RAJIVGANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE,

KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECTS
FOR DISSERTATION
1. NAME OF THE CANDIDATE

: MS.SUKHDEEP KAUR

AND ADDRESS

I YEAR M.Sc NURSING

CHINAI COLLEGE OF NURSING,
SAPTHAGIRI MANSION,
BHAANU NURSING HOME ROAD,
BOMMANAHALLI, BANGALORE-68.

2. NAME OF THE

INSTITUTION

CHINAI COLLEGE OF NURSING,

BANGALORE -68

3. COURSE OF STUDY AND

SUBJECT

4. DATE OF ADMISSION TO

MASTER DEGREE OF NURSING,

COMMUNITY HEALTH NURSING.

15.06.2009

COURSE

5. TITLE OF THE TOPIC

: A STUDY TO ASSESS THE EFFECTIVENESS

OF STRUCTURED TEACHING PROGRAMME ON
MENSTURAL HYGIENE KNOWLEDGE AND
PRACTICE AMONG ADOLESCENT GIRLS
STUDYING IN 8TH TO 10TH STANDARD IN SELECTED
SCHOOL AT BANGALORE.

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

I Want to fly _ _ _ _ _ _ _ _ _ do not cut my wings.

[2004, UNFPRA PROGRAMME]
In INDIA about 24%of total population belongs to adolescent period. The
blossoming of adolescence in each generation is as fascinating a sight as the unfolding
offspring each year predictable and repetitive. Adolescents belong to vital age group,
not only because they are the entrant population to parenthood but also because they
are threshold between childhood and adulthood. As they attempt to cross this
threshold they face various physiological, psychological and developmental changes.
The word Adolescent is derived from the Latin word adolescere which means to
grow to maturity that indicate the defining features of adolescence. During puberty
the physical changes occur which transform the body of child into that of an adult,
changes in body size, and changes in body proportions.
Menstruation is a physiological phenomenon which is unique to females
that begins in adolescence. Menstruation is also properly called menses (or) catamenia
and more commonly a period of monthly flow. Menstruation is not an illness. It is a
healthy, normal, mature process. The ages of onset is from 9-16 years and termination
occurs approximately every 28days and last for about five days. Menstrual flow
consists of blood, mucus, and tissue particles. Average blood loss is about three

ounces. Factors that may alter the menstrual cycle are stress, fatigue, exercises, acute
(or) chronic illness, and changes in climate. Personal hygiene to be followed during
menstruation are to use sterile pads during early period of heavy flow, bathe daily for
comfort and to feel fresh, keep perineal area clean from anterior to posterior, cotton
under garments preferred. The most striking change in adolescent girls is the onset of
menstruation, 3-5 days bleeding from the uterus once a month that will occur
throughout the lifetime till menopause. The first menses is called Menarche.
Menarche is the signal that sexual maturation of the young female has occurred and
that the body is capable of supporting pregnancy. With onset of menstruation a girl
becomes aware of her emerging identity as a female capable to reproduce. Her
understanding and acceptance of her new identity will be greatly influenced by the
feed back she receives from peers, educators and most importantly her parents.
Menstruation occurs periodically throughout the child bearing years, except during
pregnancy and lactation. The ages of onset of menstruation differ from person to
person but seem to be affected by heredity, racial background and nutritional status.
Most of the girls receive their gynecological information from their
mothers, religious books, older sister or a peer. However such information was
generally given after menarche rather than before A study conducted in (2006) using
qualitative research data and quantative survey revealed, that prior to menarche the
knowledge about menstruation was deficient among the respondents and ten percent
of women respondedants and reported various taboos related to menstruation. Hence
there is a need to provide healthy family life education to the woman particularly the
adolescent girls. Very few similar studies have been conducted in India which has

explored the knowledge and practice areas. But the attitudinal aspects of menstruation
have not been studied specifically.
Menstruation is still regarded as something unclean or dirty in Indian society.
The reaction to menstruation depends upon awareness and knowledge about the
subject. The manner in which a girl learns about menstruation and its associated
changes may have an impact on her response to the event of menarche. Although
menstruation is a natural process, it is linked with several misconceptions and
practices, which sometimes result into adverse health outcomes.
Menstruation is still regarded as something unclean or dirty in Indian
society. The reaction to menstruation depends upon awareness and knowledge about
the subject. The manner in which a girl learns about menstruation and its associated
changes may have an impact on her response to the event of menarche. Although
menstruation is a natural process, it is linked with several misconceptions and
practices, which sometimes result into adverse health outcomes.
Hygiene-related practices of women during menstruation are of
considerable importance, as it has a health impact in terms of increased vulnerability
to Reproductive Tract Infections (RTI). The interplay of socio-economic status,
menstrual hygiene practices and reproductive tract infections are noticeable. Today
millions of women are sufferers of Reproductive tract infections and its complications
and often the infection is transmitted to the offspring during pregnancy.
Women having better knowledge regarding menstrual hygiene and safe
practices are less vulnerable to Reproductive Tract Infections and its consequences.
Therefore, increased knowledge about menstruation right from childhood may
escalate safe practices and may help in mitigating the suffering of millions of women.

