Research DRC PPT for PhD in community health nursing

DRC stands for Departmental Research Committee, which is a committee in a university department that monitors research activity

1. Guided by Co-Guided by Dr. Bhawana Pant Dr. Geeta Parwandha Community Medicine Community Health Nursing Neta Ji Subhash Chandra Bose Panna Dhai Maa Subharti Subharti Medical College, Meerut Nursing College Meerut Presented By Ms. Shaila Panchal PhD Scholar Community Health Nursing Department Subharti University, Meerut Research Presentation

2. TITLE of the study “ A Study To Assess The Impact of Nurse Led Program in Term of Knowledge & Quality of Life Regarding Menopause Transition & it’s Symptoms Among Women Residing in Selected Rural Community, At Dehradun .”

3. A change in your periods is often the first sign of perimenopause, but there are other signs to look out for. Dr. Esther Eisenberg

4. INTRODUCTION “Changing women’s health-naturally” According to (WHO) Most women experience menopause between the ages of 45 and 55 years as a natural part of biological ageing. The menopausal transition can be gradual, usually beginning with changes in the menstrual cycle . ‘Perimenopause’ refers to the period from when these signs are first observed and ends one year after the final menstrual period. Perimenopause can last several years and can affect physical, emotional, mental and social well-being. A variety of non-hormonal and hormonal interventions can help alleviate perimenopausal symptoms.

5. Need for the study Sudha Sharma (2012) conducted a study in a selected urban community in India 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 vary 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.

6. Meenakshi kalhan et.al. (2020) conducted a community based cross-sectional study in 400 middle aged women (40–60 years) by random sampling technique. The menopause rating scale was used to assess the prevalence of menopausal symptoms and the QOL and data were collected for sociodemographic factors, relevant menstrual history and other variables. Prevalence of menopausal symptoms was found to be 87.7%. Majority of the study subjects had anxiety (80%), followed by physical and mental exhaustion (71.5%), sleep problem (61.2%), irritability (60.7%), Joint and muscular discomfort (56%) and heart problems (54%). The most classical symptom of menopause i.e ., hot flushes were reported in 36.7% . The mean age of menopause was 47.53 standard deviation 45 years. The QOL was impaired in 70.2% of study subjects. The psychological symptoms attributed 70.8% to the poor QOL . According to the researcher facts t o improve the QOL and to decrease the menopausal symptoms in these women, a holistic approach in the form of lifestyle and behavioral modification are required .

7. Review of the literature 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.

8. Mansi Patel, et.al. (2017) cross-sectional study was conducted among 425 middle-aged women residing in Urban Health Training Center. The menopausal status is classified according to STRAW + 10 (simplified bleeding criteria for the early and late menopausal transition) classifications. The English version of the MRS questionnaire was used as a tool for assessing menopausal symptoms . 425 women evaluated , the mean age of attaining menopause was 42 years. Menopause-related symptoms were present among 304 (71.5%) women . Majority of women suffered joint and muscular discomfort (62.6%), 47.5% had hot flushes, and physical as well as mental exhaustion. Logistic regression analysis reveals that postmenopausal women had highest prevalence of menopausal symptoms as compared to other groups. Age of attaining menopause was bit lower in present study . Availability of treatment modalities for various menopause-related symptoms requires women’s attention to improve their quality of life.

9. PROBLEM statement “A study to assess the impact of Nurse Led Program in term of knowledge & Quality of life regarding menopause transition & it’s symptoms among women residing in selected Rural Community, At Uttarakhand”

10. Objectives To assess the Knowledge regarding menopause transition & it’s symptoms among perimenopausal women residing in rural community at Dehradun. To assess the Quality of life among perimenopausal women. To determine the effectiveness of Nurse Led Program regarding menopause transition & it’s symptoms among perimenopausal women.

11. OPERATIONAL DEFINITION Evaluate: - It refers to determining the effectiveness of Nurse led program and it is measured in terms of significant knowledge gain in the post test knowledge score. Nurse Led Program: - - In this study Nurse Led Program refers to the intervention (Health Education, Yoga, Deep Breathing Exercise & One Structured Hobby Club (Ludo play, Dancing, Self-made Video, Discussion about Dietary Habit & Daily Life Activities, Knitting Sweaters, Aerobics)) which is used to provide knowledge about Menopause transition & it’s symptoms & which will improve the knowledge and quality of life of women. Knowledge: - It refers to the appropriate response by the Women on knowledge regarding Menopausal transition & it’s symptoms before and after intervention as measured by Self structured knowledge questionnaire.

