“A evaluative study (if impact to be notified) to assess the

Knowledge & Quality of life regarding perimenopausal symptoms

among selected women of 35-45 age and the impact of
behavioural changes after the BCC (Behaviour change
communication) session in rural and urban community, at
Dehradun.”
Ph.D. NURSING PROBLEM STATEMENT

PANNA DHAI MAA SUBHARTI NURSING COLLEGE

SWAMI VIVEKANANDA SUBHARTI UNIVERSITY,
MEERUT
BY
MS. SHAILA PANCHAL
Ph.D NURSING
DEPARTMENT OF COMMUNITY HEALTH NURSING
 PANNA DHAI MAA SUBHARTI NURSING COLLEGE,
SUBHARTI UNIVERSITY MEERUT, UTTAR PRADESH
REGISTRATION OF SUBJECT FOR DISSERTATION

NAME OF THE CANDIDATE AND MS. SHAILA PANCHAL

ADDRESS Ph.D NURSING
PANNA DHAI MAA SUBHARTI
NURSING COLLEGE,
SUBHARTI PURAM, MEERUT

NAME AND ADDRESS OF THE 1. Guide-: Dr. Rahul Bansal

GUIDE & Co-GUIDE (Subharti Medical College Meerut)

2. Co-Guide-: Dr. Geeta

Parwandha
(Panna Dhai Maa Subharti Nursing
College, Subharti Puram, Meerut)

PANNA DHAI MAA SUBHARTI

NAME OF THE INSTITUTION NURSING COLLEGE,
SUBHARTI PURAM, MEERUT

COURSE OF STUDY AND Ph.D NURSING

SUBJECT COMMUNITY HEALTH NURSING

DATE OF ADMISSION TO THE

COURSE

TITLE OF THE TOPIC

“A evaluative study (if impact to be notified) to assess the Knowledge
& Practice regarding perimenopausal symptoms among selected
women of 35-45 age and the impact of behavioural changes after the
BCC (Behaviour change communication) session in rural and urban
community, at Dehradun.”
 BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

“Changing women’s health-naturally”

Aging is a fact of life and it is a normal process of having brittle bones,

sagging skin and degenerating body functions. In aging women, they may
experience a popularly known condition called menopause. This is
characterized by changes that occur in a woman’s life before and her
menstruation ends signalling her infertility years.

Menopause starts gradually and usually signalled by changes in

menstruation. The specific symptoms women experience may varies from
woman to woman. In some women, menstrual flow comes to a sudden halt. The
monthly flow may increase, decrease, become irregular and finally cease. Often
interval between period is longer; a lapse of several months between period is
not uncommon.

Perimenopausal symptoms affect about 70% of women approaching

menopause. Typical menopause symptoms, such as hot flashes or night sweats,
are caused by changing hormonal levels in the female reproductive system.
Almost all women notice early symptoms while still having periods. This stage
of gradually falling and fluctuating hormone levels is called perimenopause,
which often begins in the early40s.

The symptoms of menopause usually last for the whole menopause

transition (until the mid 50s), but some women may experience them for the rest
of their lives. The most common symptoms are: hot flashes, night sweats,
irregular periods, loss of libido, and vaginal, depression, anxiety, irritability,
panic disorder, joint pain, burning tongue, digestive problems ,muscle tension,
tingling extremities and osteoporosis.

Approximately 10% of the women have no symptoms of menopausal

other than cessation of menstruation,70% to 80% are aware of other changes but
have no problems and approximately 10% experiences changed severe enough
to interfere with activities of daily living.

NEED FOR STUDY

Healthy women during their reproductive period will menstruates cyclically and
regularly with normal flow and duration of bleeding. As the age approaches the women
notices changes in the menstrual cycle, such as changes in the frequency, duration and flow
of bleeding. These irregularities in the menstrual cycle signal the onset of menopause in the
midlife women. The onset of menopause denotes the gradual decline of fertile period in the
women. The onset natural menopause is signed by the changes in hormonal levels mainly
depletion in the oestrogen.

The prevalence of menopausal symptom varies in geographical region and ethnicity

of the population. Only limited studies are conducted among Asian women to analyse the
severity of premenopausal symptoms. According to The Study of women’s health Across
Nation (SWAN), studies report shows that Japanese and Chinese women manifested less
symptoms than Caucasian women.

According to various studies conducted in various parts of the world, among the
incidence of premenopausal symptoms, most commonly seen are hot flushes, menstrual
irregularity, fatigue, vaginal dryness, urinary incontinence, mood disturbances, depression
and anxiety. Among which most commonly occurring and hindering the daily life of women
are hot flushes (55.80%) and depression (37.30%).

In a study conducted in a selected urban community in India by Sudha Sharma has

found that with age advances the nature and prevalence of premenopausal Symptoms also
varies. The vasomotor symptoms (35%) and psychological disturbances (38%) increases with
increase in age. The occurrence in frequency and severity of symptoms varies among
individuals, population and different cultures of the world. The symptoms of menopause
varies with biological change, psychological factors, socio cultural factors and environmental
influences. According to various studies conducted to measure quality of life of Aged
Women from different socio cultural background reveals that perception of quality and
menopause status influences the quality of life.