The social stigma attached to menstruation causes many girls and women
to carryout dangerous hygiene practices. Lacking a platform to share menstrual
hygiene problems, girls and women often suffer from discomfort and infection,
avoiding urination during menstruation and using any kind of cloth available old (or)
unwashed as an absorbent. These kinds of practices can lead to problems like
infection, boils and itching but still girls are not visiting medical practitioners.

6.1 NEED FOR THE STUDY:

Todays adolescents (24%) are tomorrows adults who are the strength of the
nation. Todays adolescent girls are our future homemakers. Most of the adolescents
tend to be extremely unaware of their own body their physical well being and
psychological change. Half of the adolescence age 12- 15 years residing in 9th to 12 th
standard do not know about menstruation until its onset.
Menstrual cycle has come to occupy an increasingly important place in
discussions of womans health attention is again focusing on the impact of the onset
of menarche. Studies of girls response to menarche have determined that it is a highly
salient, intensely experience event and a turning point in female development. They
also have demonstrated that more adequate preparation is associated with a more
positive initial response .Despite a sense of being prepared and even excited about
impending event, however, most girls still find menarche mildly stressful.
A study was conducted in (2007), due to lack of information on this
natural phenomenon and culturally divergent beliefs and practices, rural adolescent
girls in India often manage menstruation in an unsafe manner that leads to
reproductive tract infections and other reproductive health problems.

The girls should be educated about significance of menstruation and

development of secondary sexual characteristics, selection of sanitary menstrual
absorbent and its proper disposal. So that she does not develop psychological upset
and received education would indirectly wipe away the age-old wrong ideas and make
her feel free to discuss menstrual matters without any inhibitions.
Menstruation and puberty hygiene is rarely discussed at home as well as
schools; especially in the regions the current study was conducted. Due to some
cultural and religious restrictions many young girls in this country lack appropriate
and sufficient information regarding menstrual hygiene causing incorrect and
unhealthy behavior during their menstrual period.
A study was conducted by James (2003) on, knowledge and practice of
menstrual hygiene in Punjab. The main finding of the study was that adolescent
school girls as a whole had an inadequate knowledge on menstrual hygiene.
A study was conducted by Kolf (2001), on Understanding of menstruation
in early adolescent girls. Their explanation for menstruation reflected at best
incomplete knowledge and more typically a variety of misconception or ignorance.
A study was conducted by Sreenivasa (1999), on Knowledge and Attitude
of adolescent girls regarding menstruation showed that the emotional response of the
majority of girls (60%) at the onset of menstruation.
The above studies and personal views of the investigator and her exposure to
the surroundings in the form of relatives, neighborhood who faced certain problems in
the aspect of menstruation and its crisis situation created an insight to conduct a study
to assess the effectiveness of STP on menstrual hygiene and practice among
adolescent girls in 8th to 10th standard in selected school at Bangalore.

6.2 REVIEW OF LITERATURE

Review of literature is a broad systematic and critical collection and
evaluation of important scholarly published literature as well as unpublished
materials. The review serves as an essential background for any research.
[B.T. Basavanthappa, 2004]

A study was conducted by Dasgupta A, Sarkar. (2008) Menstrual hygiene;

how hygienic is the adolescent girls. Menstruation and menstrual practices are still
clouded by taboos and socio-cultural restrictions resulting in adolescent girls
remaining ignorant of the scientific facts and hygienic health practices, which
sometimes result into adverse health outcomes. A descriptive, cross-sectional study
was conducted among 160 adolescent girls of a secondary school situated in the field
practice area of Rural Health Unit and Training Center, Singur, West Bengal, with the
help of a pre-designed and pre-tested questionnaire. Data was analyzed statistically by
simple proportions. Results shows Out of 160 respondents, 108 (67.5%) girls were
aware about menstruation prior to attainment of menarche. Mother was the first
informant regarding menstruation in case of 60 (37.5%) girls. One hundred and thirtyeight (86.25%) girls believed it as a physiological process. Seventy-eight (48.75%)
girls knew the use of sanitary pad during menstruation. Regarding practices, only 18
(11.25%) girls used sanitary pads during menstruation. For cleaning purpose, 156

