Chapter – 1

Introduction
Learning is the beginning of health, learning is the beginning of wealth
Learning is the beginning of spirituality searching and learning is where the miracle process
all begins

Background of the study:

The transition period between childhood and adulthood is adolescent during which there are
profound changes occurs in biological, intellectual, psychological, in economic sector of
individual. The changes in adolescence is important in order to understand the implication of
the changes in health and its risk to which young’s are exposed .gynaecological problems are
common but most of the females ignore the symptoms or they don’t know about them.one of
the most common is polycystic ovarian syndrome(PCOS).
Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder amongst
women of reproductive age. It affects 5-10% female population in developed countries. The
estimation of high prevalence rates appears in countries where diagnosis of obesity and
type 2 diabetes are also common. It is common in adolescent girls. PCOS affect throughout
the life and produce gynaecological and metabolic health problems.

Women with PCOS may have in frequent or prolong menstrual periods or excess male
hormone (androgen) level. The ovaries may develop numerous small collections of fluid
(follicles) and fail to release eggs. Early diagnosis and treatment along with weight loss may
reduce the risk of long-term complication such as type 2 diabetes and heart disease,
infertility. Since it is one of the causes of infertility, we have to educate the women about
boosting fertility in PCOS.
It affects about 5-10% of the female population who are in the age group of 12-45 years.
Poly cystic ovarian syndrome (PCOS) was formally called Stein- Levinthal syndrome. in
1935 Dr. Stein and Levinthal described a syndrome in which women suffered irregular and
rare menstrual cycle, hirsutism and varying degree of infertility. The exact cause of PCOS is
unknown but it is thought of abnormal disturbances in androgen and insulin produced by the
combination of genetic and environmental factor such as lifestyle and obesity.
Currently PCOS is affecting 2.2-26% of young girls in India with 9.13% - 36% prevalence in
adolescent girls only. Females are facing many problems due to the hormonal imbalances.
Women of child bearing age with PCOS have demonstrated higher rate of mood disorders
including bipolar disorder, depression, anxiety (5-8%) and lower quality of life.
The study will evaluate the effectiveness of structure teaching program of knowledge
regarding among adolescent girls.

Need of the study:

Information regarding the prevalence and severity of PCOS is still taking in many areas of
the world especially in low income and middle-income regions
PCOS is a complex endocrine disorder which is most common in women of reproductive age
group. PCOS may first present in adolescence, but the incidences of PCOS in adolescence is
not known. It is usually associated with increased risk of endometrial cancer and increase
metabolic and cardiovascular risk. The exact mechanism of the manifestation of PCOS is not
yet completely understood. The syndrome appears to involve genetic, environmental, dietary,
metabolic components. Many female or girls does not know about the occurrence or origin of
the PCOS.
As PCOS starts from early life of mother womb, extending throughout the life, and
environment insults and life style issue may affect vulnerable women, leading to the
occurrence of phenotypic characteristic of PCOS. Diet seems to be one of the foremost
environmental determinants for the occurrence of PCOS. hormone level is not balance among
girls with PCOS. Girls with PCOS commonly present with overweight and obesity,
particularly visceral obesity.
Although PCOS has no cure, there are several ways by which condition can be managed or
treated such as weight loss is effective in lessening many of the health condition associated
with PCOS. lack of knowledge and negative attitude towards polycystic ovarian syndrome
among females and not taking any measure for lifestyle improvement is of great concern.
Through our structure teaching programme, we will tell to the adolescent girls about the
occurrence of PCOS and how can be it prevented by modifying life style and dietary pattern
therefore this study will have the adolescent girls to take early preventive measure to
overcome the health issue.

Problem statement:
A study to assess the effectiveness of structural teaching programme on knowledge
regarding poly cystic ovarian syndrome among adolescent girls at selected government
school, Lucknow, U.P.
Aim of the study:

To aware the adolescent girls about polycystic ovarian syndrome and how it can be
prevented by taking early intervention, preventive measure and by lifestyle
modifications.
Objectives:

• To assess the pre-test level of knowledge regarding PCOS among adolescent girls.
• To assess the effectiveness of structured teaching programme regarding PCOS
in adolescent girls at selected government school of Lucknow.
• To find the association between pre-test knowledge score with their selected
demographic variables among adolescent girls.

