Professional Documents
Culture Documents
Menopause Problem
Menopause Problem
Menopause Problem
By
Ms. JINY JAMES
Dissertation Submitted to the Rajiv Gandhi University of Health Sciences
Bangalore, Karnataka
MASTER OF SCIENCE
IN
COMMUNITY HEALTH NURSING
Under the guidance of
Mrs. R.CHITRA
HOD
2012
I
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
KARNATAKA, BANGALORE
I hereby declare that this dissertation entitled “A study to evaluate the effectiveness of structured
teaching programme on knowledge regarding menopausal problems and its remedial measures
among middle aged women in selected rural areas, Bangalore” is a bonafide and genuine
research work carried out by me under the guidance of Mrs. R. Chitra M.Sc(N), HOD,
Nagar Post, Bangalore. The Thesis is not submitted for any other diploma or degree course
II
CERTIFICATION BY THE GUIDE
This is to certify that the dissertation entitled “A study to evaluate the effectiveness of
remedial measures among middle aged women in selected rural areas, Bangalore” is a
bonafide research work done by Ms. Jiny James in partial fulfillment of the requirement for the
HOD
III
ENDORSEMENT BY THE HOD/PRINCIPAL/HEAD OF THE
INSTITUTION
This is to certify that the dissertation entitled “A study to evaluate the effectiveness of
remedial measures among middle aged women in a selected rural areas, Bangalore” is a
bonafide research work done by Ms.Jiny James under the guidance of Mrs. R. Chitra, M Sc
(N), HOD of Community Health Nursing, Acharya College of Nursing, Cholanagar, R.T. Nagar
Post, Bangalore-560032.
Mrs.R.Chitra, M Sc (N)
Place: Bangalore
IV
COPY RIGHT
I hereby declare that Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka,
shall have the rights to preserve, use and disseminate this dissertation / thesis in print or
V
ACKNOWLEDGEMENT
I thank Lord Almighty for his unconditional love, treasures of wisdom and knowledge
Mrs. Poornima Reddy Managing Director of Acharya College of Nursing for your
designer and guide of my study, Acharya College of Nursing for your gentle and persistent
nudges toward excellence.
Mrs. Ponnarasi, M Sc (N), Professor, HOD of Medical and Surgical Nursing, Acharya College
of Nursing for your detailed and constructive comments throughout this work.
Mrs Sofiya Rani, , M Sc (N), Lecturer in Community Health Nursing, Acharya College of
Nursing for your time and expertise to help shape this study.
VI
Ms. Navya C.D M.Sc (N), Lecturer in Psychiatric Nursing Acharya college of nursing for
her inspiration for the success of this study.
Nursing for helping me craft words and ideas to mould this study.
The entire team of all the experts who spared their valuable time and effort for content validity
and refining of the tool.
The Medical Officer, PHC, Kadusonappahalli, Bangalore. Mr. Javaraya , Health worker,
Dodda Gubby, and the participants of my study who gave me the opportunity to work with them
and gave me untiring help during my study period, without whom this study cannot be
completed.
Library staffs of Acharya College of Nursing, Rajiv Gandhi University of Health Sciences,
Indian Medical Association (IMA), Bangalore and my Classmates for their help and co-
operation in one way or other in the completion of this dissertation.
Mr. H.S. Surendra for his expert guidance and suggestions in statistical analysis.
It is my privilege to thank my former colleagues and friends in Holds worth memorial Hospital,
Mysore.
I am thankful to Ms Madhushree S. for the Kannada version of my tool and the structured
teaching programme and for helping me during my data collection period.
VII
I am deeply indebted to my lovable father Mr. James K Thomas, mother Mrs. Mercy and my
sister Ms.Jaisy James and my brother Mr. Jijo James and my friend Mrs.Jincy Joyees, for
their inspiration, constant support, patience and prayers for the completion of my dissertation.
It is my pride and prestige to express my gratitude to Mr. Tim Mathew for his personal
interest, patience and constant encouragement.
My sincere thanks and gratitude to all those who directly or indirectly helped in the successful
completion of this dissertation.
Date:
.
HRT Hormone Replacement Therapy
VIII
BMD Bone Mineral Density
% Percentage
HT Hormone Therapy
χ2 Chi Square
df Degrees of Freedom
Reliability
SD Standard Deviation
ABSTRACT
BACKGROUND AND PURPOSE OF THE STUDY:
IX
The status of women in modern India is a sort of a paradox. Menopause is the physiologic cessation
of menses associated with declining ovarian function. It is usually complete after 1 year of
amenorrhea. Many women approach menopause with uncertainty about what will happen and how
to deal with changes that occur. It is necessary for all the women to understand menopause which
will make them to cope up with menopausal symptoms and will also improve quality of life of
menopausal women. There are various remedial measures to treat menstrual problems. Some
women may find relief from menopausal symptoms with herbal or alternative remedies, however
most have not been studied or shown to be of benefit scientifically and some, like black cohosh,
have been occasionally linked to liver damage. Hormone therapy can help relieve the symptoms of
menopause. OBJECTIVES: 1. To assess the pretest knowledge level of middle aged women
regarding problems of menopause and its remedial measures. 2. To evaluate the effectiveness of
structured teaching programme on knowledge regarding menopausal problems and its remedial
measures among middle aged women.3. To find out the association between the pre test knowledge
level of middle aged women with selected socio-demographic variables. DESIGN: One group pre
test and post test pre experimental design was selected for the study. SUBJECTS: The participants
were 60 middle aged women in selected rural areas, Bangalore. SAMPLING METHOD: A
convenience sampling technique was used to select the sample of the study. DATA
COLLECTION TOOL: A structured interview schedule was used to collect data from the
subjects. DATA ANALYSIS: The obtained data was analyzed using descriptive and inferential
statistics and interpreted in terms of objectives and hypothesis of the study. The level of
significance was set at 0.05 levels. RESULT: In the pre test, the subjects had inadequate
knowledge with a mean percentage of 37.4% and a standard deviation of 12.9% whereas in the post
test, there was a significant mean knowledge gain of 80.2% and a standard deviation of 6.8%. A
significant association was found between age (χ 2 = 7.72*) age at menarche (χ 2 = 5.04*) number of
children (χ 2 = 7.09*) type of family (χ 2 = 5.45*) previous source of information (5.92*) source of
information (8.72*) and the mean pre test knowledge scores at 0.05 level of significance.
CONCLUSION: In the pre test, about 71.7% of the samples had inadequate knowledge, whereas in
the post test of the samples 68.3% had gained adequate knowledge. These findings indicate that the
structured teaching programme was effective in enhancing the knowledge of the middle aged
women regarding menopausal problems and its remedial measures.
Key words: Structured teaching programme, Knowledge, middle aged women, Menopause,
Remedial measures.
TABLE OF CONTENTS
X
CHAPTER CONTENT PAGE NO
1 INTRODUCTION 1-8
2 OBJECTIVES 9 – 16
3 REVIEW OF LITERATURE 17 – 29
4 METHODOLOGY 30 - 44
5 RESULTS 45 - 72
6 DISCUSSION 73 - 77
7 CONCLUSION 78 - 83
8 SUMMARY 84 - 88
9 BIBLIOGRAPHY 89 - 94
10 ANNEXURE 95 - 165
LIST OF TABLES
XI
TABLE
NO TABLES PAGE NO
LIST OF FIGURES
FIGURE PAGE
NO: FIGURES NO:
XII
1 Conceptual framework based on modified Pender’s Health promotion
16
model.
2 Schematic representation of Research Design. 31
12 Bar diagram representing the Overall Pre test and Post test Mean
Knowledge on Menopausal Problems & its Remedial Measures. 63
13 Cylindrical Diagram representing the Classification of Respondent 65
on Knowledge level on Menopausal & its Remedial Measures.
14 Cylindrical Diagram representing the Aspect wise Mean Pre test and 67
Post test Knowledge on Menopausal & its Remedial Measures
XIII
15 Conical Diagram representing the association between Age group
(years) and Pre test Knowledge level on Menopausal Problems & its 70
Remedial Measures
LIST OF ANNEXURES
XIV
ANNEXURE TITLE PAGE NO
NO
1. Letter requesting permission to conduct pilot study 95
XV
1. INTRODUCTION
“NO ONE CAN MAKE YOU FEEL INFERIOR WITHOUT YOUR CONSENT”
ELEANOR ROOSEVELT.
The status of women in modern India is a sort of a paradox. If on one hand she is at the
peak of ladder of success, on the other hand she is mutely suffering the violence afflicted on her by
her own family members. As compared with past women in modern times have achieved a lot but in
reality they have to still travel a long way. The women have left the secured domain of their home
and are now in the battlefield of life, fully armored with their talent, and proven themselves. But in
Middle age is the period of age beyond young adulthood but before the onset of old age.
Various attempts have been made to define this age, which is around the third quarter of the average
life span of human beings. It is the period between early adulthood and old age. A baby, although
destined to have the mental ability and dexterity is greatly superior to any other species, is delivered
into this world at a relatively early stage of development and is totally reliant on parental care. [2]
Middle-aged adults often show visible signs of aging such as loss of skin elasticity and
graying of the hair. Physical fitness usually wanes, with a 5–10 kg (10-20 lb) accumulation of body
fat, reduction in aerobic performance and a decrease in maximal heart rate. Strength and flexibility
also decrease throughout middle age. However, people age at different rates and there can be
significant differences between individuals of the same. There are many problems which women in
1
Nature does not allow a child to bring a baby into the world and similarly avoids a baby
having a mother who is beyond middle age. Menopause is the physiologic cessation of menses
associated with declining ovarian function. It is usually complete after one year of amenorrhea. A
natural menopause occurs at the time nature intended. Artificial menopause tends to be medically
related. This is usually surgical - the ovaries are removed typically during hysterectomy. It is, a
normal biological shift in mid to late 30′s, when estrogen and progesterone levels decline gradually.
Estrogen is the main female hormone responsible for all reproductive functions. Menopause is due
to estrogen deficiency. This deficiency brings about lots of changes in sex hormones. [2]
18 October is World Menopause Day and as the world’s population ages, there will be
increasing numbers of women entering menopause and living beyond post menopause. The
potential symptoms of menopause may have a negative impact on the quality of daily life. The sex
ratio of India shows that the Indian society is still prejudiced against female. [4]
Women may experience physical and emotional changes during menopause but that doesn’t
mean life has taken a turn for the worse; Many women are prompted at this time to ‘take stock’ of
their lives and set new goals. The menopause occurs at a time when many women may be juggling
roles as mothers of teenagers, as careers of elderly parents, and as members of the workforce.
Experts suggest that creating some ‘me time’ is important to maintain a balance in your life.
