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)
BINU PAULOSE
FIRST YEAR M. SC. NURSING
SAHYADRI COLLEGE OF NURSING
FALNIR ROAD, KANKANADY, MANGALORE
2 Name of the institution SAHYADRI COLLEGE OF NURSING
FALNIR ROAD. KANKANADY
MANGALORE -02
3 Course of study and subject M.Sc. NURSING,
COMMUNITY HEALTH NURSING
4 Date of admission to course 5.6.2009
5 Title of the study:
A COMPARATIVE STUDY TO ASSESS THE QUALITY OF LIFE OF
POST-MENOPAUSAL WOMEN RESIDING IN SELECTED RURAL AND
URBAN COMMUNITIES WITH A VIEW TO CONDUCT AN
AWARENESS PROGRAMME ON POST MENOPAUSAL HEALTH.
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6. BRIEF RESUME OF INTENDED WORK
Introduction
Menopause is a complex time in a woman’s life leading to both physical and
emotional challenges. Menopause currently affects the lives of millions of women
globally and will be an issue of increasing concern as the population ages over the
next few decades. The word menopause literally means the permanent physiological
or natural cessation of menstrual cycle. In other words, menopause means the natural
and permanent stopping of monthly reproductive cycles, which is usually manifest as
a permanent absence of monthly periods or menstruation. Post menopause refer to
the period of life after menopause has occurred. It is generally believed that the
postmenopausal phase begins when 12 full months have passed since the last
menstrual period. From then on, a woman will be postmenopausal for the rest of her
life1.
According to IMS (Indian Menopause society) research, there are about 65
million Indian women in the age group of 45 years. Average age of menopause is
around 48 years but it strikes Indian women as the age as 30-35 years. So
menopausal health demands even higher priority in Indian Scenario.2
6.1. Need for study
Menopause is an important time in women’s life. Declining levels of the
hormones i.e., oestrogen and progesterone produced by the ovaries bring about many
changes in the female .The historical and social construction of the menopause
experience has significant implications for menopausal women. Persistent
stereotypes imply that menopause is a time associated with a loss of youth and
sexuality. Further influencing the way in which menopause is perceived and
understood is the fact that the medical discipline has largely defined menopause as a
negative experience filled with a variety of undesirable physical and emotional
symptoms (Winterich & Umberson, 1999). Menopause is an inevitable milestone in
the reproductive life of every woman. Technically, it refers to a woman’s last
periods; a woman can be said to have reached menopause when she had one year
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without menstruating. Menopause as a change in hormonal levels can conceal the
social context in which it occurs as a change of life marked by many life stages.3
Women play an important role in replenishing the earth but her reproductive
capacity is not permanent; it ceases one day which is coined as menopause.
Menopause, especially in a rural woman brings in lot of changes which she has to
tackle to get rid of chronic illnesses especially psychosomatic problems. The efficient
and effective means of preventing and controlling these problems is through
improving social support, self-esteem, and empowerment.
A research study measured on 56 middle-aged rural Indian women of selected
villages of Chennai, Tamilnadu reported correlations were statistically significant
with P < 0.01 in a two tailed test. Self-esteem was positively associated with social
support (r=0.044), empowerment (r=0.354), and self-efficacy (r=0.566). The highest
absolute correlation was found between loneliness and stress (r=716), depression and
stress (r^0.701) and social support with loneliness (r=0.646). The study concluded
that social support, self-esteem, empowerment, and psychosocial indicators have a
correlation.4
Menopause is accompanied by biological and psychological changes that
affect a women’s health and sense of well being. Menopause is the time in a
woman’s life, usually occurs naturally, often after 45 years. Menopause happens
because the woman’s ovaries stop producing the hormones oestrogen and
progesterone. Changes and symptoms can start several years earlier. They include
changes in periods – shorter or longer, lighter or heavier with more or less time in
between hot flushes and/or night sweats, trouble sleeping, vaginal dryness, mood
swings, trouble focussing and less hair on the head, more on the face, women as to
men, experience an age-related decline of physical and mental capacity. They
observe symptoms such as periodic sweating or hot flushes, depression, insomnia,
impaired memory, lack of concentration, nervousness, and bone and joint complaints.