Operational definitions:

Effectiveness:

In this study the term effectiveness means the extend to which our structured teaching
programme has fulfills it’s role.

Structured teaching programme

It refers to a systematically developed programme that uses audio- visual method to provide
information about polycystic ovarian syndrome.
Polycystic ovarian syndrome:

Polycystic ovarian syndrome, it is a hormonal disorder that cause enlarged ovaries with
small cysts on the outer edge.

Adolescent:
In this study adolescent means the girls between the age group of 14 to 18 years.

Hypothesis:
H1: there will be significant difference in the pre-test and post-test knowledge regarding
PCOS among girls.
H2: there will be significant association between the pre-test knowledge score and their
selected socio-demographic variable of adolescent girls.

Conceptual framework:
The Conceptual framework is a theoretical approach to the study of problem that is
scientifically based and which lay emphasis on the solution.
The very brief time frame in which research must be conducted to know about the knowledge
of adolescent girls regarding polycystic ovarian syndrome and provide structural teaching
programme to increase their knowledge in selected government school of Lucknow UP.
The present study aims to aware the adolescent girls regarding polycystic ovarian syndrome
and how it can be prevented.
Health belief model:

History
The Health Belief Model was first developed in the 1950s by Social Psychologists
Hochbaum, Rosenstock and Kegels working in US Public Health Services who wanted to
explain why so few people were participating in programs to prevent and detect diseases.
The model was developed in response to the failure of a free Tuberculosis (TB) health
screening program.
HBM model is an approach or competence-oriented model rather than one include fear or
threat as a key concept.
In this revised model, importance of health and cues to action were deleted, definition of
health, perceived status and demographic and biological characteristics were moved and
included in a category labelled “personal factors. Three new variables, activity related affect,
commitment to a plan of action and immediate competing demands and preferences were
added to the model.
HBM is a value-expectancy theory.

Based on these assumptions:

People desire to avoid illness or get well
People believe that a specific health action that is available to him or her will prevent illness.
Feels that a negative health condition can be avoided.
Initial development based on probability- People who believed they were susceptible and
believed in the benefits of early detection were much more likely to be screened for TB.

COMPONENTS OF HBM

Perceived susceptibility: How likely do you think you are to have this health issue?
Perceived seriousness: How serious a problem does you believe this health issue is?
Perceived Benefits: how well does the recommended behaviour reduce the risk (s) associated
with this health issues?
Perceived barriers: what are the potential negative aspects of doing this recommended
behaviour?

ADDITIONAL COMPONENTS OF HBM

Cues to action: factors which cause you to change or want to change.
Self –efficacy: one’s” conviction that one can successfully execute the behaviour required to
produce the outcomes “. (Bandura’s, 1977).

APPLICATION OF HBM
Health behaviours and subject populations.
Preventive health behavior, which include health promoting and health risk behaviours.
Sick role behaviour, which refers to compliance with recommended medical regimens ,
usually following professional diagnosis of illness .
Clinical uses, which includes physician visits for a variety of reasons.

LIMITATION
• It does not account for environment or economic factors that may prohibit or promote
the recommended action.
• It assumes that everyone has access to equal amounts of information on the illness or
disease.
• It assumes that cues to action are widely prevalent in encouraging people to act and
that “health” actions are the main goal in the decision-making process.

The model addresses the relationship between a person’s belief and behaviour. It provides
away of understanding and predicting how client will behave in relation to their health. The
model describes about three variables
1. Individual perception
2. Modifying factors
3. Likely hood of action

Individual Perception
View of susceptibility to disease and seriousness of disease combine to form her perceived
threat to illness.
The present study is done among adolescent girls of selected government school of Lucknow
U. P.
Perceived susceptibility towards knowledge regarding Polycystic ovarian syndrome.
Demographic Variables are age of puberty, area of living, age of menarche, number of days
of menstrual cycle, any family history of PCOS, dietary pattern, source of information.
Modifying Factors
Modifying factors include demographic variables such as Age of puberty, area of living, age
of menarche, number of days of menstrual cycle, any family history of PCOS, dietary pattern,
source of information. Present study is done among adolescent girls of selected government
school of Lucknow U.P.