Menopause can be seen as a new beginning: it’s a good time to assess your lifestyle and your health
and to make a commitment to strive for continuing ‘wellness’ in the mature years. [5]
There are various remedial measures to treat menstrual problems. Some women may find
relief from menopausal symptoms with herbal or alternative remedies, however most have not been
studied or shown to be of benefit scientifically and some, like black cohosh, have been occasionally
2
linked to liver damage.Hormone therapy can help relieve the symptoms of menopause. It can
replace female hormones no longer made by the ovaries. Bio identical hormones – mixtures of
hormones supplied by compounding chemists – may be touted as beneficial and more “natural” than
hormone replacement therapy (HRT) but there is inadequate evidence for their safety and
effectiveness. [6]
Many women approach menopause with uncertainty about what will happen and how to
deal with changes that occur. It is necessary for all the women to understand menopause which will
make them to cope up with menopausal symptoms and will also improve quality of life of
menopausal women. However, they agreed that education about menopause is extremely important
However, the public health care system does not aknowledge the special health needs of
older women. There has been extensive research on menopause in the west but in India only a few
3
NEED FOR THE STUDY
Menopause is the transition period in a woman's life. After the age of 40years, ovaries
reduce their production of sex hormones. As a result, the menstruation as well as other body
functions is disturbed. Finally the menstruation cease permanently. This ultimate pause is described
as menopause. Needless to say that this phase also marks the end of fertility in women. [7]
and feminist scholars alike as a time of transition and border crossing. Biomedical literature
suggests that menopause primarily represents negative change. Its research focuses on
can represent positive change or a neutral experience for individual women, depending on the
However, there are ways to reduce or eliminate some of the symptoms of menopause.
Menopause is different for everyone. Some women notice little difference in their bodies. Others
may find it difficult to cope with their symptoms. The most common symptom of menopause is hot
flushes (hot flashes).As many as 75% of menopausal women in the United States will have them. [9]
Current population of India in 2011 is 1.21 billion. National sex ratio rises to 940 females
for every 1000 males in 2011 from 933 in 2001. Population of Karnataka is 6.1 crores which is 5%
of India’s 1.21 billion people. The state today has 968 females to every 1000 males. The number of
menopausal women comes in around 43 million and would include women between the ages of 40
to 60. [10]
4
The increasing focus on girl education and aggressive adult education programmers’ have
pushed up female literacy rate in the state by 11.2%, according to provisional data of census
2011.Today 68.1% women in Karnataka are literate ,as compared to 56.9% in 2001. Kerala has the
highest literacy rate of 92%. The sheer size of these figures indicates the necessity of implementing
India’s population is largely rural based (72%) making it very difficult if not impossible for
women to seek out medical care. Just as women in rural America find it challenging to access
quality medical facilities, women in rural India also face an uphill battle to be seen and heard.
Women in India’s cities fare slightly better in that they are closer to some of the most modern
hospitals and clinics but many women are too poor to take advantage. [11]
India has a deep divide between the educated and uneducated. Despite one of the largest
percentages of post-secondary degree holders in the world, India also has one of the highest
illiteracy rates especially for women (65% based on the 2011 census). Women with lower levels of
education and literacy generally lack access to and knowledge of medical information and medical
assistance. [12]
Women are taught to remain silent and are usually forced to remain at home or work very
close to it. Topics that were once forbidden in Western society: menstruation, reproduction, and
health matters including menopause are still not discussed. As a result, women’s health issues are
postmenopausal women (rural 110; urban 70) from Eastern India. A structured schedule was
5
prepared by the researchers to collect data .The result indicated that rural women were more likely
to be affected by hot flushes (78.2%)and night sweats(62.7%) than their urban counterpart. Rural
forgetfulness (81.7%), and a lack of concentration (68.2%) than the urban women did. The present
study made an attempt to explore the health problems of menopausal women. [14]
A Cross sectional study was conducted to determine median age at menopause and
frequency of various related clinical symptoms among 256 postmenopausal and 283
conducted for collecting information about menopause and symptoms associated with it. The result
indicated that 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
A descriptive study was conducted to assess the knowledge, attitude, problems and
remedial measures adopted by menopausal women among 100 women in south Delhi. Structured
interview schedule and Likert attitude scale was used for this study. The result indicated that 45% of
the subjects were in the age group above 55 years,51% of the subjects were literates and 77% were
menopausal women had positive attitude towards menopause.89% of the subject had mood
swings.67% had loss of recent memory,66% had vaginal dryness ,58% had insomnia, 56% hot
flushes, 56% decreased libido , 53% headache, constant fatigue 78% .There was a positive
6
A cross sectional study was conducted on frequency of menopausal symptoms and their
impact on the quality of life among 202 women of age 40-60 years in pakistan. Menopause specific
quality of life questionnaire was used as an evaluation tool. Mann-Whitney U test and Pearson Co-
efficient of correlation was used for statistical analysis. Most prevalent symptom within study
subjects was body ache 165 (81.7%). Frequencies of some classical symptoms were 134(66.3%)
reported "hot flushes", 139 (68.8%) and 134 (66.3%) reported "lack of energy" and decrease in
"physical strengths" respectively. The score of physical domain were significantly more in
transition group p<0.003.To conclude menopause related symptoms had negative effect on the
A study was done on knowledge attitude and practice of menopause, risk and benefits of
hormone replacement therapy, their attitude concerning HRT and menopause among 218 women. A
Questionnaire method was used for this study. The results showed that overall knowledge was
lacking regardless of menopausal status, ethnicity or educational background. Less educated women
were more inclined to believe that HRT was inappropriate principally because they regarded the
menopause as a natural process (p = 0.023). Only 24% of postmenopausal women were practicing
some form of HRT. A minority (7%) had previously been undergoing the therapy but had stopped.
Most postmenopausal women (69%) simply never considered treatment because the majority had
never heard about HRT. This study reveals low awareness of menopausal information and
In rural areas, women are generally not perceived to have any meaningful income generation
capacity. Without the power to work and earn a good income, their voices are silenced. The time
7
has come to improve women’s lives everywhere and remember that menopause does not
discriminate Nations around the world should continue to educate women about menopause and the
benefits of preventive health care, Knowledge, Attitudes, and Behaviours regarding Menopausal
8
2. OBJECTIVES
menopausal problems and its remedial measures among middle aged women in selected rural
areas, Bangalore.”
1. assess the pretest knowledge level of middle aged women regarding menopausal problems and its
remedial measures
3. find out the association between the pre test knowledge level of middle aged women with selected
socio-demographic variables.
Operational definitions
1. Evaluate
programme on the knowledge of middle aged women regarding menopausal problems and its
remedial measures
9
2. Effectiveness
Significant gain in the knowledge as determined by statistical difference between pre test and
post test scores on knowledge level regarding menopausal problems and its remedial measures
middle aged women from selected rural areas regarding menopause, menopausal problems and its
remedial measures using selected teaching aids for about 45-50 minutes.
4. Knowledge
The correct responses obtained from the middle aged women to the questionnaire regarding
menopausal problems and its remedial measures. It is measured by structured interview schedule.
5. Menopausal problems
The physiological problems like hot flushes and night sweat, irregular periods, vaginal
symptoms, digestive problems, and osteoporosis and Psychological problems include emotional and
6. Remedial measures
Management of those factors that could lead to an adverse consequence including self
10
7. Middle aged women
Assumptions:
• the middle aged women may have some basic knowledge regarding menopausal symptoms and its
remedial measures.
• structured Teaching programme could be an effective teaching tool which may enhance knowledge
Hypothesis
H1: The mean post test knowledge score of middle aged women on menopausal problems and its
H2: There will be a significant association between pre-test knowledge level of middle aged women
on menopausal problems and its remedial measures with the selected demographic variable.
Delimitation
11
CONCEPTUAL FRAME WORK
Conceptual frame work serves as a springboard for theory development and as a building block
for the research study. As this is made up of concepts which are mental images of a
phenomenon, it provides for thinking and interpreting what is seen. A model is used to depict
provides for systematic approach to nursing research, education, administration and practice.
The present study is aimed at evaluating the effectiveness of structured teaching programme on
knowledge regarding menopausal problems and its remedial measures among middle aged
women. The investigator has modified Pender’s Health promotion model which was found
suitable to evaluate the effectiveness of STP among middle aged women to improve the
knowledge of middle aged women on menopausal problems and its remedial measures.
interacting with the environment as they pursue health. In this model individual’s seek to
actively regulate their own behavior and person’s seek to create conditions of living through
INPUT
In Health promotion model, it includes personal factors and prior related behavior. Prior related
behavior includes pre test knowledge level in health promoting action regarding menopausal
problems and its remedial measures. The personal factors has been categorized into
12
Previous Source of Information) and Socio cultural factors (Marital Status, Qualification,
THROUGHPUT
It includes procurement of knowledge and its association which affect the person’s plan to
participate in health promoting behaviours and may facilitate continued practice. The perceived
benefits of action comprises of hypothesis: H1: The mean post test knowledge score of middle aged
women on menopausal problems and its remedial measures is significantly higher than the pre-test
knowledge score. H2: There will be a significant association between pre-test knowledge level of
middle aged women on menopausal problems and its remedial measures with the selected
demographic variable.
A person’s perception about time inconvenience, expence and difficulty in performing has not
been affected as a barrier by the investigator in the study as convenience sampling technique is
used.
This concept refers to the conviction that successful administration of STP to improve
knowledge which is the desired outcome has been successfully carried out.
13
Activity related affect
The subjective feelings that occur during an activity can influence the behaviour. A behavior
associated with a positive affect or emotional response is likely to be repeated. Here the subjects
comprehend the knowledge on menopausal problems and its remedial measures. So knowledge
Interpersonal Influences
The use of charts and pamphlets by the researcher to influence a person’s perception concerning
behavior
Situational Influences
They are direct influence on environment of rural areas where adequate facilities improves the
effectiveness of STP.
OUTPUT
This involves activities to assess the knowledge level of subjects after carrying out plan of action
that is post-test
The exposure of teaching programme which demands acquisition of knowledge for the subjects
14
Behavioural outcome
Health promotion model directed towards improved health, better quality of life and
enhanced functional ability of the subjects. In the study outputs entails post test of the middle
aged woman on menopausal problems and its remedial measures and find whether they have
structured teaching programme is found to be effective and if the knowledge level is found to
15
INPUT THROUGHPUT OUTPUT
16
3. REVIEW OF LITERATURE
A review of literature enables one to get an insight into the various aspects of the problem under
study. It covers promising methodological tools, throws light on ways to improve the efficiency
of data collection and suggest how to increase effectiveness of data analysis and interpretation.
Review of literature is therefore an essential step in the development of the research project. The
about the effectiveness of structured teaching programme regarding menopausal problems and its
remedial measures among middle aged middle aged womenin selected rural areas, Bangalore.
Studies related to the prevalence of menopausal problems among middle aged women.
A descriptive study was conducted to assess the prevalence and severity of menopausal
symptoms among 495 menopausal middle aged womenaged 40-60. The result showed that 20.7% of
the respondents complained of vaginal dryness, 17.6% with hot flushes, 8.9% with night sweats.
The most prevalent symptoms were low back pain and joint pain reported by 51.4% respondents.