These symptoms more seen in rural communities. Quality of life different from rural
and urban communities.5
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The investigator during her community health field experience observed as
well as listened to menopausal women complaining about various minor problems
that interfere in their day to day life. These complaints can be overcome to improve
the quality of life. Due to illiteracy Indian women are ignorant about the changes
taking place in their reproductive system. Religion and culture of our society also
inhibits to express these changes. So awareness programme need to be conducted to
overcome these issues. But there is a lack of awareness of cause, effect and
management pertaining to it. A wide gap in the knowledge has been documented on
the women from developed and developing countries. And this gap is even wider in
women from rural and urban communities. So the investigator felt that there is a
need to improve the quality of life of post menopausal women through an awareness
programme.
6.2 Review of Literature
A study was conducted to evaluate the factors influencing the quality of life
(QOL) of Moroccan postmenopausal women with osteoporosis. Forty-three post
menopausal women aged 48-60 yrs participated in this study. Questionnaire was used
to assess the quality of life of post menopausal women. The independent factors were
associated with poor quality of life, low educational level (p=0.01), vertebral
fractures (p=0.03) and a history of peripheral fracture (p=0.006). Worse QOL was
observed in the group with fractures in all domains except “pain,” namely, physical
functioning (p=0.002), fear of illness (p=0.00), and psychosocial functioning
(p=0.007). The number of fractures was a determinant of a low QOL, as indicated by
an increased score in physical functioning (p=0.001), fear of illness (p=0.007), and
total score (p=0.01) after adjusting on age and educational level. Patient with higher
score had low quality of life in these two domains too (p=0.002, p=0.001
respectively) and in the total score (p=0.01) after adjusting on age and educational
level.6
A study was conducted among women in age after 45 years from Poland,
Belarus, and Greece. The menopause rating scale (MRS) was used. It consists of and
letter of 11 symptoms which had been answered. The respondents have and choice
among 5 categories – no symptoms, mild, moderate, marked, and severe. Mild and no
complaints in similar degree were reported by all women from these three countries.
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The investigator also found that almost 14.4% of women from Greece had marked
complaints in menopause rating scale compared to complaints of 9% respondents
from Belarus and 9.5% from Poland. These differences were significant (P < 0.001).
Moderate complaints were reported more frequently by women from Poland
(32.56%) and Belarus (34%) compared to women from Greece 28.5%). Severe
complaints were noted more rarely in 1.6% Greek women compared to 2.6%
Belarusian and 3% Polish respondents. These findings were not significant.
Furthermore, a half of the respondents from Poland, Belarus, and Greece reported hot
flushes (in moderate degree). In contrast 70% of Greek women declared hot flushes
from, 54.4% from Poland, and 60% from Belarus. Insomnia was reported more
frequently by women from Poland (34.6%) and Belarus (36%) than by respondents
from Greece (17.6%). No significant differences between no complaints, mild,
moderate, marked and severe were found between women from Belarus, Poland and
Greece.7
A study was conducted on health related Quality of Life of post menopausal
women. The age group 45-60 yrs was selected. A randomized lifestyle intervention
trial of diet, physical activity was included in the study. Analysis focused on the
women who lost ≥5lb during the initial phase of the study, baseline to 6 months
(n=248). This cohort was divided into 3 groups based on sub sight weight change
between 6 & 18 months : weight loss (WL; ≥lb loss), wt stable (WS; <±5lb change)
& weight regain (WR; ≥5lb gain) of the 248 women studied, 5, (21%) continued to
loss weight after initial weight loss, while 127 (51%) maintained & stable weight &
70 (28%) regained weight. Between baseline & 6 months, women in weight regain
group had deceased mental health & social functioning scores, while the weight loss
and weight stable groups improved in those subscales. Between baseline & 18
months, energy improved most significantly in those with continued weight loss
(P=0.0003).8
A study was conducted in Chandigarh, India. Systematic random sampling was
used. The study population comprised of women above 40 years and resident of
study area. Out of total 528 women interviewed, 302 (56%) were residing in urban
area and rest were the resident of slums. 78.8% urban 60.2% from slums had attained
menopause. Majority (70.3%) of urban residents had heard about menopause as
compared to 30.9% in slums. The most common menopausal symptoms were vaginal
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irritation /discharge (47.7%) less than half of females (38.7%) took treatment for
menopausal symptoms. Calcium supplements were taken by majority 63%.
