioned

themes were stress, contraception, environmental toxins, violence and injury. 32

Boivin J et al study has highlighted a lack of fertility awareness in the

general population especially in relation to the optimal fertile period during the

menstrual cycle, incidence of infertility and duration of the reproductive life span.

The study assessed fertility knowledge more broadly in young people and

investigated three areas of knowledge, namely risk factors associated with female

infertility (e.g. smoking), beliefs in false fertility myths (e.g. benefits of rural living)

and beliefs in the illusory benefits of healthy habits (e.g. exercising regularly) on

female fertility. An analysis of variance showed a significant main effect of factor

and post hoc tests revealed that young people were significantly better at correctly

identifying the effects of risks compared with null effects of healthy habits or

fertility myths. Young people are aware that the negative lifestyle factors reduce

fertility but falsely believe in fertility myths and the benefits of healthy habits. We

suggest that the public education campaigns should be directed to erroneous beliefs

about pseudo protective factors. 34

6.3 STATEMENT OF PROBLEM

A study to assess the effectiveness of structured teaching programme

on knowledge regarding common causes of infertility among women under the

reproductive age group studying in a selected IT college, Bangalore.

6.4 OBJECTIVES OF THE STUDY

1. To assess the pre test knowledge regarding common causes of infertility among

women in experimental and control group.

2. To administer structured teaching programme among selected sample of

subjects in experimental group.

3. To assess the post test knowledge regarding common causes of infertility

among women in experimental and control group.

4. To assess the effectiveness of structured teaching programme by comparing

pre and post scores in experimental group over control group.

5. The find out the association between the pre test knowledge with the.

demographic characters of the subjects

5.6.5 OPERATIONAL DEFINITIONS

Assessment:

In this study it is an organized, systematic and continuous process of

collecting data on common causes of infertility among women under the

reproductive age group studying in a selected college.

Effectiveness:

In this study it refers to determine the extent to which the structured

teaching programme has brought about the result intended and is measured in

terms of significant gain in the post test.

Structured teaching programme:

In this study it refers systematically organized teaching strategy of

structured material on common causes of infertility among women under

reproductive age group studying in a selected college.

Infertility.

In this study it refers that the terms infertility, childlessness or sterility all

refer to the incapacity of couples to conceive or bear children when desired.

Knowledge:

In this study knowledge refers to process of imparting information regarding

common causes of infertility to the women in reproductive age in selected IT

colleges.

6.6 RESEARCH HYPOTHESIS

H1: There will be significant difference between the pre and post test knowledge

regarding common causes of infertility in experimental group l.

H2: There will be significant difference between the pre and post test knowledge

regarding common causes of infertility in control group.

H3: There will be significant difference of post test knowledge regarding common

causes of infertility between experimental and control group

H4: There will be significant association between the pre test knowledge with

selected demographic characters of subjects in experimental group

H5: There will be significant association between the pre test knowledge with

selected demographic characters of subjects in control group

6.7 ASSUMPTIONS 6.8 The selected women under reproductive women may have inadequate

knowledge regarding infertility.

i. Tool will be adequate to assess the knowledge on infertility.

ii. Structured Teaching programme may improve the knowledge regarding

common causes of infertility among the subjects.

iii. Structured Teaching programme will be practicable.

VARIABLES

Independent variables:

Structured Teaching Programme.

Dependent variables:

knowledge on common causes of infertility.

Attributed variables:

socio demographic characters of women under reproductive age.

6.9 DELIMITATIONS OF THE STUDY

The study is delimited to:

i. Women under reproductive age who are only from a selected college.

ii. Women under reproductive age who are willing to participate in the study.

iii. Structured Teaching Programme will be provided only by the investigator

7. MATERIAL AND METHODS

7.1 SOURCE OF DATA:

Women under reproductive age group of selected IT college at Bangalore

7.1.1 RESEARCH DESIGN:

A Quasi experimental Research Design.

7.1.2 RESEARCH APPROACH :

An evaluative descriptive approach will be used to assess the effectiveness

of STP through comparing the outcomes of experimental and control group.

7.1.3 STUDY SETTING :

The study will be originated at selected IT college at Bangalore.

7.1.4 POPULATION:

The population of the study comprises all women under reproductive age

group students studying in selected IT college, Bangalore.