17
psychological symptoms compared with pre-perimenopausal (n=178) and post peri-menopausal
women (n=133).[19]
A descriptive study was conducted to assess the prevalence and predictors of night sweats,
dry sweats and hot flushes among menopausal women. They had collected data from 795 subjects
between the ages of 45-55 years by using questionnaire method. The study result showed that 10%
of them complained of night sweats, 9%experienced day sweats and 8% with hot flushes. These
three symptoms were strongly correlated and were associated with reduced quality of life. [20]
osteoporosis with menopause and compare the health seeking among 925 women. Cluster sampling
was used for this study. . In-depth interviews were conducted at their houses. T-scores were
calculated to get BMD (Bone Mineral Density) for all the subjects through heel ultrasound. The
result indicated that there was a significantly lower score of BMD of postmenopausal women (mean
= -1.833 + 0.65) compared to pre-menopausal women (mean = -1.597 + 0.60, p=0.016). Lower
bone mineral density was found in greater proportion among older females. Majority needed
related symptoms among 546 postmenopausal women. Questionnaire method was used. The result
found out was that 97.7% of women reported they had complaints during menopause, while 54.9%
reported that they experienced problems in their sexual lives. The ratio of women whose total scores
were higher than the breakpoint of 17 was 42.2%. Single, widowed, divorced women, primary
18
school or lower education women, with problems in their sexual lives had higher ratios than high
school or lower education graduate women, married women, other women within the
survey(P<.05).[22]
356 middle aged women. Modified menopause rating scale was adopted for this study. The result
indicated that the most prevalent symptoms reported were joint and muscular discomfort (80.1%);
physical and mental exhaustion (67.1%); and sleeping problems (52.2%). Followed by symptoms of
hot flushes and sweating (41.6%); irritability (37.9%); dryness of vagina (37.9%); anxiety (36.5%);
depressive mood (32.6%). Other complaints noted were sexual problem (30.9%); bladder problem
fatigue, among 85 women. Data were collected through purposive sampling for this study. . The
total score for sleep quality was 7.71 ± 4.66, and 62.4% of women were identified as poor sleepers.
The mean score of perimenopausal fatigue was 3.02 ± 2.41, indicating mild fatigue. Results showed
that the quality of sleep among perimenopausal women was significantly affected by factors
including long-term drug use, hormone and/or nutritional supplement consumption, perimenopausal
status, and tendency toward anxiety and/or depression (t = 5.43, p < .01; t = -3.15, p < .01; t = -3.33,
p < .001; F = 4.33, p < .05; F = 20.20 and 12.73, p < .001.). Fatigue and perimenopausal
disturbances were related to sleep quality (r = .63 and .61, p < .01), and 43% of sleep quality
19
probability convenient sampling technique was adopted. Structured questionnaire and menopausal
rating scale was used to collect data. Result indicated that maximum of women12(40%) had
moderate symptoms ,10(33%) of women had mild symptoms and 8(27%) of women had severe
symptoms.[25]
headaches among 556 women. Kuppermann Index was used for this study. The result indicated that
Seventy-six out of 556 women (13.7%) were affected by headache of either the migraine or tension
type. In 82% of cases onset had preceded the menopause. migraine improved in almost two-thirds
of cases, tension-type headache worsened or did not change in 70% of cases .In women who had
undergone surgical ovariectomy, the natural course of migraine was worse than in those who had a
period can be attributed primarily to the absence of variations in sex hormone levels.[26]
A descriptive cross sectional study on Knowledge and attitude towards menopause and
was conducted at Karachi among 102 postmenopausal women. Structured pretest questionnaire was
used for this study. The result indicated that 97% percent of women had heard about menopause and
29.4% were aware of the symptoms. Four (3.92%) knew the long term implications of menopause.
Out of 102, only 02 (1.96%) respondents were aware of HRT. Decrease libido and frequency was
reported by 33 (32.3%) respondents .The study concluding majority of women lacked sufficient
20
A qualitative study was conducted on expectations, apprehensions and knowledge about the
menopausal period and climacteric symptoms among 39 women .Convenient sampling method was
adopted. The result indicated that apprehensions were described as different climacteric symptoms,
which were well known to the women through their own or other's experiences and women lacked
knowledge about these changes or self-care activities that could prevent problems or mitigate
symptoms.[28]
A community mail-based survey received responses from 665 women to questions in three
areas includes sources of information about menopause, knowledge of health risks associated with
menopause, and knowledge about hormone replacement therapy (HRT). Women received
information from many sources, including healthcare providers, friends, and mothers, but the
number one source of information about menopause was women's magazines (76%). Over half of
women surveyed said they had left healthcare appointments with unanswered questions about
menopause and HRT. Although women seemed to have a basic understanding of the symptoms of
menopause, their knowledge of the long-term health risks affected by menopause was poor. Many
women thought that menopause itself (independent of aging) increased the risk of breast cancer.
This finding may help explain the low percentage of women taking HRT for menopause despite
proven health benefits. It is clear that better education about menopause needs to be accomplished
regarding the long-term risk associated with menopause and the pros and cons of HRT.[29]
income urban women was carried out to characterize knowledge of menopause and HRT and
factors associated with knowledge level. Socio demographic characteristics, patterns of HRT use,
and knowledge about menopause and HRT were collected through a structured interview.
Results revealed a general lack of knowledge about menopause and HRT, particularly relative to
21
heart disease and the role of HRT in prevention. Major independent predictors of increased
knowledge (R2 = 0.31) were having talked with a healthcare provider about HRT, having at least
a high school education, and being less than 60 years of age. These findings emphasize the key
role of providers in educating this vulnerable population about menopause and HRT and the
A study was done to identify the correlations among climacteric symptoms, knowledge of
menopause and health promoting behavior in middle-aged women. Structured questionnaire was
used for this study. The data was analyzed using T-test, ANOVA and Pearson's correlation
coefficients with SPSS/pc program. The result indicated that the relationship between knowledge
of menopause and health promoting behavior was statistically significant with a positive
correlation. Therefore to conclude the knowledge of menopause by middle aged women was in
A survey was undertaken to study women's knowledge of the physical and emotional
changes associated with menopause between two groups of midlife women: a random sample (n
= 381) and a sample of women who attended menopause seminars (n = 95). The mean score for
the commonly available knowledge items was 27 out of 39 (69.2% correct). The mean
biomedical knowledge score was lower, 19.3 out of 35 (55.1 % correct). While the two groups of
women were significantly different in terms of current and past hormone replacement therapy
(HRT) use, we found no differences between them in the mean commonly available knowledge
or biomedical knowledge scores. This finding challenges the widely held assumption that active
information-seekers are more interested and have a better level of knowledge than the general
population. [32]
22
A descriptive cross sectional study was conducted on knowledge of menopause and
hormone replacement therapy and factors associated with knowledge level among 215 low
income urban women .Structured interview was carried out for this study. Results revealed a
general lack of knowledge about menopause and HRT, particularly relative to heart disease and
the role of HRT in prevention. Major independent predictors of increased knowledge (R2 = 0.31)
were having talked with a healthcare provider about HRT, having at least a high school
education, and being less than 60 years of age. These findings emphasize the key role of
providers in educating this vulnerable population about menopause and HRT and the potential
who at baseline were aged 45-55 years, to determine the rate and timing of medical consultations
for menopausal problems during the menopausal transition and to identify baseline and prospective
variables associated with these consultations. 387 women completed the 9-year study, of which
86% consulted a doctor about menopausal problems; with an annual mean of 31%.Hot flushes was
2.1 years after the First Menopausal Period. An increased number of consultations for menopausal
problems was associated with the baseline variables as vasomotor symptoms (p< 0.005), rating
one's health as 'worse than most' (p< 0.005) and taking two or more non-prescription medications
(p< 0.05); and the follow-up variables: dysphoric symptoms (p< 0.05), vasomotor symptoms (p<
0.005) and hormone therapy use (p< 0.001).The study concluding nearly one third of women will
consult a doctor annually during the years of the menopausal transition. [34]
23
A study was conducted among 197 low-income perimenopausal women to determine
knowledge of menopause and hormone replacement therapy (HRT). A non probability sampling
was used for this study. The result indicated that 58% experienced expected levels of occurrence of
symptoms, but perceived them as not very bothersome, 74.5% had a knowledge deficit related to
menopause and HRT, and 60% had expectations about menopause that underestimated their lifetime
risk of heart disease. Thus it suggests that low-income African-American women need better
among 101 women over the age of 40 years. Significant correlations were found between self-rated
health and health perceptions (r = .44, p = .0004), self-rated health and total symptoms (r = -.30, p =
.0023), self-rated health and worrisome symptoms (r = -.26, p = .0085), health perceptions and
worrisome symptoms (r = .30, p = .0195), health perceptions and self-care responses (r = .43, p =
.0009), and total symptoms and worrisome symptoms (r = .38, p = .0001). To conclude health is
A study was conducted for Evaluation and management of sleep disturbance during the
menopause transition among midlife women in United States. Evaluation tool was used for this
study. The result indicated that different types of sleep disturbance occurring in midlife women and
presents data supporting the use of hormone therapy, hypnotic agents, and behavioral strategies to
A telephone survey regarding self-reported prevalence of the use of alternative therapies for
menopause symptoms among 886 women aged was conducted in Washington State. Women were
24
asked about eight alternative therapies and their use for menopause symptoms. The proportion of
women who used each therapy was 76.1% for any therapy, 43.1% for stress management, 37.0% for
over‐the‐counter alternative remedies, 31.6% for chiropractic, 29.5% for massage therapy, 22.9%
for dietary soy, 10.4% for acupuncture, 9.4% for naturopath or homeopath, and 4.6% for herbalists.
The proportion of women who used it to manage menopause symptoms was 22.1% for any therapy,
9.1% for stress management, 13.1% for over‐the‐counter alternative remedies, 0.9% for
chiropractic, 2.6% for massage therapy, 7.4% for dietary soy, 0.6% for acupuncture, 2.0% for
naturopath or homeopath, and 1.2% for herbalists. Among women who used these therapies, 89–
100% found them to be somewhat or very helpful. Current users of hormone replacement therapy
were half as likely to use alternative remedies or providers (odds ratio 0.48, 95% confidence limits
0.29, 0.77) as were never users. This study concluded that women who use the alternative therapies
menopausal issues of 209 rural women. Convenient sampling method was adopted. Questionnaire
was used for this study. The results indicated that women (30 -97%) did not know the effect of
25
menopause on the incidence of heart disease, cancer of the gallbladder, urinary incontinence,
vaginal thickness, vision, and frequent bacterial infection. Although most women knew about HRT
they had very little knowledge about its specific benefits and risks. About 50 to 59 % reported that
they would gladly take HRT for different health reasons but 37% of them were anxious because of
its unknown long-term effects. However, they agreed that education about remedies of menopause
A cross sectional intervention type study was conducted to assess and compare the
intervention programme among 205 respondents through total house-to- house visit. From the study
findings, it revealed that significant achievement among the respondents regarding the knowledge
on menopause, health care seeking behavior through an educational intervention program imparted
to them. The total intervention program was evaluated ranking their answers and found that before
the intervention the only 27.8% respondents had some knowledge regarding menopause related
problems and 72.2% had no such perception. After intervention respondents it was observed that
49.27% respondents improved their knowledge. Statistically it was found significant. [40]
A study was conducted to evaluate effectiveness of education and awareness on the quality
of life among 62 women aged 44-55 referring to and academic outpatient clinic. Simple random
sampling was used for this study. Data was collected using a modified Hildich questionnaire on
quality-of-life in menopause stage. Mean quality-of-life score in study and control groups, prior to
26
education, was 81.7 and 74.8; changing to 75.3 and 75.8, respectively three months after
intervention. The study group showed a significant improvement in their quality-of-life (P = 0.001).