7.7% female complained of post menopausal bleeding out of which 13(14.8%) had it
after intercourse. Only 2(28.6%) women had their pap smear done after being
suggested by doctor and they were from urban area only. The study highlights that
there is lack of awareness regarding menopause and related aspects especially post
menopausal bleeding in both urban and slum population.9
A study was conducted on Quality of Life impairment among postmenopausal
women living in urban areas. In this study women aged 40-50 years participated in a
cross-sectional study filling out the Menopause Rating Scale (MRS) and a general
questionnaire. A total 579 women were included. 153 Hispanic, 295 indigenous and
131 Afro-descendent. Hispanci Women had an average age of 55.3+/- 3.3 years.
Indigenous and balck women were less educated than the Hispanic ones (2.2+/- 1.8
and 4.6+/--4.4 vs. 6.4+/- 3.5 years, p<0.0001). Hispanic women displayed lower total
MRS score (better QoL) when compared to indigenous and black women. Urogenital
scoring was worse among indigenous women compared to Hispanic and black
women. Black women presented higher MRS psychological and somatic scorings
than Hispanic and indigenous women. After adjusting for confounding factors,
indigenous and black women continued to display a higher risk for impaired QoL,
total menopause rating scale score >16 which was significantly higher among
indigenous women due to urogenital symptoms and black women due to
psychological and somatic symptoms.10
A study was conducted on the effects of physical exercise on the quality of life
of post-menopausal women. Forty-eight menopausal women aged 55-72 years were
recruited at a primary care centre as voluntary participants in a quasi experimental
study. They were randomly assigned to one of the two groups – control (n = 24) and
experimental (n=24). The experimental group participated in a 12-month programme
of cardiorespiratory, stretching, muscle-strengthening, and relaxation exercise carried
out during two fully supervised exercise sessions per week (total 3 hours weekly).
Health-related quality of life was assessed by using the Quality of Life Profile for
Chronically Ill Patients, a generic questionnaire widely used in epidemiological and
clinical studies to measure the wellbeing and function, incorporating as an optional
module, the Kuppeman Index of Menopausal Symptomatology. There was a
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statistically significant improvement in health-related quality of life of the
experimental group, whereas the health-related quality of life of the control group
significantly worsened. Menopausal symptoms also significantly improved in the
experimental group and significantly worsened in the control group over the 12-
month study period.11
6.3 Problem Statement
A comparative study to assess the quality of life of post-menopausal women
residing in selected rural and urban communities with a view to conduct an
awareness programme on post menopausal health.
6.4 Objectives of the Study
1. To assess the quality of life of postmenopausal women residing in selected
rural and urban communities.
2. To compare the quality of life of post menopausal women residing in selected
urban and rural communities.
3. To find out an association between quality of life of postmenopausal women
and selected demographic variables such as age, income, occupation.
6.5 Operational definitions
1. Quality of life: According to the World Health Organization, Quality of Life
can be defined as “Individual’s perception of their position in life in the
context of the culture and value systems in which they live, and in relation to
their goals, expectations, standards and concerns.
In this study, quality of life refers to the way a woman overcomes significant
physical, physiological, emotional, and psychological changes taken place
due to menopause which may affect interms of health.
a. Physical changes such as weight gain, ageing process, skin changes,
dryness of vagina and painful intercourse. These changes can be
managed by physical exercises like jogging, walking and cross
legging.
b. Physiological changes such as low back pain, joint ache, hot flushes,
night sweats, and dryness of vagina, and sexual changes. These
changes can be handled by meditation, pranayama, yoga, and
nutritious diet containing Calcium, Vitamin E, C and A.
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c. Psychological changes refer to mood swings, irritability, anxiety,
depression and sexual problems. These changes can be managed by
recreational therapies like reading books, music, picnics, and spiritual
gathering.
d. Emotional changes are irritation, nervousness, headache, and feelings
of fear, sadness, and loneliness. These changes can be managed by
family support and social support.
2. Postmenopausal women: According to Webster New World medical
dictionary “It is the time after which a women has experienced 12 consecutive
months of amenorrhoea.
In this study, postmenopausal women refer to married, unmarried, employed
or unemployed women in the age group of 45-60 years, who have
experienced 12 consecutive months of amenorrhoea and who are not on
hormone replacement therapy (HRT)
3. Rural: Rural are large and is isolated areas of a country, often with low
population density (Wikipedia).
In this study, it refers to the selected villages which comes under selected
primary health centre.
4. Urban: Urban area is characterized by higher population density and vast
human features in comparison to areas surrounding it (Wikipedia).
In this study, it refers to the selected areas which comes under selected urban
family welfare centre.
5. Awareness Programme on post menopausal health: In this study it refers
to the individual health education and selected demonstration such as breast
self examination, yogas and calcium preparation which will be provided to
postmenopausal women of selected areas with the use of charts to improve
the quality of life.
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6.6 Assumptions
The study assumes that:
Post-menopause is a period in which women will have some health problems
which contribute to having changes in the quality of life.