REVIEW OF LITERATURE

Omaima M., et al. 2013, A descriptive study was conducted with descriptive
research design that included 200 married women randomly selected from Faculties of Ain
Shams University in Egypt. An interviewing questionnaire was used to collect data based on
literature review. Main finding 81% and 79% of premenopausal women had physical and
social health complaints, while 74% and 71% of them had sexual and psychological
complaints respectively.

Jennifer Whiteley., et al. (2012) A cross-sectional study that included 8,811women

40– 64 years from USA. Data from the 2005 United States National Health and Wellness
Survey were used. Finding reveals that women experiencing menopausal symptoms reported
significantly lower levels of HRQOL and significantly higher work impairment, and
healthcare utilization than women without menopausal symptoms, depression, anxiety, and
joint stiffness were symptoms with the strongest associations with health outcomes.

Jansirani Natarajan., et al. (2013), A literature review that included 15 studies

published between 2007 and 2013 conducted in 13 different countries. MRS (Modified
Menopausal Symptom), MENQOL (Menopausal quality of life), WHOQOL (World health
organization quality of life), and Self-reported menopausal symptom questionnaire has also
been used. Result of the study It is evident that there is great diversity in symptom
frequencies across the cultures and ways of coping adopted by these women. Based on these
values, the healthcare professionals can use different approaches to educate and treat women
with menopausal symptoms and concerns that are culturally relevant.

Nabarun Karmakar., et al. (2017) Descriptive cross-sectional study 100 peri and
postmenopausal women (40–60 years) in Dearah village of West Bengal, India during
February–March 2014. The Menopause-Specific Quality of Life Questionnaire MENQOL.
Result reveals that Occurrence of vasomotor symptoms was average with 60% of them
reporting hot flushes and 47% sweating. Most prevalent psychosocial symptoms reported
were feeling of anxiety and nervousness (94%) and overall depression (88%). Physical
symptoms were quite varying in occurrence with some symptoms such as feeling tired 49%
reported of avoiding intimacy with a partner and 26% complained of vaginal dryness.
 Miranda Hajdini., et al. (2017), The study was conducted in Tirana and some rural
areas around in 2016. Sample included 1207 women aged 45-64 years old and for data
collection we used a self administered questionnaire. As all around the world, in Albania
women report various symptoms that can influence the quality of life, but with a lower
prevalence. The most frequently reported symptoms include forgetfulness (26.3%), hot
flushes (25.9%), frequent headaches (23.3%), aching joints (21.6%) and stomach bloating
(21.0%).

STATEMENT OF THE PROBLEM

“A evaluative study (if impact to be notified) to assess the Knowledge & Practice regarding
perimenopausal symptoms among selected women of 35-45 age and the impact of
behavioural changes after the BCC (Behaviour change communication) session in rural and
urban community, at Dehradun.”

OBJECTIVES

 To assess and evaluate the knowledge & practice regarding perimenopausal

symptoms and its management among rural and urban women before and after the
administration of BCC (Behaviour change communication) session.

 To compare the effectiveness of BCC session regarding perimenopausal symptoms

and its management among rural and urban women.

 To find out the relationship of post test level of knowledge with post test level of
practice among rural and urban women.

 To find out the association between the level of knowledge and practice with
demographic variables.

OPERATIONAL DEFINITION

1. Evaluate: - It refers to determining the effectiveness of BCC Package and it is

measured in terms of significant gain in the post test knowledge score.
2. BCC Package : In this study BCC Package refers to the intervention which is used
to provide including Yoga, meditation & pranayam knowledge about
perimenopausal symptoms and its management.
 3. Knowledge: It refers to the appropriate response by the Women on knowledge
regarding perimenopausal symptoms and its management before and after
intervention as measured by structured knowledge & Practice questionnaire.
4. Perimenopausal symptoms:- The physical and psychological changes in women
such as hot flushes, menstrual irregularity, weight gain, palpitation, urinary
incontinence, vaginal dryness, fatigue, anxiety, mood swings, depression and panic
disorders experienced by the women in the period just before the menopause.
5. Management:- The measures available and applicable to overcome the difficulties
during the menopausal period.
6. Aged Women:- The women refers to females aged between 35-45 years.
7. Rural Community:- A rural community or a countryside is a geographic
community that is located outside towns and cities.
8. Urban Community:- An urban community is the region surrounding a city.

RESEARCH HYPOTHESIS

The hypothesis mentioned below will be tested at 0.05 level of significance

 H0-: There will be no significant difference between the knowledge & Practice of
rural and urban women regarding perimenopausal symptoms and its management
before and after BCC session.
 H1:-There will be significant difference between the knowledge & Practice of rural
and urban women regarding perimenopausal symptoms and its management before
and after BCC session.

ASSUMPTIONS

The study will be based on the following assumptions:

 Women may have inadequate knowledge & practice regarding perimenopausal
symptoms and its management.
 Urban mothers may have better knowledge & practice regarding premenopausal
symptoms and its management.
 Women may gain knowledge about perimenopausal symptoms and its management
from BCC (Behaviour change communication) session which will prepare to educate
them.