12. 4. Quality of Life: - It refers to transition into menopause is related to different physical and mental changes that may affect women’s health. That the physical, psychological, social, and sexual changes in menopause have an adverse effect on women’s quality of life.  5. Menopause transition :- In this study the menopausal transition (perimenopause) is the period that links a woman’s reproductive (childbearing) years and menopause. A woman is said to be in menopause if she has had no menstrual periods for 1 year. Once in menopause, the ovaries essentially stop making hormones and women lose their ability to become pregnant. The average age for menopause is 51 years. 6. Menopause transition 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.

13. 7. Women: - The term “women” refer to Menopausal transition females aged between 45-55 years (according to WHO). 8 . Rural Community: - A rural community or a countryside is a geographic community that is located outside towns and cities.

14. RESEARCH HYPOTHESIS The hypothesis mentioned below will be tested at 0.05 level of significance. H1:- There will be significant relationship between the knowledge & quality of life of rural women regarding menopausal transition & it’s symptoms. H2-: There will be significant effect of Nurse led Program on knowledge and quality of life regarding regarding menopausal transition & it’s symptoms among perimenopausal women.

15. NULL HYPOTHESIS The null hypothesis mentioned below will be tested at 0.05 level of not significance. H01-: There will be no significant relationship between the knowledge & quality of life of rural women regarding menopausal transition & it’s symptoms. H02-: There will be no significant effect of Nurse led Program on knowledge and quality of life regarding menopausal transition & it’s symptoms among perimenopausal women.

16. ASSUMPTIONS The study will be based on the following assumptions: Women may have inadequate knowledge regarding menopausal transition & it’s symptoms. Women may gain knowledge & lifestyle changes about menopausal transition & it’s symptoms from Nurse Led Program which will prepare to educate them.

17.   DELIMITATIONS The subjects are limited to those women aged between 45-55 years. The sample size was limited to only 400 women from rural community so that findings can be generalized.

18. CONCEPTUAL FRAMEWORK Conceptual framework of the study -based on Stufflebeam’s CIPP model of program evaluation (1983)

19. RESEARCH GAP H ormone therapy and alternative treatment options provide evidence to inform updates on existing policy recommendations and coverage. To promote health and wellness during the menopausal transition and post-menopause, healthcare providers. Knowledge gaps among healthcare providers concerning menopause. Menopause-specific education, providers can easily misunderstand or dismiss menopause symptoms related to irregular menstrual cycles or heavy bleeding, mood, vaginal symptoms, and disordered sleep.

20. RESEARCH SCOPE Menopausal transition related research scope improve the knowledge of Health care providers, and do the research with psychomotor domain, vasomotor domain.

21. Methodology

22. Research Approach In the view of accomplishing the objectives and developing a nurse led awareness program for improving the knowledge & quality of life regarding menopausal transition & it’s symptoms among women of rural area an evaluative research approach is considered to be the most appropriate.

23. Systematic Presentation of Research Design Quasi experimental research design (Non- Randomized control group design) Experimental Group Control Group Pre- test Pre-test Treatment Post-test Post-test Mix Methodology Research Design QUANTITATIVE QUAILITATIVE Data Analysis By the Structured Questionnaire INTERPITATION DATA ANALYSIS Inferential Statistical Analysis DATA ANALYSIS

24. Systematic Presentation of the study Research Approach (Quantitative) Evaluative R esearch Approach Research Design Quantitative Quasi experimental Research (Non- Randomized control group design) Research Setting Rural Area at Dehradun Sampling Technique Purposive sampling technique ( Non-Probability Sampling) Population 45-55 women of rural community Sample size 400 Women of rural community Tools Tool-1 Demographic variables of the samples Tool-2 Knowledge Related Questionnaire Tool-3 Quality of Life Related Checklist Data Analysis Descriptive & inferential statistical Analysis Qualitative Research Design

25. VARIABLE UNDER STUDY Attribute variable-: The demographic variables included in the study are: age group, education, occupation, marital status, types of family, income, personal history, source of information about menopause, living with children, dietary pattern, and family history of medical illness. etc. Independent variable: - In this study the Nurse Led Program regarding Menopausal transition & it’s symptoms is the independent variable. Dependent variable: In this study Knowledge and Quality of Life levels are the dependent variable under in this study.

26. SAMPLING CRITERIA INCLUSION CRITERIA:- Women aged 45-55 years present during the time of the study. Women who are willing to participate in the study. Women who could understand and speak in Hindi language.