A significant difference was seen between groups in terms of changing quality-of-life after
A semi-experimental study with a comparison group was conducted regarding effect caused
by self-help programme for climacteric and menopause on the psychological state of women of
menopausal age among 106 women in primary care of Spain. Interview method was used for
collecting data. Psychological well being was assessed using Goldberg Health questionnaire before
and after the intervention. The result indicated that 82.5% of the women in the control group had
probable psychological disorders, but only 8.3% of those in the intervention group. The difference
was statistically highly significant (P < 0.00001; RR = 9.9; 95% Cl, 3.8-25.3). The results show that
educational programmes were very useful in the Primary Care setting. [42]
An experimental study was conducted to examine the effect of hormone therapy (HT)-
related education and counseling among 119 women. Data was collected using questionnaire and
follow up form. Chi-square was used in data evaluation. The result indicated that there was no
difference between the groups at the third month for those who were continuing HT (P> 0.05), but
at the sixth month a significant difference was found (P< 0.05). The primary reason for stopping HT
at the third month in the experimental group was fear of cancer and in the control group it was the
side effects of HT. At 6 months, the primary reason for stopping HT in the experimental group was
again; fear of cancer but in the control group it was the woman's desire not to continue. There was
27
no significant difference in the groups at either 3 or 6 months in experiencing benefits or side
effects from HT (P> 0.05). Education and counseling services given by nurses or other health care
health education intervention for mid-life women. The health education intervention included a
health education brochure, one-on-one teaching. One hundred seventy-nine women were in the
intervention group and 174 women were in the control group. Education effectiveness was assessed
by participants’ scores on four questionnaires at the beginning of the study and 3 months after initial
recruitment. Both groups of women were compared on changes in their scores on health knowledge,
level of perceived uncertainty, health behaviors and perceived perimenopausal disturbances. The
intervention group had significantly reduced scores on perimenopausal disturbances (P<0.005) and
reported increase practice of healthy behaviors (P<0.001) compared to the control group. However,
a significant decrease of perceived uncertainty was only found in the subgroup of women recruited
from the Chinese medicine clinic of the control group (t=2.22; d.f.=58;P<0.05). [44]
A Quasi Experimental study was conducted to assess the effectiveness of structured teaching
and rating scale was used for this study. The result indicated that the comparison of pretest and post
test knowledge level and attitude of menopausal women showed a statistically significant level
(p<0.001). Moderate positive correlation (r=0.63) was found between knowledge and attitude on
menopause. [45]
28
A descriptive cross sectional study was conducted on knowledge of menopause and
hormone replacement therapy and factors associated with knowledge level among 215 low income
urban women .Structured interview was carried out for this study. Results revealed a general lack of
knowledge about menopause and HRT, particularly relative to heart disease and the role of HRT in
prevention. . Major independent predictors of increased knowledge (R2 = 0.31) were having talked
with a healthcare provider about HRT, having at least a high school education, and being less than
60 years of age. These findings emphasize the key role of providers in educating this vulnerable
population about menopause and HRT and the potential subsequent impact on HRT use.[46]
An evaluation of the long term impact of a health education intervention in primary care, for
premenopausal women (45 years of age), is presented. The intervention included information and
group discussion about menopause, stress management, health behaviours (smoking, exercise, diet)
and treatment choices. Questionnaires were sent to 86 women who had been randomised into two
groups (prepared/control) and were now aged 50 (response rate 91%).The prepared group had
significantly greater knowledge of menopause and attributed fewer symptoms to the menopause
than the controls. There were no group differences in measures of general health or mood, but there
was a tendency for the prepared group to report more interest in sexual activity. Subjective
evaluation of the intervention was positive in terms of increasing knowledge and helping women to
29
4. METHODOLOGY
Methodology represents the framework of a study. It indicates the general pattern for
organizing the procedure to gather valid and reliable data for an investigation. This chapter
presents the description of methodology and the different steps that were taken to collect the data
and organize the data for investigation. It includes description of research approach, research
design, setting, sample technique, sampling, development and description of the tool, pilot study,
data collection and plan for data analysis. The methodology of an investigation is of vital
importance to understand the view of the nature of problem selected for the study and the
objectives to be accomplished.
Research approach
A research approach tells the researcher to know what data to collect and how to analyze
it. Research approach is the most significant part of any research. An evaluative approach was
used for this study to test the effectiveness of structured teaching programme on knowledge
regarding menopausal problems and its remedial measures among middle aged women in rural
30
Research Design
Researcher’s overall plan for obtaining answer to the research questions for testing the
research hypothesis is referred to be as the research design. The essential question that the
research design is concerned with is how the study subjects will be brought into the research and
how they will be employed within the research design. The research design used in this study
31
RESEARCH DESIGN
community
-Preparation of
Structured Teaching
Population:
Programme(STP) and
Middle aged
Phase I structured Interview
women in rural
Schedule.
areas.
-Content Validity
-Reliability
Sampling Technique
-Pilot Study
Convenience
Sampling Pretest (O1) 1st Day- Data
collection through
structured Interview
schedule.
-Evaluation
Phase III
-Comparison of pretest
32
and posttest (paired‘t’ test)
-Analysis and
interpretation of data
Key:
O1 = Pretest
O2 = Posttest
Community
Variables
Variables are the characteristics that vary among the subjects being studied. It is the focus
of the study and it reflects the empirical aspect of concepts being studied, the investigator
Dependent Variable
research. Changes in the dependent variable are presumed to be caused by the independent
variable. In this study, the level of knowledge of middle aged women on Menopausal Problems
Independent Variables
Independent variable is a variable which influences the dependent variable.In this study, the
structured teaching programme regarding menopausal problems and its remedial measures is the
independent variable.
Socio-Demographic Variables
33
Baseline characteristics such as Age, Religion, No of Children, Type of Family, Age of
The study was conducted at rural areas under the PHC of kadusonappahalli, Bangalore. 60
middle aged women of these rural areas were selected for the study.
Population
Sampling
Sampling refers to the process of selecting a portion of population to represent the entire
population.
Sample
Sample consists of the subjects selected to participate in a research study. In the present study,
samples are the middle aged women who fulfill the inclusion criteria.
Sample size
Sample comprises of 60 middle aged women in rural areas’ in selected rural areas, Bangalore.
Sampling technique
34
In this study, the convenience sampling technique was used to select the samples based on
Sampling criteria
1. Inclusion criteria
2. Exclusion criteria
35
Data Collection Instrument
The data collection will be done with the help of a structured Interview Schedule on menopausal
SECTION A- It contains socio demographic profile which consist of age, religion, number of
children, type of family, age of menarche and marriage, previous source of information, marital
remedial measures.
Data collection tools are the procedures or instruments used by the researcher to observe
a) review of literature,
e) content validity,
g) reliability
36
Preparation of blue print:
A blue print of the tool was prepared by the researcher, which includes sections, number
Children, Type of Family, Age of Menarche And Marriage, Previous Source of Information,
This part of the tool consisted of 34 items covering the content of areas such as meaning,
definition, age, cause and risk factors, common menopausal problems: physiological,
The items were objective type questions given under the following headings.
Unit I : This unit deals with general information of menopausal problems which includes 18
multiple choice questions regarding introduction, meaning, definitions, age, causes and risk
37
Unit II: This unit deals with remedial measures of menopausal problems among middle aged
Scoring technique:
The structured interview schedule consisted of 34 objective type questions with a single
correct answer. Every correct answer was awarded a score of one (1) and every incorrect/
unanswered answer was awarded zero (0). The maximum score on the structured knowledge
questionnaire was thirty four(34). A scoring key item was prepared showing item numbers and
correct responses.
Obtained score
Percentage = ……………………
Total score
≤ 50 Inadequate
51-75 Moderate
>75 Adequate
38
The STP was developed for middle aged women regarding menopausal problems and its
remedial measures. It was prepared based on review of literature and discussion with experts.
The STP was developed according to the objective planned. The developed STP was
given to 12 experts to establish content validity, and they were requested to give their opinion
and suggestions about the content. They were given the criteria checklist and asked to place a
tick mark (3 ) against agree or disagree. There was 100% agreement on the content of STP from
the experts.
The suggestions were incorporated in the final draft. The STP covered the following
content
1. Introduction
2. Meaning
3. Definitions
4. Age of menopause
39
7. Management tending to cure for menopausal problems
Criteria checklist was prepared against which the STP content was to be evaluated. The
of the content, presentation, language, and diagrams. The response column was developed such
as strongly agree, agree, disagree and a column for remarks of the evaluator.
The draft of the STP along with the criteria checklist was given to twelve experts of
whom, 8 were in the field of community health nursing, 1 was in the field of Obstetrical and
Gynaecological nursing, 2 medical officers and 1 statistician. There was 100% agreement by
experts in the content area. Modifications were made as per suggestions after discussing with the
guide.
The final draft of the STP was prepared based on the suggestions given by the experts.
Content Validity:
Content validity refers to the degree to which an instrument measures what it is supposed
to measure. [48]
In order to ensure content validity of the data collection tool, the prepared instrument,
along with the problem statement, objectives, operational definitions and criteria checklist
designed for validation were submitted to 12 experts. The experts were post graduates in
40
community health nursing (8) and obstetrical and gynaecological nursing (1) with more than 3
There was 100% agreement on most of the items. Minor suggestions were given. Modification
Pre testing was carried out at Doddagubbi, under the PHCof kadusonnappahalli, Bangalore. The
tool was administered to 6 middle aged women and was found to be feasible.
The reliability of the tool is the degree of consistency with which it measures the
The reliability of the structure Interview questionnaire was established by using split half
method. In order to establish the reliability, the tool was administered to 6 middle aged women s
in rural area who fulfilled the inclusion criteria. The reliability quotient obtained for the tool was
0.9777.
Pilot Study:
Pilot study is a small preliminary investigation of the same general characters as a major
study. The main aim is to assess the feasibility, practicability and assessment of measurement.
41
Formal approval was obtained from the Medical Officer of Primary Health Centre,
Doddagubby by convenience sampling technique. After a brief self introduction, the investigator
explained the purpose of the study and obtained consent from them. On the first day, data was
collected by structured Interview schedule on knowledge regarding menopausal problems and its
remedial measures and structured teaching programme was given to them on the same day. On
the seventh day, a post test was conducted on knowledge regarding menopausal problems and its
The statistical analysis of the pilot study for the overall knowledge on menopausal
problems and its remedial measures was the mean pre test knowledge scores was 25% and the
same for the mean post test knowledge score was 77.5% . From the above analysis, the
structured teaching programme was found to be effective and the same was used for the main
study.
Formal written permission was obtained from concerned authorities before data
collection. The data collection period was one month at the convenience of the respondents.