(97.5%) girls used both soap and water. Regarding restrictions practiced, 136 (85%)
girls practiced different restrictions during menstruation. Conclusions: Menstrual
hygiene, a very important risk factor for reproductive tract infections, is a vital aspect
of health education for adolescent girls. Educational television programmes, trained
school nurses/health personnel, motivated school teachers and knowledgeable parents
can play a very important role in transmitting the vital message of correct menstrual
hygiene to the adolescent girl of today.
A study was conducted by Rembeck G I, Moller .M. (2006). Attitude and
feelings towards menstruation and womanhood in girls at menarche. To elucidate
early adolescent girls' attitudes, thoughts and feelings towards menstruation and their
bodies. METHODS: 309 12-y-old girls answered questionnaires. One part of the
questionnaire dealt with thoughts and feelings towards menstruation. The other part
dealt with thoughts and feelings towards menstruation and sex and ability to
communicate on aspects of womanhood. The study reveals that Postmenarcheal girls
were less positive towards menstruation than premenarcheal girls (p = 1 x 10(-6)).
Many girls (43%) did not reaffirm the statement "I like my body" and almost one
quarter stated being teased for their appearance. Many of the girls claimed that they
had been called "cunt" (38%) or "whore" (46%). If called "cunt" or "whore", 17%

stated that they felt alone, 76% felt anger and 50% were offended. Mothers were those
with whom girls could most easily "chat" about their period. Sixty-seven per cent
received information about menstruation from school nurses.
A study was conducted by Parwej.S, Kumar, Agarwal AK. (2005)
Experiences in relation to menstruation. The study finding showed that most of the
girls talked about how their menstrual bleeding makes they feel dirty and unclean and
reported feelings of embarrassment and shame. During menstruation one was
completely shocked; another reported that she was not allowed to enter in the temple
and kitchen. Such prohibitions do induce feelings of isolation and shame in young
girls.
A study was conducted by Ei-Gilany AH, Badawai K, (2005). Menstrual
hygiene among adolescent schoolgirls in Mansoura, Egypt. This study among 664
schoolgirls aged 14-18 in Egypt, asked about type of sanitary protection used,
frequency of changing pads or cloths, means of disposal and bathing during
menstruation. Girls were selected by cluster sampling technique in public secondary
schools in urban and rural areas. Data were collected through an anonymous, selfadministered, open-ended questionnaire during class time. Use of sanitary pads may
be increasing, but not among girls from rural and poor families and other aspects of
personal hygiene were generally found to be poor, such as not changing pads regularly
or at night, not bathing during menstruation. Lack of privacy was an important
problem. But a large majority of girls said they needed more information.
A study was conducted by Shukla .S (2005). working on
menstruation with girls in Mumbai, India. Menstruation is considered a polluting

factor among Hindus. In many places menstruating girls and women are considered
untouchable. Such attitudes and practices are unlikely to create a positive self image
with in girls. Shukla found that girls and women teachers were very knowledgeable
about the intricate system of taboos and sanctions that pertained to menstruation but
had very little actual knowledge about the biological process of maturation and
normal physiology. This is lack of factual information, compounded by the prevalence
of myths, means that girls practical needs related to managing menstruation are often
not appreciated (or) appropriately addressed, e.g. of the provision of adequate sanitary
protection .Most girls are left to cope as they can with rags (or) other insufficient
protection.
A study was conducted by Kirk .J, Sommer, M. (2005). Menstruation and
awareness; critical issues for girls education. Lack of sanitary protection during
menstruation is often mentioned as a barrier to girls regular attendance in school. In
many poor families providing adequate clothing for the whole family can be a
challenge. Insufficient (or) inadequate sanitary protection can be very embarrassing
for a girl attending school during her monthly period.

A study was conducted by Bista,M.B(2004). A review of research literature

on girls education in Nepal. Bista reports, local cultural expectations that
menstruating women should remove themselves from public spaces has led to classes
taught by female teachers being discontinued for several days at a time (or) to women
teachers who continue to teach during menstruation being viewed negatively by the

community not only does this disrupt the learning process, but it may simultaneously
very negative messages about what is expected of women and girls.