27. EXCLUSION CRITERIA Women already treated with Hysterectomy. Women already had Chronic Gynaecological Illness . Women with induced menopause, receiving any kind of hormone therapy, presence of medical conditions such as diabetes, hypertension, cardiac disease, and thyroid disorders. Locked houses or the women who did not give the consent were not included in the study. Women who are on the treatment of mental illness. Women who are physical disabled.

28. Sample Size Sample size included in the study will 400 Rural women. According to (Cochran’s formula) in the study will be 384 Women. S= z2x p* (1-P)/ M2 S = sample size for infinite population Z = z score (95%= 1.96) P= population proportion (assumed 50%= 0.5) M= margin of error (5% =0.05) S= (1.96)2 x 0.5 (1-0.5)/ (0.05)2 S= 3.8416x 0.25/0.0025 S=384.16

29. Pilot Study After taking the formal approval for conducting the pilot study, it was initiated to take sample in rural community at Laxmipur , Horrawala and Bharotiwala , Jamankhata villages at Dehradun. The pilot study can conduct to assess the effectiveness of criterion measures, to find out the feasibility of undertaking the study and decide on the plan of statistical analysis. It is planned to be conducted in the selected rural community at Dehradun and the sample size will be 1/4 th of the main study . 100 women from each rural community area will select respectively. Findings of the study revealed that the criterion measures i.e. knowledge and Quality of life can assess to be effective group. It was feasible to conduct the pilot study.

30. INTERVENTION FOR THE STUDY In this study Nurse Led Program refers to the intervention (Health Education, Yoga, Deep Breathing Exercise & One Structured Hobby Club (Ludo play, Dancing, Self Made Video, Discussion about Dietary Habit & Daily Life Activities, Knitting Sweaters, Aerobics)) which is used to provide knowledge about Menopause transition symptoms & which will improve the knowledge and quality of life of women.

31. Data Collection Method Section A-: consisted of items seeking information about demographic characteristics Section B-: It consist self-structured questionnaire section . These sections containing set of questions seeking knowledge of the subjects on menopausal transitions. Each item carries one mark for the correct response. Section C- : It consist Structured question checklist . These sections containing set of questions to express competency skill of Quality of life of the subjects on menopausal transitions and it’s symptoms. Each item carries one mark for the correct response.

32. Tools:- Related to Quality of life

33. Day 1 to 49 Days (7 Weeks) (Pre-Test) Days 51 to 160 Days (16 Weeks) Nurse Led Program Nurse Led Program refers to the intervention ( (Health Education, Yoga, Deep Breathing Exercise & One Structured Hobby Club (Ludo play, Dancing, Self-Made Video, Discussion about Dietary Habit & Daily Life Activities, Knitting Sweaters, Aerobics)) which is used to provide knowledge and assess the daily life activity about Menopause transition & it’s symptoms & which will improve the knowledge and quality of life of women.   Day 192 to 238 Days (7 Weeks) (Post-Test) Diagramatic Data Collection Presentation

34. PLAN FOR DATA ANALYSIS Tool 1-: Collect data and will analyse by descriptive statistics the tabulation on frequency distribution & Percentage. Tool 2- : Collect data for Knowledge and will prepare descriptive statistics and inferential statistics (Mean, Median, Standard deviation & T test, Chi square) Tool 3-: Collect data for Quality of life and will prepare descriptive statistics and inferential statistics (Mean, Median, Standard deviation & T test, Chi square)

35. ETHICAL CLEARENCE Ethical clearance can be obtained from the community, Dehradun. Information will be collected from the samples after obtaining the informed consent.

36. EXPECTED PERIODS OF CHAPTERS Sr. No. Chapters Months 1. Chapter- 1 June-August (2023) Introduction 2. Tools Prepration August-October (2023)  3. Chapter-2 September-November (2023) Review of Literature  4. Chapter-3 December-May (2023-2024) Methodology  5. Chapter-4 June-October (2024) Analysis & Interpretation of Data  6. Chapter-5 November- January (2024-2025) Discussion 7 . Chapter-6 February-April (2025)   Summary, Finding, Conclusions, Implications, Limitations and Recommendations

37. REFERENCES Goolsby, “Postmenopausal hormones and incontinence”, Journal of American Medical Association, 97(1), 116-120. Ginsberg J et al, “The management of Menopause”, The Millenium Review, 2000, 59-68. 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. Utian W, Bogys P, “Menopause and midlife”, Menopause, 6, Page no. 122-128. B Jayabharathi , “Perception of physical and psychological symptoms of Perimenopause, 2011 september 7(8), Page no. 15-17.

38. 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. 

39. 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