The subjects were assembled as per the fixed schedule. The purpose of the study was
explained to them and confidentiality was taken from all the middle aged women by explaining
Phase 1:
42
In this phase, pretest was conducted on a total of 60 respondents by interviewing with the
structured questionnaire regarding menopausal problems and its remedial measures and
instructions were given on answering the questionnaire and doubts were clarified. Each women
Phase II:
In this phase, a structured teaching programme regarding menopausal problems and its
remedial measures was administered to the subjects and explained to them. All the questions or
Phase III:
In this phase, post test was conducted on the 7th day after administration of the structured
teaching programme, the same structured knowledge questionnaire was used. During the
conduction of the study there was no problem aroused and subjects were co operative to conduct
the study. The investigator thanked and appreciated all the subjects for their goodwill. The
Data collected was processed every day. Missed out data were identified and immediately
Data analysis is the evaluation of information and its pertinence to the study variable.
43
The data was analyzed by using both descriptive and inferential statistics based on the
objectives and hypotheses of the study. The plan of data analysis was as follows:
Descriptive statistics:
• The knowledge level of middle aged women regarding menopausal problems and its
remedial measures before and after administration of STP was calculated using descriptive
Inferential statistics:
Ethical Consideration:
Written permission from the authorities of the primary health centre and informed
consent from the subjects were obtained before conducting the study. No ethical issue was
44
5. RESULTS
Statistical analysis is the process of organizing and synthesizing the data in such a way
that research questions can be answered and hypotheses tested. The purpose of the analysis is to
reduce the data into an intelligible and interpretable form, so that the relation of research problem
This chapter deals with the statistical analysis, which is a method of rendering
quantitative information in a meaningful and intelligible manner. Statistical procedure of the data
gathered to assess the knowledge regarding menopausal problems and its remedial measures
among middle aged women, enabled the researcher to organize, interpret and communicate
information meaningfully.
In order to find a meaningful answer to the research questions, the collected data must be
processed, analyzed in some orderly coherent fashion, so that patterns and relationships can be
discussed. Tables and figures are used to explain the results. Analysis is a process of organizing
and synthesizing the data in such a way that research question must be answered and hypotheses
tested.
The analysis and interpretation of data are based on the data collected through structured
interview schedule from 60 subjects in selected rural areas, Bangalore. Organization and
presentation of the obtained data were entered into the master sheet for tabulation and statistical
processing and the results were computed using descriptive and inferential statistics.
45
Objectives of the study
4. assess the pretest knowledge level of middle aged women regarding menopausal problems and its
remedial measures.
6. find out the association between the pre test knowledge level of middle aged women regarding
menopausal problems and its remedial measures with selected socio demographic variables.
Research hypothesis
H1: The mean post test knowledge score of middle aged women on menopausal problems and its
H2: There will be a significant association between pre-test knowledge level of middle aged women
on menopausal problems and its remedial measures with the selected demographic variable.
The analysis of data is organized and presented in the form of tables and diagrams
46
Section 1: Demographic Characteristics of Respondents
Section-1:
This section deals with the distribution of the samples according to the socio demographic
characteristics. The obtained data on the socio demographic profile are described under the
following sub headings which include age, religion, number of children, type of family, age of
menarche and marriage, previous source of information, marital status, qualification, occupation
and monthly income. The data were analyzed by using descriptive statistics and are summarized
47
Section -1: Demographic characteristics of middle aged women
TABLE - 1
N=60
Characteristics Category Respondents
Number Percent
35-40 26 43.4
41-45 17 28.3
Widow 6 10.0
SSLC 8 13.3
Coolie 9 15.0
Agriculture 6 10.0
Homemaker 26 43.3
12-13 44 73.3
48
20-21 17 28.3
Total 60 100.0
Table 1 depicts the classification of middle aged women by age, marital status, qualification,
occupation, age at menarche(years) and age at marriage(years). The findings indicate that
majority of the women (43.4%) are in the age group of 35-40 years. 31-35 and 41-45 years are
with 28.3% each. With regard to marital status, 90% are married and others were widows (10%),
with 60% having an educational status of below seventh standard. Majority of the women were
home makers (43.3%) whereas self employed, cooli and agricultural workers are with 31.7%,
15% and 10% respectively. 73.3% attained menarche in the age group of 12-13 years.
Interestingly, 71.7% were married by the age group of 18-19 years, and remaining 28.3% by 20-
21 years of age.
49
Figure.4: Classification of Respondents by Age group (years) and Marital status
50
Figure.5: Classification of Respondents by Qualification and Occupation
51
TABLE – 2
N=60
Characteristics Category Respondents
Number Percent
Muslim 29 48.3
Two 29 48.4
Three 20 33.3
Joint 28 46.7
Rs.5,001-6,000 21 35.0
Rs.6,000-7,000 10 16.7
Information No 39 65.0
Friends/Neighbours 12 20.0
Total 60 100.0
52
This table represents the percentage and distribution of the middle aged women by family related
characteristics. With regard to religion, majority of women are Hindus (51.7%) and others are
muslims (48.3%). Most of the women have atleast two children (66.7%) and 33.3% had three
children. 53.3% are in nuclear family and 48.3% have family income of Rs. 4,000-5,000.
Surprisingly none of their family members had menopausal problems. Source of health
information for the majority (35%) is from health personnel and friends/Neighbours with 15%
53
Figure.7: Classification of Respondents by Religion and No. of Children
54
Figure.9: Classification of Respondents by Family members, Previous source of
information and Source of Information
55
Section 2: Overall and Aspect wise Knowledge Scores of Respondentson Menopausal
Problems & its Remedial Measures.
TABLE – 3
Classification of Respondents on Pre test Knowledge level on Menopausal Problems & its
Remedial Measures
Total 60 100.0
Table 3 represents the percentage distribution of middle aged women on Pre test Knowledge
level on Menopausal Problems & its Remedial Measures. With regard to the women majority
71.7% of them had inadequate knowledge ( < 50%)scores, 28.3% of them had moderate
knowledge (51-75%) scores and none of them had adequate knowledge (>75%) score in the pre
56
Figure.10: Classification of Respondents on Pre test Knowledge level on Menopausal
Problems & its Remedial Measures
57
TABLE -4
Aspect wise Pre test Mean Knowledge scores of Respondents on Menopausal Problems &
its Remedial Measures
N=60
No. Knowledge Aspects Statements Max. Respondents Knowledge
Menopause &
Menopausal Problems
The data presented in the above table shows the aspect wise mean pretest knowledge
scores of middle aged women regarding menopausal problems and its remedial measures. It
shows that the participants had highest mean percentage score (41.9%) in the area of remedial
menopause and menopausal problems the mean percentage score was 33.4%. The combined
58
TABLE – 5
Classification of Respondents on Post test Knowledge level on Menopausal Problems & its
Remedial Measures
Total 60 100.0
The above table shows the frequency and percentage distribution of middle aged women
on post test knowledge level regarding menopausal problems and its remedial measures. Among
the 60 subjects under study, majority 68.3% of them had adequate knowledge level (>75%
score), 31.7% had moderate knowledge level (51-75% score) and none of them had inadequate
59
Figure.11: Classification of Respondents on Post test Knowledge level on Menopausal
Problem & its Remedial Measures
60
TABLE -6
Aspect wise Post test Mean Knowledge scores of Respondents on Menopausal Problems &
its Remedial Measures
N=60
No. Knowledge Aspects Statements Max. Respondents Knowledge
Menopause &
Menopausal Problems
The data presented in the above table shows the aspect wise mean post test knowledge
scores of middle aged women regarding menopausal problems and its remedial measures. It is
seen that the participants gained the highest mean percentage score (83.3%) in the area of
menopause and menopausal problems the mean percentage score was 77.5% .The combined
61
TABLE – 7
Over all Pre test and Post test Mean Knowledge on Menopausal Problems & its Remedial
Measures
N=60
Aspects Max. Respondents Knowledge Paired ‘t’
27.17*
The above table projects the overall pre test, post test and enhancement of mean knowledge
The mean pre test knowledge was 37.4% with SD 12.9%. The mean post test knowledge found
to be 80.2% with SD 6.6%. However, the enhancement was proved as mean (42.8%) and SD of
(12.3%). Further, the paired t-test value (27.17*) shows statistical significance at level of p< 0.05
62
Figure.12: Overall Pre test and Post test Mean Knowledge on Menopausal Problems & its
Remedial Measures
63
TABLE – 8
Classification of Respondents on pre test and post test Knowledge level on Menopausal
Problems & its Remedial Measures
The above table shows that in the pre test, out of 60 subjects majority of them 71.7% of them had
inadequate knowledge, 28.3% of them had moderate knowledge and no subjects had adequate
knowledge. In the post-test, majority of them 68.3% had adequate knowledge level, 31.7% had
moderate knowledge level and none of them had inadequate knowledge level. The obtained χ2
value 84.11* is greater than the χ2 (0.05) 5.991 which is found to be significant at degree of
freedom 2.
64
Figure.13: Classification of Respondents on pre test and post test Knowledge level on
Menopausal & its Remedial Measures
65
TABLE – 9
Aspect wise Mean Pre test and Post test Knowledge on Menopausal Problems & its
Remedial Measures
N = 60
No. Knowledge Aspects Respondents Knowledge (%) Paired
Pre test Post test Enhancement ‘t’
Mean SD Mean SD Mean SD Test
I General Information 33.4 15.1 77.5 9.6 44.1 16.4 20.83*
on Menopause &
Menopausal Problems
II Remedial Measures 41.9 15.6 83.3 9.0 41.5 16.0 20.09*
The above table shows the aspect wise pre test and post test mean and standard deviation
regarding knowledge of middle aged women on menopausal problems and its remedial
measures.
A paired ‘t’test was done to compare the mean pre test and post test scores on each aspect. For
general information regarding menopause and menopausal problems, the obtained ‘t’ value is
20.03* and it is found to be significant at 0.05 level (‘t’= 0.05 with df (59). In the area of
remedial measures, the obtained ‘t’ value is 20.09* is also significant at 0.05 level (‘t’= 0.05
with df (59).. The obtained ‘t’ value for the combined aspects of knowledge is 27.17* is also
significant at 0.05 level (‘t’= 0.05 with df (59).
From the above statistical information it is evident that the structured teaching
programme was effective in enhancing the knowledge of middle aged women regarding
menopausal problems and its remedial measures in all knowledge aspects under investigation.