A study was conducted by Trinoye OO, OPgunghomi A, Ajo AO. (2003)

Menstruation : knowledge, attitude and practices of students in Taiwan. The
purpose of the study was to explore gender differences in knowledge and attitudes
towards menstruation among Taiwanese adolescents. This study was a secondary data
analysis of a cross-sectional comparison study conducted in Taiwan. A total of 287
female and 269 male students at a junior high school participated in the study. The
results showed that almost all the students had heard about menstruation and most of
them had received menstrual information at school. However, their knowledge about
menstruation was not accurate. Moreover, the male students expressed more negative
attitudes towards menstruation than the female students.
A study was conducted by Turkan Turan (2003). Determination of
knowledge and practices about menstruation. The data was collected using a 21-item
questionnaire developed by the researcher based on information in the literature. The
mean age of the girls included in the study was 12.88+0.94. More than half of the
girls (52%) had begun menstruating and the mean age for menarche was 12.29+0.81.
The majority (90%) had received information about menstruation but 10% had not. A
significant difference was found between frequency of changing sanitary pads and the
students' income status (p=0.001). As their income level decreased their frequency of

changing pads decreased. In conclusion the children had a knowledge deficit about
menstruation and education needs to be given at their schools and in their families.
A study was conducted by Rajashree R. Kamble (2001). A study to access
the knowledge and practice of menstruation and menstrual hygiene among school
girls. The findings of the study showed that 61.66%of the girls had an average
knowledge regarding menstruation on menstrual hygiene and 87.66% of the girls
followed correct practices.

STATEMENT OF THE PROBLEM:

A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED
TEACHING PROGRAMME ON MENSTURAL HYGIENE KNOWLEDGE AND
PRACTICE AMONG ADOLESCENT GIRLS STUDYING IN 8 TH TO 12TH
STANDARD IN SELECTED SCHOOL AT BANGALORE.

6.3 OBJECTIVES OF THE STUDY:

1.

To assess the knowledge and practice on menstrual hygiene among adolescent

girls studying in 8th to 12th standard before and after structured teaching
programme.

2.

To evaluate the effectiveness of structured teaching programme in term of

knowledge and practice on menstrual hygiene.

3.

To determine the corelation between the knowledge and practice on menstrual

hygiene among adolescent girls studying in 8th to 12th standard.

4.

To determine the association between the knowledge and practice on menstrual

hygiene among adolescent girls with their selected socio-demographic
variables

6.4 HYPOTHESES OF THE STUDY:

H1:

There will be significant increase in the knowledge and practice on menstrual

hygiene among adolescent girls studying in 8th to 12th standard after

structured

teaching programme.

6.5. OPERATIONAL DEFINITIONS:

1. Knowledge: Refers to understanding of adolescent girls on
menstrual hygiene as elicited by the structured questionnaire devised by the
questionnaire.
2.

Effectiveness ; it refers to determine the extent of significant

knowledge gaion among among adolescent girls studying in 8th to 12th

standard.
3. Menstrual hygiene: Includes all those measures taken by the
individual to keep the genital area clean and dry during the menstrual period / cycle.

4. Adolescent girls: Refers to the girls who had attained menarche

between 13-17 years Adolescent girls who are studying in 8 th and 12th standards
of selected schools.

5. Structured Teaching Programme ; It is a well prepared

teaching

programme with systematically developed instruction for a group of

adolescent girls on Menstrual hygiene knowledge and practice for one hour.

6.6. ASSUMPTION:
1. Adolescent girls may have some knowledge and practice regarding
menstrual hygiene.

6.7. DELIMITATION:
This study is de-limited to 13-17 years Adolescent girls who are
studying 8th and 12th standards.
This study is de-limited to young adult females.
This study is de-limited to 80% Adolescent girls who are studying 8th
and 10th standards.

7.0. MATERIALS & METHOD:

7.1. SOURCE OF DATA:
Data will be collected from adolescent girls who are studying 8th
and 10th standards selected at Bangalore.
7.2 METHOD OF COLLECTION OF DATA:
7.2.1 RESEARCH DESIGN:
The research design that will be used to achieve the objectives of the
study is one group pretest posttest experimental design.
7.2.2RESEARCH APPROCH:
The approach of this study will be experimental in nature.
7.2.3 SETTING OF THE STUDY:

This study will be conducted in selected schools in Bangalore .