Modifying factors
Demographic variable which can modify is dietary pattern
Perceived seriousness is lack of knowledge regarding polycystic ovarian syndrome.

Likelihood of action
In the study we assess the knowledge of adolescent girls regarding PCOS such as what is
PCOS, it's cause, early symptoms and how it can be prevented and provide structural
teaching programme on PCOS.
Perceived benefits are increased awareness.
 CHAPTER – 2
REVIEW OF LITERATURE

Review of literature is an account of what is already known about a particular phenomenon.

A literature reviews is an account of the previous effort and achievement of scholars and
researchers on a phenomenon.it is one of most important step of research process. Literature
reviews are secondary sources, and do not report new or original experimental work.
This chapter includes the reviews of selected research that are directly or indirectly relevant
to present study.
The reviews of literature for the present study was organised under the following heading-
• Studies related to effectiveness of structured teaching programme
• Studies related to knowledge regarding pcos

Studies related to effectiveness of structured teaching programme

1. Sawmya M.A. and philomena fernandes (2013) conducted a study to assess the
effectiveness of structured teaching programme on knowledge of pcos among
adolescents’ girls. The study design adopted was pre- experimental one group and
post test design. A significant difference between pre test and post was found. the
study findings showed that the structured teaching programme was effective in
improving the knowledge of adolescent girls regarding pcos. There was no significant
association between the level of knowledge and demographic variables except the
group in they study.

2. Dr. Sukanya( et al 2019) conducted a study on effectiveness of structure teaching

programme on knowledge regarding boosting fertility in women with PCOS in
selected hospital Anekal.The aim of the study was to assess the existing knowledge
regarding boosting fertility in women with PCOS.30 participant were selected
through non probability purposive sampling technique and data was obtained
through structured interview schedule. The result shows over all mean percentage
score in the pre-test and post-test were 50.2%& 83.2% respectively.

3. Khushbu patel (2017) conduced a study at Ahmedabad city to assess the

effectiveness of planned teaching programme on pcos in terms of knowledge and
attitude among adolescents’ girls, with the objective of to assess knowledge of
adolescent girls before and after planned teaching programme in selected higher
secondary school. Researcher used quantitative research approach with pre
experimental research design, and selected sample size if 60 aged between 16 – 18
years. Tool used for the study is structured knowledge questionnaire and summated
 Likert’s attitude scale. The result found to be 76.67% having inadequate knowledge
in pre test and 48.33% having moderate knowledge in post-test. Attitude level of
adolescent girls in pre and post test are 80% and 55% of unfavourable and
favourable attitude respectively.

4. Sheelamma M.A (et al 2017) conducted a study on effectiveness of structure

teaching programme on knowledge regarding polycystic ovarian syndrome among
nursing students. The purpose of the study was to increase awareness among
women so as to avoid major cases of fertility problems in the future. 100 participants
were selected through simple random sampling and data was obtained through
questionnaire. The result shows that in pre- test 33.3%subjects were having poor
knowledge, 56.6% were having average knowledge ,and only 10 % having good
knowledge whereas post- test score was 53.3% showed good knowledge ,46.6%
showed average knowledge and none showed poor knowledge.

5. Pramila D’Sauza(2013) conducted the study to assess the effectiveness of planned

teaching programme on PCOS among adolescent girls in selected high schools at
Mangalore. The main objectives of the study were to assess the pre-test and post-
test level of knowledge regarding PCOs among adolescent girls in selected high
schools at Mangalore and to evaluate the effectiveness of planned teaching
programme on knowledge regarding PCOS among adolescent girls selected by
convenience sampling technique. The mean post test knowledge score(X2=21.74) is
higher than the mean pre-test knowledge score(X1=11.86). The result showed, the
significant difference between the mean pre-test and post- test knowledge
(t99=7.02, p<0.05). There was no association between the pre-test knowledge score
and selected demographic variables.