66
Figure.14: Aspect wise Mean Pre test and Post test Knowledge on Menopausal & its
Remedial Measures
67
Section - 3 : Association between Demographic variables and Knowledge level of
Respondents on Menopausal Problems & its Remedial Measures
TABLE – 10
Association between Demographic variables and Pre test Knowledge level on Menopausal
Problems & its Remedial Measures
n=60
2
Demographic Category Sa Respondents Knowledge χ P
Variables mp Inadequate Moderate Value Value
le N % N %
Age (years) 31-35 17 15 88.2 2 11.8 7.72* P<0.05
35-40 26 20 76.9 6 23.1
41-45 17 8 47.1 9 52.9
Marital Status Married 54 39 72.2 15 27.8 0.08 P>0.05
Widow 6 4 66.7 2 33.3 NS
Qualification No formal 16 11 68.7 5 31.3 0.12 P>0.05
Education NS
Below 7thStd 36 26 72.2 10 27.8
SSLC 8 6 75.0 2 25.0
Occupation Self Employed 19 11 57.9 8 42.1 2.70 P>0.05
Coolie 9 7 77.8 2 22.2 NS
Agriculture 6 5 83.3 1 16.7
Homemaker 26 20 76.9 6 23.1
Age at Menarche 10-11 16 8 50.0 8 80.0 5.04* P<0.05
(years) 12-13 44 35 79.5 9 20.5
Age at Marriage 18-19 43 32 74.4 11 25.6 0.57 P>0.05
(years) 20-21 17 11 64.7 6 35.3 NS
Religion Hindu 31 22 71.0 9 29.0 0.12 P>0.05
Muslim 29 21 72.4 8 27.6 NS
Number of Children One 11 11 100 0 0.0 7.09* P<0.05
Two 29 21 72.4 8 27.6
Three 20 11 55.0 9 45.0
68
Type of Family Nuclear 32 27 84.4 5 15.6 5.45* P<0.05
Joint 28 16 57.1 12 42.9
Family Income/month Rs.4,000-5,000 29 22 75.9 7 24.1 0.52 P>0.05
Rs.5,001-6,000 21 14 66.7 7 33.3 NS
Rs.6,000-7,000 10 7 70.0 3 30.0
Previous Source of Yes 21 11 52.4 10 47.6 5.92* P<0.05
Information No 39 32 82.1 7 17.9
Source of information No 39 32 82.1 7 17.9 8.72* P<0.05
Health Personnel 9 3 33.3 6 66.7
Friends/Neighbors 12 8 66.7 4 33.3
Combined 60 43 71.7 17 28.3
* Significant at 5% Level, NS : Non-significant
The table presents the association of pre test level of knowledge with selected demographic
variables.
The Chi-square test was carried out to determine the association between the pre test
knowledge level and demographic variables such as age marital status, qualification, occupation,
age at menarche, age at marriage, number of children, type of family, family income /month,
previous source of information. Out of which age (χ 2= 7.72*) age at menarche (χ 2= 5.04*)
number of children (χ 2= 7.09*) type of family (χ 2= 5.45*) previous source of information
(5.92*) source of information (8.72*)were found to be significantly associated with pre test
knowledge at 5% level and the rest of the demographic variables were not significant. Hence
research hypotheses H2 is proved and accepted.
It is evident that pre-test knowledge score is better influenced by age, age at menarche,
number of children, type of family, previous source of information and source of information.
69
Figure.15: Association between Age group (years) and Pre test Knowledge level on
Menopausal Problems & its Remedial Measures
Figure.16: Association between Age at Menarche (years) and Pre test Knowledge level on
Menopausal Problems & its Remedial Measures
70
Figure.17: Association between Type of Family and Pre test Knowledge level on
Menopausal Problems & its Remedial Measures.
Figure.18: Association between Previous source of Information and Pre test Knowledge
level on Menopausal Problems & its Remedial Measure.
71
Figure.19: Association between Source of Information and Pre test Knowledge level on
Menopausal Problems & its Remedial Measures
72
6. DISCUSSION
This chapter presents the major findings and discusses them in relation to similar studies
conducted by other researchers. The aim of this study was to evaluate the effectiveness of
structured teaching programme on knowledge regarding menopausal problems and its remedial
Pre-experimental design with one group pre test-post test was used to evaluate the
effectiveness of structured teaching programme regarding menopausal problems and its remedial
measures among 60 middle aged women. A structured interview schedule was used to collect the
data from subjects. Pre test was conducted on first day among middle aged women after
explaining the purpose of the study. Structured teaching programme was conducted among the
samples on first day after conducting pretest examination. Posttest was done on the seventh day
7. assess the pre test knowledge level of middle aged women regarding menopausal problems and its
remedial measures
73
9. find out the association between the pre test knowledge level of middle aged women regarding
menopausal problems and its remedial measures with selected demographic variables.
Regarding the demographical variables majority of middle aged women(43.3%) are in the
age group of 35-40 years.With regard to marital status, 90% of the middle aged women were
married and others were widow. While considering their qualification 60% of them having
below 7thstandard education. With regard to occupation 43.3% were homemakers, Majority of
the women were home makers (43.3%) whereas self employed, cooli and agricultural workers
are with 31.7%, 15% and 10% respectively. 73.3% attained menarche in the age group of 12-13
years. Interestingly, 71.7% were married by the age group of 18-19 years, and remaining 28.3%
The findings of the study are discussed according to the objectives and hypotheses.
Majority 71.7% of them had inadequate knowledge (≤50%) scores, 28.3% of them had
moderate knowledge (51-75%) scores and none of them had adequate knowledge (>75%) score
74
This finding is supported by the study done by H K Sinclair, C M Bond, and R J Taylor on
generated, representative sample of 1500 women. A postal questionnaire was used for this
study. The most common reason for postmenopausal women never having taken hormone
replacement therapy was that they had never considered the treatment (70%) and had not
discussed it with a doctor (79%). The results showed that women had a poor knowledge of the
potential risks and benefits of estrogen, lack of knowledge being greatest in the less educated and
older women.[50]
In the present study it was also found that the overall pretest knowledge scores of the
menopausal women regarding menopausal problems and its remedial measures was found to be
inadequate with 37.4% and a standard deviation of 12.9%. The highest mean pretest knowledge
score is noticed in the remedial measures (41.9%) and 33.4% in general information on
middle aged women regarding menopausal problems and its remedial measures.
In the present study it is observed that the mean post test percentage knowledge score
regarding general information on menopause and menopausal problems was 77.5% which was
higher than the mean pretest knowledge score of 33.4%. Regarding remedial measures it was
found that the mean post percentage knowledge score was 83.3% which was higher than the
mean pretest knowledge score of 41.9%. Regarding all the knowledge aspects under
75
The mean percentage of posttest knowledge scores on menopausal problems and its
remedial measures was 80.2% which was higher than the mean percentage of pretest knowledge
score of 37.4% with an enhancement of 42.8%. A paired ’t’ test was done and it was found to be
significant (t= 27.17*, p<0.05) which indicates the effectiveness of structured teaching
This study supports the findings of the study conducted by K.L.M. Liao, M.S. Hunter to
evaluate the short-term outcome of a health education intervention devised among 178 samples
of 45-year old women. Preparation involved two health education sessions carried out in small
groups and covering information and discussion of the normal menopause transition in the
context of mid-life. The women completed pre- and post-intervention (3 and 15 months)
questionnaires which assessed knowledge and beliefs about menopause and a number of health-
related behaviours. Knowledge improved significantly at the follow-up assessments for the
3. find out the association between the pre test knowledge menopausal problems and
In the present study association was sought between pre test knowledge level of
significant middle aged women and selected socio demographic variables where a significant
association was found with age (χ 2= 7.72*) age at menarche (χ 2= 5.04*) number of children (χ
2
= 7.09*) type of family (χ 2= 5.45*) previous source of information (5.92*) source of
information (8.72*)were found to be significantly associated with pre test knowledge at 5% level
76
and the rest of the demographic variables were not significant. Hence research hypotheses H2 is
. The study supports the findings of the study conducted by Yangin HB, Kukulu K, Sözer
GA regarding the symptoms and perception of menopause, as well as factors affecting and
influencing this perception with the help of 300 women in menopause. The study used
sociodemographic data from a descriptive survey form. The data were collected by researchers in
face-to-face interviews. The mean menopause age of participating women was x = 45.75 ± 4.7.
A total of 41.3% of the women had primary education, and 62% of the women also had one or
two children. There was a significant relationship between attitudes toward menopause and a
woman's age, educational status, number of children, duration of living with spouse, satisfaction
with marriage, menopausal age, menopause duration. The most important aspect of polyclinic
services related to menopause is to increase and maintain women's quality of life. [52]
77
7. CONCLUSION
The chapter enlightens the importance of this research study. The purpose of this study was to
This research revealed that there is a significant difference in knowledge of middle aged women
regarding menopausal problems and its remedial measures after Structured Teaching Programme. The
study statistically proved that there is an association between pre test knowledge and selected socio
The following conclusions were drawn on the basis of the data analysis
• Majority of the participants (middle aged women) were in the age group of 35-40 years
(43.4%) followed by 28.3% among 31-35 and 41-45 year age group.
• About 90% of the middle aged women were married and 10% of them are widows.
• Majority of the participants (43.3%) were home makers and 31.7% are self employed.
• 60% of the middle aged women had education below 7 thstandard, 13.3% with SSLC and
• 71.7% were married by the age group of 18-19 years, and remaining 28.3% by 20-21
years of age.
• Most of the women have atleast two children (66.7%) and 33.3% had three children
• 53.3% of participants belong to nuclear family and 46.7% belong to joint family.
78
• The mean pre test knowledge score of the mothers regarding menopausal problems and
• The aspect wise mean pretest knowledge score was found to be higher in remedial
• The overall mean post test knowledge score of middle aged women was found to be
80.2% as compared to mean pretest 37.4% with an enhancement of 42.8%. A paired ‘t’
test result indicated significant difference between the pre test and post test knowledge
score regarding menopausal problems and its remedial measures(t= 27.17*,p<0.05), from
which it can be inferred that structured teaching programme was effective in enhancing
level of middle aged women regarding menopausal problems and its remedial measures.
did not show any significant association with the knowledge of significant middle aged
women.
NURSING IMPLICATIONS
The result of the study shows that majority of the middle aged women had inadequate knowledge
regarding menopausal problems and its remedial measures during pre test. So the study had several
implications for nursing practice, nursing education, nursing administration and nursing research.
79
Nursing Education
practical level. In this present study the nurse educator gives priority to uphold the value of
education to improve the knowledge of middle aged women regarding menopausal problems and
• Nurse educators need to lay emphasis on the causes, manifestations and adverse effect of
menopausal problems. Appropriate vitamin Supplements, healthy life style and balanced
• Nurse educators initiate and insist on health education programs among middle aged
Nursing Practice
development of mankind. The main focus of nursing practice is to reduce the morbidity and
• Regular health education programs should be carried out for middle aged women by nursing
• Help the middle aged women to learn their role in controlling causative factors, modifying
• Nurse education has a great part to play in the practice of remedial measures as all the potential
causes discussed could be alleviated by the educational process. Structured teaching program is
80
considered as an effective education strategy to improve the awareness and knowledge of the
Nursing Administration
Nursing administration is a service sector to control the management operation along with
arrangement of service policies in order to plan for organization. Nursing administrators take
initiatives for continuous education program. Moreover, administration can evaluate the merits
• In co-operation with the hospital authorities and other health administrators, nurse administrator
should take initiative to organize health education programs for middle aged women regarding
• Appropriate teaching/learning materials needs to be prepared and made available for health
education programs.
• An administrator must be responsible to co-ordinate all health education and public awareness
program.
• Nurse managers can conduct periodical menopausal problems checkups to take appropriate
measures.