7.2.4 POPULATION:

The population of the study comprises of adolescent girls who

are studying 8th and 10th standards in selected school Bangalore.
7.2.5 SAMPLE SIZE:
The total sample of the study consists of 80 adolescent girls who
are studying 8th and 10th standards.
7.2.6 SAMPLING TECHNIQUE:
Convenient and Purposive sampling technique.
7.2.7 SAMPLING CRITERIA:
INCLUSION CRITERIA

1. Adolescent girls who are studying 8th and 12th standards who are willing
to participate.
2. Adolescent girls who are studying 8th and 12th standards who are
available during the period of data collection.
3. Adolescent girls who are studying 8th and 12th standards who are able to
speak and read Kannada.
4. Adolescent girls who are studying 8th and 12th standards between the age
between of 13 to 17 years.
EXCLUSION CRITERIA

1. Adolescent girls who are studying 8th and 12th standards are not
willing to participate and not available during the data collection.
2. Adolescent girls who are studying 8th and 12th standards are not able
to speak and read Kannada.

3. Adolescent girls who are studying 8th and 12th standards are above 17
years.
7.2.8 TOOL FOR DATA COLLECTION:

A structured Questionnaire is drafted for this purpose and the relevant

data will be collected from the sample.
Part I:
Selected demographic variables such as age, educational status, religion,
type of family, family income monthly, source of information, age at menarche,
educational status of the mother, number of elder sisters.
Part- II:
Structured knowledge questionnaire regarding menstrual hygiene
PROCEDURE FOR DATA COLLECTION:
The data will be collected with in the prescribed time period in selected
Adolescent girls who are studying 8th and 12th standards.
The objective of the study will explained to adolescent girls who are
studying 8th and 12th standards before starting the data collection.

7.2.9 DATA ANALYSIS METHOD:

The data analysis will be carried out through experimental and
inferential statistics with the help of computer software package (SPSS).
INFERENTIAL STATISTICS:

Chi square test will be used to find out the association between the
knowledge and practice with selected demographic variables.

7.3 DOES THE STUDY REQUIRE ANY INTERVENTION TO BE CONDUCTED

ON PATIENTS OR OTHER HUMANS OR ANIMALS?

No, health education pamphlet will be given to adolescent girls regarding

substance abuse based on identified needs.
7.4 ETHICAL CLEARANCE:
Permission will be obtained from
- The research committee of Chinai College Of Nursing.
- Authorities of selected areas.

8. LIST OF REFERENCES:
BOOK REFERENCE
1. Parthasarathy. A Text book of pediatrics. 2nd edition. jaypee Brothers (p)
New Delhi; 2002; 38-40.
2. Kolf.e, Rierdan. Early adolescent girls understanding of menstruation. Journal of
women health. 1995; v 22(4); 1-21.
3. Basavanthappa B.T. The text book of community health nursing. 1stedition.
Jaypee Brothers (p). New Delhi: 1998; 205-206.
4. Dawn C.S. The text book of gynecology.The dawn books (p): Calcutta. 1982; 234.

JOURNAL REFERENCE
5. Mohammad poureslam. Project (online): 2001 Nov ;(cited 2001 Nov) availalable
From: URL: http;//www.ams.ac.ir/Aim/0254/0254219.htm.32k.

6. Dasgupta.A, Sarkar. Menstrual hygiene; how hygienic is the adolescent Girl.

Indian Journal of community medicine. 2008: v 33(2); 77-80.
7. Rembeck G.I, Moller. M. Attitudes and feelings towards menstruation and
womanhood in girls at menarche. Journal of pediatrics. 2006: v (95);
8 . Ei-Gilany .AH, Badawi,Karima. Reproductive health matters. 2005: V 13(26);
147-152.
9 . Shukla. Working on menstruation with girls in Mumbai, India. Vacha Womens
resource centre equals.2005: v (15);4-5.
10. Krick. J, Sommner.M. Menstruation and body awareness, critical issues for girls
on education. 2005: v (15); 4-5.
707-714.
11. Bista. M.B. A review of research literature on girls education in
Nepal. Journal of medical sciences. 2004.
12. Trinoye. Ogunghomi. A. Menstruation: knowledge attitude and practices of
students in Nigeria. Journal of Medical Sciences. 2003: v 12(1); 43-51.
13. Parwej.S, kumar, agarwal A.k. Reproductive health education international trial.
Journal of pediatrics India. 2005: v (72); 287-291.
14. Turkan, Turan. Determination of knowledge and practices about
Menstruation. (Online) 2003.
15. Rajashree R. Kamble. A study to assess the knowledge and practice of
menstruation and menstrual hygiene among school girl. Journal of sch.
2001: v 75 (3); 89-99.