7.1.5 SAMPLE SIZE :

The sample consist of 60 women under reproductive age group those who

meet the inclusion criteria of the study.

7.1.6 SAMPLING TECHNIQUE:

Sample (n=60) will be selected through simple random sampling

technique and will be allotted 30 each in control and experimental group

7.1.7 Criteria for sample selection:

Inclusion Criteria :

The women under reproductive age group.

women who are willing to participate in study.

women who are available at the time of study.

women who are able to speak Kannada and English.

Exclusion Criteria :

women who are not willing to participate in the study.

women who are not available at the time of study.

women who are not able to speak Kannada and English.

7.2 METHOD OF DATA COLLECTION :

7.2.1 Data collection tool: Tool consists of two two parts

Part 1: Demographic characters of women under reproductive age group,

Part 2: Structured questionare contains Knowledge regarding common

causes of infertility among women.

7.2.2 Plan for data analysis:

The collected data will be analyzed by the descriptive and inferential analysis

Frequency and percent will be used to describe the demographic characters of

women of two groups.

Descriptive measures such as mean, standard deviation will be used assess

the pre, post scores of knowledge in experimental and control group.

Paired t-test will be used to compare the pre and post scores fo the statistical

significance in each groups.

Chi-square analysis will be carried out to bring out the association between

knowledge of women and their demographic characters.

77.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR

INTERVEVTIONS TO BE CONDUCTED ON PATIENTS OR ANIMALS?

Yes

7.4 HAS ETHICAL CLEARENCE BEEN OBTAINED FROM YOUR

INSTITUTION .

Permissions will be obtained from

1.The research committee of the Varalakshmi College of Nursing.

2.Ethical Committee of selected IT colleges.

8. LIST OF REFERENCES

1. van der Kwaak A, et al. 1991. Women and health. Vena Journal 3(1):2-33.

2. Jessica Evert, MD. en.wikipedia.org/wiki/Infertility - 83k Common Causes

of Infertility.

3. Kumar D. Tribal literacy disparity in India. Current Science 2005; 88: 676.

4. Mory Nouriani, MD. Glendale, CA .Sher Institute of Reproductive

Medicine. InterNational Council on Infertility Information

Dissemination, Inc. http://www.inciid.org

5. Donor insemination Edited by C.L.R. Barratt and I.D. Cooke. Cambridge

(England): Cambridge University Press, 1993. 231 pages., page 13,

citing Berger (1980)

6. Domar AD, Zuttermeister PC, Friedman R (1993). "The psychological

impact of infertility: a comparison with patients with other medical

conditions". J Psychosom Obstet Gynaecol 14 Suppl: 45–52.

7. Beutel M, Kupfer J, Kirchmeyer P, et al (Jan 1999). "Treatment-related

stresses and depression in couples undergoing assisted reproductive

treatment by IVF or ICSI". Andrologia 31 (1): 27–35.

8. Schmidt L, Christensen U, Holstein BE (Apr 2005). "The social

epidemiology of coping with infertility". Hum Reprod. 20 (4): 1044–

52.

9. Family and Medical Leave Act (FMLA) in 2004.

10. Reproductive Health Outlook. Infertility: overview/lessons learned. Online

(1997-2005). Available: http://www.rho.org

11. Inhorn MC. Global infertility and the globalization of new reproductive

technologies: illustration from Egypt. Social Science and Medicine

2003; 56: 1837-1851.

12. Cates W, Farely TMM, Rowe PJ. Worldwide patterns of infertility: is Africa

different? The Lancet 1985; 2 (8455): 596-598.

13. Department of Family Welfare. Ministry of Health and Family Welfare

Yearbook 1993-1994. New Delhi: Government of India, 1995.

14. Vaessen M. Childlessness and infecundity. WFS Comparative Studies, Series

31. Voorburg, The Netherlands: Cross National Summaries, 1984.

15. Farely TMM, Baisey EM. The prevalence of a etiology of infertility.

Proceedings, African Population Conference. 28 November 1988;

Senegal, Dakar; 1998.

16. Tewari DN. Primitive tribes of Madhya Pradesh, Strategy for Development.

New Delhi: Tribal Development Division, Ministry of Home Affairs,

Government of India, 1984.