• Nursing leaders are challenged to take the health needs of vulnerable groups especially, by
menopausal problems.
81
Nursing Research
order to establish facts and reach conclusions. A researcher can bring innovative approaches and
modern theories in the field of research. It has been reported that menopausal problems are
unrecognized and may cause serious physical, emotional and behavioural consequences. Further
and its effects in women’s life. Further research is necessary to examine what kinds of stratergies
are effective for a menopausal women to function in her community. A research study can make
remarkable changes in their knowledge, attitude, potentials and thereby improving the quality of
living.
• The sample size is limited to 60 middle aged women in selected rural areas, Bangalore.
• Due to time constraint and the sample availability a convenience sampling technique
• Randomization was not done. So the sample may not be the true representation of the
population.
• The qualitative portion of the study consisted of a brief interview and did not involve a
recorded, transcribed and was based solely on the notes of the researcher.
82
Suggestions
• Health education programs on menopausal problems and its remedial measures could be
Recommendations
Based on the findings of the study, following recommendations have been made:
• A similar study can be carried out to evaluate the efficiency of various teaching
• Based on study findings, intervention should be given to all women through mass
media, role-play, drama, and puppet show, etc. to enhance the knowledge level.
83
8. SUMMARY
Menopause has been described as a normal, natural, event which is associated with
reduced functioning of the ovaries due to aging, resulting in lower levels of estrogen and other
hormones. It marks permanent end of sterility and is sometimes called “change of life”. During
this transition a women experiences many physical and psychological changes. Some of women
will have troublesome symptoms whereas others may navigate the transition with few or even no
symptoms. As one approaches menopause, many women wonder if these changes are normal,
and many are confused about treating the symptoms. Thus it is beneficial to educate women
addition, organizations should make available stratergies such as workshops and other
educational programs that target implementing knowledge on menopausal problems and its
remedies for women well being. Above all, organizations must ensure that they extend their
10. assess the pre test knowledge level of middle aged women regarding menopausal problems and its
remedial measures
11. evaluate the effectiveness of structured teaching programme on knowledge regarding menopausal
84
12. find out the association between the pre test knowledge level of middle aged women regarding
menopausal problems and its remedial measures with selected demographic variables.
Hypothesis
H1: The mean post test knowledge score of middle aged women on menopausal problems and its
H2: There will be a significant association between pre-test knowledge level of middle aged women
on menopausal problems and its remedial measures with the selected demographic variable.
ASSUMPTIONS
• The middle aged women may have some knowledge regarding menopausal symptoms and its
preventive measures.
programme on knowledge regarding menopausal problems and its remedial measures among
middle aged women at selected rural areas, Bangalore. The investigator has adopted the modified
Health promotion model which was found suitable to evaluate the effectiveness of STP among
middle aged women to improve the knowledge about menopausal problems and its remedial
85
interacting with the environment as they pursue health. Model employ a feedback cycle of input
throughput and output. It provided the comprehensive framework of achieving the objectives of
the study.
One group pretest-post test pre-experimental design was used to evaluate the
effectiveness of STP regarding menopausal problems and its remedial measures among middle
aged women who were selected by convenience sampling method. A structured interview
schedule was used to collect data from the study subjects. The tool for the study was validated by
Pilot study was conducted among middle aged women in doddagubbi under PHC
investigator explained the purpose of the study and obtained informed consent from them. Data
was collected by structured interview schedule to assess the pre test knowledge on the 1st day.
On the same day STP was given to the group. On the seventh day, a post test was conducted on
knowledge regarding menopausal problems and its remedial measures. The obtained data was
analysed and proved in terms of objectives and hypotheses using descriptive and inferential
statistics.
• With regard to marital status, 90% are married and others were widows (10%).
86
• While considering educational status 60% having qualification below seventh standard.
• Majority of the women were home makers (43.3%) whereas self employed, cooli and
• Interestingly, 71.7% were married by the age group of 18-19 years, and remaining 28.3%
• Regarding marital status, 56.7% were married and others were unmarried .
• While considering their designation 93.3% were staff nurses and others were head Nurses.
• With regard to total experience in nursing profession, 48.3% had 0-2 years, 13.3% had 2-4
years, 15% had 4-6 years and 23.3% had above 6 years of experience.
• Majority of staff 51.7% were permanent, 33.3% were temporary and 15 % of staff were
With regard to the middle aged women, majority 71.7% of them had inadequate
knowledge (≤50%) scores, 28.3% of them had moderate knowledge (51-75%) scores and none of
them had adequate knowledge (>75%) score in pretest regarding menopausal problems and its
remedial measures.
The mean pretest knowledge was 37.4% with 12.9% SD. The mean posttest knowledge
regarding menopausal problems and its remedial measures was found to be 80.2% with SD
6.6%. However, the enhancement was proved as mean (42.8%) and SD of 12.2%. Further, the
paired t-test value (27.17*) shows statistical significance at level of p< 0.05 with 59 df,
The paired ‘t’ test was used to test the significance of difference between pretest
knowledge score and posttest knowledge score and found to be significant at p<0.05. The
87
computed statistical test value on general Information on menopausal problems and remedial
Further, the result showed that there is significant association between pre test knowledge
level with selected socio demographic variables like which age (χ 2 = 7.72*) age at menarche (χ 2
2 2
= 5.04*) number of children (χ = 7.09*) type of family (χ = 5.45*) previous source of
information (5.92*) source of information (8.72*) among middle aged women regarding
menopausal problems and its remedial measures. Since there was significant association between
the pre test knowledge level and selected socio demographic variables, the research hypotheses
88
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Annexure – 1
95
Annexure – 2
96
Annexure – 3
97
Annexure – 4
98
99
Annexure – 5
Annexure – 6
100
ACCEPTANCE FORM FOR TOOL VALIDATION
Name:
Designation:
problems and its remedial measures among middle aged women in selected rural areas.
Date:
Name and Designation
Signature
Annexure – 7
101
102
ANNEXURE 8
TEACHING PROGRAMME
Dear Sir/Madam,
Please go through the criteria listed below which have been formulated evaluating and validating
the structured teaching programme regarding menopausal problems and its remedial measures
Please read each statement carefully and place a tick (√) mark against the appropriate column
which expresses your opinion about the Structured teaching programme. Please give your
a. Comprehensive
b. Realistic
a. Accurate
b. Adequate
c. Relevant
103
d. According to the level of
understanding of middle aged women
a. Logical sequence
b. Integration
4. Language
a. Acceptable to clients
b. Interesting
b. Appropriate
A – Agree
DA – Disagree
Annexure- 9
104
CRITERIA CHECKLIST FOR VALIDATION OF THE TOOL
Instruction
Kindly go through the items in the structured knowledge questionnaire regarding menopausal
problems and its remedial measures among middle aged women in selected rural areas. Please give
your suggestion regarding accuracy, relevancy and appropriateness of the items in the content.
There are three response columns in the scale namely, strongly agree (SA), Agree (A), and
Disagree (DA). Please tick mark (√) against the specific column. If you disagree to any item
Socio-demographic profile
Item
1.
2.
3.
4.
5.
6.
7.
8.
9.
105
10.
11.
12.
Item
10
11
12
13
14
15
16
106
17
18
19
20
21
23
24
25
26
27
28
29
30
31
32
33
34
Annexure -10
CONSENT FORM
107
I am herewith give my consent to participate in the study conducted by Ms. Jiny James,
teaching programme on knowledge regarding menopausal problems and its remedial measures
Thanking you
Annexure 11
108
109
Annexure 12
LIST OF EVALUATORS
110
7. Ms.Shruthi.S
Lecturer
M.S Ramaiah Institute of Nursing Education and Research
Bangalore
8. Ms. A. SanthamLillypet
Professor
M.S Ramaiah Institute of Nursing Education and Research
Bangalore.
9. Mrs. V.T Lakshmamma
Principal
Kempegowda college of Nursing
Bangalore.
10. H.S. Surendra
Associate professor
Dept. of Agril.Statistics
GKVK, Bangalore
11. Dr.Rajeshwari.R
M.B.B.S. MS(OBG)
Consultant, Bangalore.
12. Dr. Vagdevi. S. K
Lady Medical Officer
Cholanayaknahalli Health Center
R.T. Nagar Post
Bangalore.
111
Annexure-13
remedial measures.
112
Annexure – 14
This structured Interview Schedule is designed for collecting relevant information from
Part-1: Consists of twelve questions related to demographic variables of the middle aged women
Part-2: Consists of 34 items regarding the knowledge of middle aged women on menopausal
problems and its remedial measures which is divided into two sections.
Section A: Deals with general information on menopause and problems of menopause includes
Section B: This section deals with remedial measures which include 16 multiple choice
Dear Participants,
This part of the questionnaire is related to demographic variables of participants. Kindly tick (√)
in the space provided for the answer, you find appropriate from the options given. This
113
information provided will be kept confidential.