There will be difference in the quality of life of urban and rural communities.
6.7 Delimitations
The study is delimited to:
Postmenopausal women in the age group of 45-60 years.
Postmenopausal women who are not on hormone replacement therapy
Selected areas of Mangalore.
6.8 Hypotheses
H1: There will be significant difference between the mean quality of life score of
postmenopausal women in rural and urban areas.
H2: There will be significant association between the quality of life of
postmenopausal women and selected demographic variables such as age,
income and occupation.
7. MATERIALS AND METHODS
7.1 Source of data
Post menopausal women in the age group of 45-60 years in selected urban
and rural areas in Mangalore.
7.1.1 Research design
Comparative survey.
Phase 1 Phase 2 Phase 3
Quality of life of postmenopausal women of rural area
Quality of life postmenopausal women of urban area
Prepare and validate awareness programme on post menopausal health.
Conduct awareness programme on postmenopausal health.
7.1.2 Setting
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The study will be conducted in selected rural and urban communities of
Mangalore.
7.1.3 Population
Post menopausal women who have experienced 12 consecutive months of
amenorrhoea living in rural and urban communities.
7.2 Method of data collection
7.2.1 Sampling procedure
The purposive sampling technique will be used to select the sample.
7.2.2 Sample size
Sample size consists of post menopausal women 40 from rural and 40 from
urban communities.
7.2.3 Inclusion criteria for sampling
Those who have experience one year of amenorrhoea in the age group of 45-
60 years.
Those who are willing to participate in the programme.
7.2.4 Exclusion criteria for sampling
Those who have been diagnosed with critical medical, surgical and
gynaecological problems.
Those who are on Hormone replacement therapy.
7.2.5 Instrument intended to be used
Demographic proforma.
Modified Menopause Rating Scale to assess the quality of life
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7.2.6 Data collection method
Permission will be obtained from concerned authorities.
The purpose of the study will be explained to postmenopausal women and
informed consent will be obtained from them.
Pilot study will be conducted prior to the study.
Quality of life of post menopausal women will be assessed using modified
menopause rating scale.
Awareness programme to improve quality of life will be given to the post
menopausal women residing in selected rural and urban communities.
7.2.7 Data analysis plan
Data will be analysed using descriptive and inferential statistics.
7.3 Does the study require any investigation or intervention to be conducted
on patients or humans or animals? If so please descriptive briefly?
No.
7.4 Has ethical clearance been obtained from institution in case of 7.3?
Yes, ethical clearance will be obtained from concerned authority.
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8. LIST OF REFERENCES
1. Tamilmani. Menopause and hormone replacement therapy. Nightingale
Nursing Times. 2006; 2(1): 24-27.
2. Puri S, Bhatia V, Mangat C. Perceptions of menopause and post menopausal
bleeding in women of Chandigarh. The Internet Journal of Family Practice.
2008; 6(2): 601-608.
3. Sharon D, Wonshik C. Menopausal symptom experience : an online forum
study. Journal of Advanced Nursing 2008; 60(7): 541-548.
4. Sharadha R. Social support system in menopause. Nightingale Nursing
Times. 2009; 5 (6): 12-15.
5. Dutta DC. Text book of gynaecology. 3rd edition, New central book agency
(P) Ltd. 2004; 46.
6. Sabbah. Quality of life in rural and urban population in Lebanon using Sf-36
health survey. Health quality of life outcomes. 2003; 1(10): 477-498.
7. Isaac S. The benefits of regular exercise for post menopausal women.
Alternative medicine for menopause. 2004; 5 (10): 90-97.
8. Robert P. Exercise boosts quality of life in post menopausal women. Jama
archives journals. 2007; 28 (12): 34-39.
9. Alvaro M, Juan B, Peter C. Quality of life impairment among post
menopausal women. Gynaecological Endocrinology. 2008 ; 25 (8): 491-497.
10. Sanat B. Effect of physical exercise on the quality of life of menopausal
women. Journal of Advanced Nursing 2009; 54 (1): 54-58.
11. D’souza S, Melba. Health promoting quality of life of post menopausal
women. Journal of Advanced Nursing Sciences 2009; (66)2:142-146.
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8. Signature of the candidate
9. Remarks of the guide
10. Name and designation of (in block letters)
10.1 Guide
10.2 Signature
10.3 Co-guide (if any)
10.4 Signature
11 11.1 Head of the department
11.2 Signature
12. 12.1 Remarks of the Chairman and Principal
12.2 Signature
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