17. Regional Medical Research Centre for Tribals. Glimpses of tribal health

(1995-96). Jabalpur, Madhya Pradesh: Indian Council of Medical

Research, 1996.

18. Russell RV, Hira L. The tribes and caste of the central provinces of India,

Vols 3 & 4, 1916. Low Price Publications: Delhi, 1997.

19. Araoye MO.Epidemiology of infertility: social problems of the infertile

couples. West Afr J Med. 2003 Jun;22(2):190-6.

20. Woods NF, Olshansky E, Draye MA.Infertility: women's experiences. Health

Care Women Int. 1991 Apr-Jun;12(2):179-90

21. de La Rochebrochard E, Thonneau P.Paternal age >or=40 years: an

important risk factor for infertility. Am J Obstet Gynecol. 2003

Oct;189(4):901-5

22. Sobek AM, Vodicka J, Hladíková B, Tkadlec E, Sobek A. The age of women

treated for infertility increases: Ceska Gynekol. 2008 Jul;73(4):227-

30

23. Pasquali R, Patton L, Gambineri A. Obesity and infertility. Curr Opin

Endocrinol Diabetes Obes. 2007 Dec;14(6):482-7

24. Al-Azemi M, Omu FE, Omu AE. The effect of obesity on the outcome of

infertility management in women with polycystic ovary syndrome.

Arch Gynecol Obstet. 2004 Dec;270(4):205-10. Epub 2003 Aug 29.

25. Goldstein I. Sexual dysfunction in women: what can urologists contribute?.

Curr Urol Rep. 2008 Nov;9(6):475-82

26. Brassard M, AinMelk Y, Baillargeon JP. Basic infertility including

polycystic ovary syndrome. : Med Clin North Am. 2008

Sep;92(5):1163-92,

27. Coulam CB, Jeyendran RS. Thrombophilic gene polymorphisms are risk

factors for unexplained infertility. Fertil Steril. 2008 Oct 16.

28. Gunasheela S. Management of endometriosis and its impact on infertility. J

Indian Med Assoc. 2001 Aug;99(8):436, 438-40.

29. Malik A, Jain S, Hakim S, Shukla I, Rizvi M. Chlamydia trachomatis

infection & female infertility. Indian J Med Res. 2006

Jun;123(6):730-4.

30. Sharma M, Sethi S, Daftari S, Malhotra S. Evidence of chlamydial infection

in infertile women with fallopian tube obstruction. Indian J Pathol

Microbiol. 2003 Oct;46(4):680-3

31. Mitchell A, Mittelstaedt ME, Wagner C.A survey of nurses who practice in

infertility settings. : J Obstet Gynecol Neonatal Nurs. 2005 Sep-

Oct;34(5):561-8.

32. Wimberly YH, Kahn JA, Kollar LM, Slap GB. Adolescent beliefs about

infertility. Contraception. 2003 Nov;68(5):385-91.

33. Akizuki Y, Kai I. Infertile Japanese women's perception of positive and

negative social interactions within their social. Hum Reprod. 2008

Dec;23(12):2737-43.

34. Bunting L, Boivin J. Knowledge about infertility risk factors, fertility myths

and illusory benefits of healthy habits in young people. Hum Reprod.

2008 Aug;23(8):1858-64. Epub 2008 May 10.

---------------------------------------------------------------------------------------------------

9. Signature of Candidate :

10. Remarks of the guide : Infertility , a common health problem prevailing among the underdeveloped and developing countries . the present

study will definitely help the women to gain knowledge thus helps to prevent

most occurrence of infertility causes .

11. Name and Designation of 11.1 Guide : Mrs. Nisha Clement

Assot. Professor. Department of obstetrics &

Gynaecology Nursing. Varalakshmi college of Nursing, T. Dasarahalli, Bangalore-57

11.2 Signature :

11.3 Head of the Department : Mrs. Nisha Clement Assot. Professor.

Department of obstetrics & Gynaecology Nursing

Varalakshmi college of Nursing, T. Dasarahalli,

Bangalore-57 11.4 Signature :

12.12.1 Remarks of the Principal: The investigator selected the topic is appropriate for her speciality choosen. 12.2 Signature :