PART-1
DEMOGRAPHIC PROFILE
Instruction: Place a tick mark in the appropriate space provided against each item
1. Age(years)
a) 31-35 [ ]
b) 35-40 [ ]
c) 41-45 [ ]
2. Religion
a) Hindu [ ]
b) Muslim [ ]
c) Christian [ ]
d) Any other [ ]
3. Marital status
a) Single [ ]
b) Married [ ]
c) Widow [ ]
d) Separated [ ]
5. Type of family
a) Nuclear [ ]
114
b) Joint [ ]
c) Extended [ ]
6. Qualification
a) No formal education [ ]
b) below 7th standard [ ]
c) SSLC [ ]
d) PUC and above
7. Occupation
a) Self employed [ ]
b) Coolie worker [ ]
c) Agriculture [ ]
d) Homemaker [ ]
9. Age at menarche(years)
a) 10-11 [ ]
b) 12-13 [ ]
115
12. Previous source of information
a) Yes [ ]
b) No [ ]
If yes, Source of information
a) Electronic media [ ]
b) Print media [ ]
c) Health Personnel [ ]
d) Relatives. Family members [ ]
e) Friends/ Neighbors [ ]
PART-2
Below there are questions under section A and B, and you are requested to tick ( √ )
PROBLEMS
a) Absence of menstruation [ ]
c) Onset of menustration [ ]
a) 45 years [ ]
116
b) 48 years [ ]
c) 50 years [ ]
d) 55 years [ ]
a) Perimenopause [ ]
b) Polymenorrhoea [ ]
c) Change of life [ ]
d) Dysmenorrhoea [ ]
a) 6 months [ ]
b) 8 months [ ]
c) 10 months [ ]
d) 12 months [ ]
a) Radiation [ ]
b) Chemotherapy [ ]
c) Medications [ ]
d) Stimulus [ ]
117
b) Thyroid hormone [ ]
c) Growth hormone [ ]
a) Vaginal dryness [ ]
b) Hot flushes [ ]
c) Fatigue [ ]
a) Tamoxifen [ ]
b) Paracetamol [ ]
c) Meftal spas [ ]
118
10. Common symptoms of vaginal dryness include
a) Itching [ ]
b) GI distress [ ]
c) Insomnia [ ]
d) Weight gain [ ]
a) Vaginal infections [ ]
b) Hot flushes [ ]
c) Uterine infections [ ]
d) Night sweats [ ]
a) Hair loss [ ]
b) Osteoporosis [ ]
c) Digestive problem [ ]
d) Allergies [ ]
a) Bone fractures [ ]
119
b) [ ]
c) [ ]
d) [ ]
a) Loss of partner [ ]
b) Irritability [ ]
c) Loss of memory [ ]
d) Menopausal changes [ ]
a) Night mare [ ]
b) Hot flash [ ]
c) Memory loss [ ]
d) Irrational thinking. [ ]
120
17. Leading cause of menopausal depression is
a) Anxiety [ ]
b) Phobia [ ]
c) Stress [ ]
d) Tiredness [ ]
a) Medication [ ]
b) Brain damage [ ]
d) Surgical menopause [ ]
a) Soya bean [ ]
b) Spinach [ ]
c) Carrot [ ]
d) Strawberry [ ]
121
20. Hot flushes during menopause can be decreased by
a) Sunflower oil [ ]
b) Badam oil [ ]
c) Olive oil [ ]
a) Yoga [ ]
b) Warm baths [ ]
c) Vitamin supplements [ ]
d) Air conditioning [ ]
a) Frigidity [ ]
b) Body temperature [ ]
c) Bone strength [ ]
d) Blood pressure [ ]
a) Dates [ ]
b) Biscuits [ ]
122
c) Wheat [ ]
d) Suppota [ ]
a) Vitamin A [ ]
b) Vitamin B [ ]
c) Vitamin D [ ]
d) Vitamin E [ ]
a) Dairy products [ ]
b) Meat products [ ]
c) Oil products [ ]
d) Vegetable products [ ]
a) Swimming [ ]
b) Skipping [ ]
c) 50m run [ ]
d) Walking [ ]
123
27. Milder symptoms of menopausal depression can be relieved by
a) Medication [ ]
b) Surgery [ ]
c) Family counseling [ ]
a) Caffeine [ ]
b) Nicotine [ ]
c) Alcohol [ ]
d) Daily exercise [ ]
a) Morning [ ]
124
b) Evening [ ]
c) Night [ ]
d) Early morning [ ]
a) Meditation [ ]
b) Sedentary life [ ]
c) Medicines [ ]
d) Surgery [ ]
a) Maturity [ ]
b) Eating [ ]
c) Exercise [ ]
d) Trait [ ]
a) Hormone therapy [ ]
b) Physiotherapy [ ]
c) Immune therapy [ ]
d) Thermotherapy [ ]
125
34. Burning and vaginal pain after intercourse can be relieved by the following
measures, except
a) Applying betadine [ ]
b) Sitz bath [ ]
d) Cold packs [ ]
126
Annexure –15
SCORING KEY:
Note: Each right answer carries ONE score and each wrong answer carries ZERO
score.
CORRECT TOTAL CORRECT TOTAL
Sl.No RESPONSE SCORE Sl.No RESPONSE SCORE
1 A 1 18 D 1
2 C 1 19 A 1
3 A 1 20 D 1
4 D 1 21 C 1
5 D 1 22 B 1
6 A 1 23 A 1
7 B 1 24 D 1
8 B 1 25 A 1
9 A 1 26 D 1
10 A 1 27 B 1
11 A 1 28 D 1
12 B 1 29 D 1
13 A 1 30 B 1
14 A 1 31 A 1
15 D 1 32 C 1
16 B 1 33 A 1
17 C 1 34 D 1
127
Annexure -16
STRUCTURED TEACHING
PROGRAMME
ON
MENOPAUSAL PROBLEMS AND ITS
REMEDIAL MEASURES
127
Topic : Problems of menopausal women and its remedial measures
Duration : 1hour
GENERAL OBJECTIVE
On completion of this Structured Teaching Programme, women will acquire adequate knowledge on
menopausal problems and its remedial measures and develop desirable attitude to comprehend it.
SPECIFIC OBJECTIVES: At the end of this teaching programme, middle aged women will be able to,
128
CONTENTS TEACHING
SPECIFIC
SL.NO TIME LEARNING AV AIDS EVALUATION
OBJECTIVES
ACTIVITIES
The
investigator
To review the Review of previous knowledge
2 2min asks questions
previous Have you heard about menopause?
knowledge and the
Do you know the problems of
regarding women
problems of menopause?
menopausal How will you manage problems of answer.
women and its menopause at home?
remedial
measures. enumerate the
meaning of
3 2min To enumerate MEANING OF MENOPAUSE menopause
the meaning of Investigator
menopause The word "menopause" literally means enumerates the
the "end of monthly cycles" from meaning of
the Greek word pausis (cessation) and the menopause
root men- (month), because the word and women
"menopause" was created to describe this listen.
change in human females. define
129
4 1min To define DEFINITION menopause?
menopause
Menopause is time in a woman's life Investigator
when her periods (menstruation) defines women
eventually stop and the body goes through understands
changes that no longer allow her to get
Investigator state the age of
pregnant.
To state the menopause ?
age of AGE OF MENOPAUSE
menopause.
5 2min states the age
The age of menopause ranges between
45-55 years, average being 50 years. of menopause
and the
Perimenopause, oftern accompanied by women listens
irregularities in the menustral cycle along
with the typical symptoms of early
menopause, can begin up to 10 years prior
to the last menstrual period. Menopause is
complete when you have not had a period
for 1 year. This is called postmenopause.
130
in the body. Lowered estrogen
levels might cause menopause
symptoms and can lead to changes
in a woman's body
Risk factors
131
Cancer, Diabetes, Thyroid disease and
Obesity
IRREGULAR PERIODS
Abnormal menopause bleeding is one of
the most frequent complaints of women
during the perimenopause. It is not
unusual to have irregular bleeding
(bleeding usually decrease in amount and
frequency) for up to 6 months before
menstrual periods stop completely. Heavy
bleeding that is excessive or prolonged
(more than 7 days) should be investigated
by your doctor.
VAGINAL SYMPTOMS
Vaginal symptoms may include vaginal
dryness, itching, or irritation and/or pain
with sexual intercourse (dyspareunia).
The vaginal changes also lead to an
increased risk of vaginal infections.
DIGESTIVE PROBLEMS
Hormonal imbalance during
perimenopause is one of the primary
causes of digestive problems. Some of the
common symptoms of digestive
problems: Cramps, Bloating, Gas,
Constipation, Diarrhoea
OSTEOPOROSIS
Osteoporosis is perhaps the most serious
symptom of menopause because it can
lead to severe health problems such as
132
chronic back pain and broken bones.
About 33% of women over 50 will
experience bone fractures as a result of
hormonal fluctuations. A hall mark of this
disease is an increase loss of bone mass
and strength.
PSYCHOLOGICAL PROBLEMS
EMOTIONAL AND COGNITIVE
SYMPTOMS
Women in perimenopause often report a
variety of thinking (cognitive) and/or
emotional symptoms, including fatigue,
memory problems, irritability, and rapid
changes in mood. Some women face the
problem of memory loss and lack of
concentration before their menopause.
SEXUAL DYSFUNCTION
INSOMNIA
Insomnia is very common just before and
after menopause. Sometimes it is due to
133
night sweats, which are hot flashes.
Women often wake up in the wee hours in
the morning and have great difficulty
getting back to sleep.
DEPRESSION
Stress is the leading cause of depression
during menopause.Sometimes menopause
can make you feel more than a little sad;
often it can make you downright
depressed. Women who have gone
through surgical menopause are also at
increased risk for depression. Investigator describe the
describes the remedial
8 23min To describe REMEDIAL MEASURES remedial measures of
the remedial measures of menopause?
measures of Home Remedies for menopause : To menopause
menopause. increase your levels of estrogen try and women
increasing your consumption of plants comprehends.
which contain estrogenic substances:
(legumes)
soybeans, soy sprouts, crushed flaxseeds,
garlic, green beans, sesame seeds, wheat,
yams, pumpkin seeds, cucumbers, corn,
apples, cabbage, beets, olive oil, papaya,
oats, peas, sunflower seeds, are all
important sources of natural estrogens .
134
REMEDIES FOR PHYSIOLOGICAL
PROBLEMS
1. Hotflush
135
2. Abnormal and irregular
menopausal bleeding
136
toner for Dry skin.
• Practicing kegal exercise:Try to
stop the flow of urine when you
are sitting on the toilet. Imagine
that you are trying to stop passing
gas. Be careful not to tighten your
stomach, legs, or other muscles.
Don't hold your breath. Repeat,
but don't overdo it.. Lie on the
floor. Pull in the pelvic muscles
and hold for a count of 3. Then
relax for a count of 3. Work up to
10 to 15 repeats each time you
exercise.
Digestive problems
Osteoporosis
137
brisk walking.
• Eating and drinking two to
four servings of dairy products,
richest source of calcium and
other calcium-rich foods a day
will help ensure that you are
getting enough calcium in your
daily diet.
• Make sure to get enough vitamin
D.
• Avoid alcohol intake and
smoking.
• Maintain a healthy weight
138
time for intimacy with your partner.
Enjoy your time together -- you can take
long romantic walks, have candlelit
dinners, or give each other back rubs and
more foreplay.
Insomnia
Depression
139
Three approaches can be considered for
treating menopausal symptoms: (1)
lifestyle changes, (2) alternative remedies,
and (3) drugs and surgery
Lifestyle changes
These can include changes such as
reducing stress, exercising more
frequently, and eating a postmenopause-
friendly diet rich in calcium and other
essential nutrients.
Alternative treatments
Ranging from acupuncture and hypnosis
to the more common herbal remedies,
many women find that combining these
with lifestyle changes makes a significant
positive impact on their lives.
Prescription drugs
It usually involves some form of hormone
replacement therapy
(HRT),Vaginalestrogen therapy and
Calcium suppliments.Isoflavones, which
are natural oestrogens will be prescribed
by doctors.
Hormone therapy (HT) (consists
of estrogens or a combination of estrogens
and progesterone),is used to control the
symptoms of menopause
Vaginal estrogen therapy is an option in
the treatment of vaginal dryness, which
may be an alternative with a lower risk of
side effects than hormone replacement
140
therapy. Applying Betadine topically on
the outer vaginal area, and soaking in a
sitz bath or soaking in a bathtub of warm
water may be helpful for relieving
symptoms of burning and vaginal pain
after intercourse..
For some women, surgery is the another
alternative. Many women think that
hysterectomy is the only choice left.
CONCLUSION
9 2 min To conclude
the topic Menopause is an unavoidable change that
every woman will experience, assuming
she reaches middle age and beyond. It is
helpful if women are able to learn what to
expect and what options are available to
assist the transition, if that becomes
necessary.
141
REFERENCES
th
2. Lewis, Heitkemper, Dirksen, O’Brien, Bucher. Medical surgical nursing. 7 ed. Missouri: Mosby; 2007.P.
th
3. Brunner and Suddarth. Text book of medical surgical nursing. 9 ed. Lippincott: Philadelphia; 2007. P.703-739
remedies.html
th
9. Lippincott Manual of Nursing Practice, 8 ed, Jaypee Brothers, : Philadelphia,2006.p.122-137
142
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