6. Rawat. S (et al 2017) conducted a study on structure teaching programme on knowledge

about polycystic ovarian syndrome among adolescent girls. The purpose of the study was to
create awareness regarding PCOS among adolescent girls to recognize the early sign of
PCOS.94 participants were selected through convenient sampling technique and data was
obtained through structural knowledge questionnaire regarding PCOS. The mean post-test
knowledge score (22.55± 3.57) was higher than that of mean pre-test mean knowledge score
(11.13± 3.32) and the mean difference was11.42. The ‘t’ calculated value was 23.45 which is
higher than the tabulated value of 1.98 (df 93 at p< 0.05)

7. K Deeksha (et.al 2017) conducted a study on effectiveness of structured teaching

programme on polycystic ovarian syndrome in terms of knowledge and attitude among
nursing students of Shimla nursing college, Annandale, Shimla. The main purpose of the
study was to implement the strategies for reducing the prevalence rate of polycystic ovarian
syndrome in adolescent girls and in women who are in child bearing age. 50 nursing
 students were selected by purposive sampling technique and data was obtained through
structured questionnaire. The result of study shows that the pre-test mean knowledge score
of control group is 7.84 and post-test is 8.28 and pre-test mean knowledge score of
experimental group is 7.44 and post-test is 12.6, whereas the mean pre-test attitude score
of control group is 29.84 and post-test is 35 and pre-test mean score of attitude in
experimental group is 30.48 and post-test is 32.72. ‘t’ test value of control group is 1.17 and
of experimental group is 5.002 which is considered to be significant of knowledge. Whereas’
test value of control group is 0.62 and of experimental group is 2.98 which is considered to
be significant of attitude.

8. Hadayat A. (et al 2014) conducted a study on Implementation and Evaluation of

Effectiveness of Educating Program for Upgrading Nurses’ Knowledge Regarding Polycystic
Ovaries Syndrome. The main purpose of the study was to implementation and evaluation of
effectiveness of educating program for upgrading nurses' knowledge regarding PCOS at
maternity clinics of all medical health centres in Port Said City. 50 nurses were selected and
data was selected through semi structured questionnaire. The result shows that the nurses
lack of knowledge about PCOS and there is a statistically significant difference in the mean of
pre- test and post - test scores (P= < 0.001). There was no significant association between
level of knowledge and socio-demographic variables.

9. Williams Sheela, j. huissan, k. m. Saraswathi (2017) conducted a study to assess the

effectiveness of structured teaching programme on knowledge regarding polycystic ovarian
disease among adolescent girls in selected college of Mysore. The study had the objective to
assess the effectiveness of STP on knowledge regarding PCOS among adolescent girls and to
find out the association between pre test knowledge of adolescent girls regarding PCOS with
the selected demographic variable. Data was collected using structured questionnaire. The
result revel significant difference between the pre test and post test score which was
statistically tested using paired T test & mean post test score was 2.5 with standard
deviation.

Studies related to prevalence rate of PCOS

10. B. Sunanda, Nayak Sabitha (2016) study to assess the knowledge regarding PCOS among
Nursing student at NUINS, the study was conducted to assess the knowledge on the PCOS
among the student nurse, the data was collected from nursing student by using structured
questionnaire. Descriptive survey approach and descriptive design was adopted in study and
sample size was 150 . Result of the study was most of the student (85%) were in the age
group of 21-25 years and most of the student were Christian (73%) the level of knowledge of
the student was assessed through frequency and percentage which depict the most of the
student (114) had average knowledge. Conclusion Nurse should be aware of the various
organisation which render support counselling for adolescent should be included in
curriculum.

11. Desai N.A., Tiwari R.Y,Patel S.S(3 July ,2018) conducted a study on the prevalence of
polycystic ovary syndrome and its associated risk factor among adolescent girls in
 Ahmedabad region. The aim of the study was to determine prevalence and its association
with risk factor among subjects. This is cross sectional multicentric prospective study
including 963 population size from 5 rural and urban school of Ahmedabad. A total of 881
girls were screened & 119 girls (13.54%) were found to have PCOS as defined by Rotterdam
criteria. The highest prevalence of PCOS found at age of 17 (30.35%). Thus, PCOS is an
emerging disorder associated with many health consequences.