DELIMITATIONS

 The subjects are limited to those women aged between 35-45 years.
  The sample size was limited to only 200 women from rural community and 200
women from urban community so that the findings cannot be generalized.

PILOT STUDY

It is planned to be conducted in the selected urban and rural community at Dehradun

and the sample size will be 1/4th of the main study.

VARIABLES UNDER STUDY

 Independent variable: - In this study the BCC (Behaviour Change Communication)

session regarding Perimenopausal women is the independent variable. Age, religion,
education, occupation, marital status, family income, type of family, source of
information, dietary pattern are other independent variables.
 Dependent variable: - Knowledge and Practice are the dependent variable under in
this study.

MATERIALS AND METHODS

Source of data-
1. Primary source of data-
The knowledge & practice regarding premenopausal symptoms and its management
among women of urban and rural with the help of structured knowledge questionnaire.

Research Approach
In the view of accomplishing the objectives and developing a BCC (Behavioural
changes communication) session for improving the knowledge & practice regarding
perimenopausal symptoms and its management among women of urban and rural women a
quantitative evaluative research approach is considered to be the most appropriate.

Research Design
To assess the validity of the BCC (Behavioural changes communication) session and
to evaluate the knowledge & practice of perimenopausal symptoms and its management,
Experimental - Pre-test Post-test Research Design was adopted for the study.

Setting of The Study

The study will be conducted in selected urban and rural community, at Dehradun.

Population
The population included in the study are 35-45 year women of urban and rural community at
Dehradun.

Sampling Techniques
Random Sampling Technique will be used for collecting the sample, who are
fulfilling the inclusion criteria.

Sample Size
Sample size included in the study will be 200 Rural women & 200 Urban women.

CRITERIA FOR SAMPLE SELECTION

Inclusion Criteria
Aged women in the selected urban and rural community

1. Who can read, write and speaks Hindi.

2. Women those who are available in the selected urban and rural community during
study.

Exclusion Criteria

1. Women those who are not willing to participate in the study

Tools and methods of data collection

It includes a structured questionnaire of Perimenopausal to evaluate the knowledge &
Practice of women in selected rural & urban community area at Dehradun.

 Tool-1:- Demographic variables of the samples.

It includes Age, religion, education, occupation, marital status, family income, type of
family, source of information, dietary pattern.

 Tool-2:-
 Structured questionnaire of Perimenopausal prepared by the researcher on the basis of
the information collected about the perimenopausal symptoms and its management.

PLAN FOR DATA ANALYSIS

Collected data will be organized, tabulated and analyzed by descriptive statistics
(Mean, SD, %) and inferential statistics (paired T test, co-efficient correlations
and chi square test) for assessing the effectiveness of teaching package on the
knowledge regarding premenopausal symptoms and its management. among
urban and rural community.

ETHICAL CLEARENCE
1. Ethical clearance can be obtained from the community, Dehradun.

2. Information will be collected from the samples after obtaining the informed
consent.

REFERENCES:
1. Goolsby, “Postmenopausal hormones and incontinence”, Journal of American
Medical Association, 97(1), 116-120.

2. Ginsberg J et al, “The management of Menopause”, The Millenium Review, 2000,

59-68.

3. Nachtigall L E, Nachtigall m J, “Menopausal changes and Quality of life and

Hormone therapy”, Clinical obstetrics and gynecology, 2004, 47(2), Page no. 485-
488.

4. Utian W, Bogys P, “Menopause and midlife”, Menopause, 6, Page no. 122-128.

5. B Jayabharathi, “Perception of physical and psychological symptoms of

Perimenopause, 2011 september 7(8), Page no. 15-17.

6. Omaima M., et al. “Menopausal Transition and Its Effect on Women’s Health”.
American Journal of Science 9.1 (2013): 369-379.
7. Miranda Hajdini Vanesa Osmani. “Prevalence of symptoms and attitudes towards
menopause in midlife female population in Albania”. International Journal of
Ecosystems and Ecology Science (IJEES) 7.3 (2017): 613-618.
8. Jansirani Natarajan., et al. “Review Literature on Distress during the Menopausal
Transition and Their Impact on the Quality Of Life of Women: What is The
Evidence”? IOSR Journal of Nursing and Health Science (IOSR-JNHS) 2.4 (2013):
01-10.
9. Aida Al Dughaither., et al. “Menopausal symptoms and quality of life among Saudi
women visiting primary care clinics in Riyadh, Saudi Arabia”. International Journal
of Women’s Health 7 (2015): 645-653.
 10. Nabarun Karmakar., et al. “Quality of life among menopausal women: A community-
based study in a rural area of West Bengal”. Journal of Mid-Life Health 8.1 (2017):
21-27.

WEBSITES:-
 www,Menopause.org
 www.healthorchid.com
 www.pubmedcentral.nih.gov
 www.boimed central.com
 www.hglo.com
 www.menopause-metamorphosis.com
 www.health.indiatimes.com

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23.
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24. https://www.nia.nih.gov/health/what-menopause

25. https://www.webmd.com/menopause/features/menopause-age-
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