12. Nidhi ram, et al (may 20, 2011) conducted a study on the prevalence of PCOS among Indian
adolescents. The objective was to find prevalence of PCOS among adolescent girls. Simple of
460 girls aged between 15 to 18 years from residential college Andra Pradesh, out of which
72 girls with oligomenorrhea evaluated for PCOS by Rotterdam criteria. Result showed that
6.30% had oligomenorrhea with polycystic ovaries and 42 girls (9.13%) had satisfied
Rotterdam criteria for PCOS. hence prevalence rate of PCOS is 9.13%.

13. Choudhary Anjali et al (sept 16, 2017) conducted a study on prevalence and
symptomatology of the polycystic ovarian syndrome in India. the objectives were to study
prevalence and symptomatology of PCOS in urban young women of Uttarakhand. It is a
population based cross sectional survey of 170 women, all were subjected to detailed
history and examination by NIH criteria. Result showed that the prevalence of PCOS was
41%. PCOS is rising in young women & to some extent of changing lifestyle. There is a
increase in the incidences of obesity, diabetes mellitus, metabolic syndrome and insulin
resistance is contributing to PCOS.
 CHAPTER – 3
METHODOLOGY

The methodology of research indicates the systemic, theoretical analysis of the methods
applied to the field of study.it comprises the theoretical analysis of the body of methods and
principles associated with the branch of knowledge.
This chapter deals with the brief description of methodology adopted to assess the
effectiveness of structured teaching programme on knowledge regarding polycystic ovarian
syndrome among adolescent girls.
The content included in this chapter are research approach, research design, variables,
research setting, sample size, sample technique, criteria for sample selection, data collection
of tool and content validation and reliability.

Research approach:
It is a plan and procedure that consists of the steps of broad assumptions to detailed method
of data collection, analysis and interpretation.
Definition:
Research approach involves the description of the plan to investigate the phenomenon under
study in a structured, unstructured or a combination of these two methods.
The research approach which is used for our study is quantitative research approach.

Research design:
Research design is a blueprint that researcher select to carry out their research study.
Definition:
Research design is the master plan specifying the methods and procedures for collecting and
analysing the needed information in a research study.
The Research designs which is selected for the present study is pre- experimental research
design

Variables:
Variables are the qualities, properties, things or situations that vary.

Demographic variables:
 The demographic variables used in research study were age, gender, educational status,
religion, social class, marital status, occupations, income, other medical diagnosis.

Research setting:
The research setting is the location where the research take place.
For present research study we choose the government school of lucknow as a research
setting.

Sample size:
The sample size is the number of subjects which is included in the data collection.
Sample size of the study is 55.

Sample technique:
The sampling technique is the name or other identification of the specific process by which
the entities of the sample have been selected.
Here we use non – probability sampling technique for this research study.

Criteria for sample selection:

Inclusive criteria

✓ Adolescent girls who are aged between (14-18 year)

✓ Adolescent girls who are present at the time of data collection
✓ Adolescent girls who can read and write English and Hindi
Exclusion criteria

✓ Adolescent girls who are not present at the time of data collection
✓ Adolescent girls who are less than 14yrs of age

Data collection tool:

data collection tool are the devices or instruments that are used to collect data, such as a paper
questionnaire computer assisted interviewing system, case studies, checklist etc. The validity
and reliability of data collection instrument is important to yield high quality data.

The present study aimed to assess the awareness of polycystic ovarian syndrome and its
prevention with a view to develop structured questionnaire.
Description of self- structured questionnaire:
Assessment of effectiveness of structured teaching programme regarding awareness of pcos

Section A: demographic variables

It consists of 7 items, current age, locality, age of menarche, diet, menstrual cycle, family
history, source of information.

Section B: awareness questionnaire

The tool consists of 30 questions

Content validity of the tool: for content validation of tool structured questionnaire is prepared.
The structured questionnaire is prepared on two basis:
• Questions for demographic variables: 7 questions
• Questions for knowledge assessment: 30 questions

The self -structured questionnaire was sent with request to the 5 experts from the field of
obstetric and gynecological nursing to check the questionnaire for relevancy, clarity,
appropriateness of the tittle and content area. The experts chosen from best in their clinical
expertise. The experts were requested to give their opinion and verify the questionnaire and
suggested modifications by the experts will be done after the discussion with the guide.