Research presentation for RDC. Phd nursing

Its a research presentation

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 to 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. Perimenopause can begin eight to 10 years before menopause when your ovaries gradually produce less estrogen. It usually starts when you’re in your 40s. Perimenopause lasts up until menopause, the point when your ovaries stop releasing eggs. In the last one to two years of perimenopause , the drop in estrogen accelerates. At this stage, many women may experience menopause symptoms. But, women still having menstrual cycles during this time and can get pregnant.

6. Need for the study Perimenopause and menopause have affected approximately one billion women worldwide. The number of women aged 45 and older in the United Kingdom is on an increasing upward trajectory. It is estimated that there are currently in the region of 13 million perimenopausal or menopausal women in the United Kingdom, equating to around one-third of the entire female population.

7. Menopause transition or perimenopause begins on an average 4 years before the FMP and is characterized by irregular menstrual cycles, endocrine changes, and symptoms such as hot flashes that may affect a woman’s quality of life (QOL). It may be considered as a biological marker for chronic disease. The biology and symptomatology of menopause are blurred due to its relationship to the underlying aging process. Long-term effects on bone and heart have been related to estrogen deficiency. It is the term coined by the Stages of Reproductive Ageing Workshop (STRAW) group, and during this period, disturbed menstrual cycle and endocrine changes are observed. Anklesaria’s staging of menopause has been adopted by the Indian Menopause Society (IMS) after modification.

8. 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 .

9. 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.

10. 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.

11. 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 Dehradun .”

12. 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 evaluate the effectiveness of Nurse Led Program regarding menopause transition & it’s symptoms among perimenopausal women. `

13. OPERATIONAL DEFINITION 1. Assess: - 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. 2. Nurse Led Program: - In this study Nurse Led Program refers to the intervention (Health Education, Yoga, Deep Breathing Exercise, Self-made Video for menopause transition & it’s Symptoms & One Structured Hobby Club ( Ludo play, Dancing, 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. 3. 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 structured knowledge questionnaire .

14. 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:- The years leading up to that point, when women may have changes in their monthly cycles, hot flashes, or other symptoms, are called the menopausal transition or perimenopause . 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.

15. 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.

16. 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 impact of Nurse led Program on knowledge and quality of life regarding menopausal transition & it’s symptoms among perimenopausal women.

17. 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 impact of Nurse led Program on knowledge and quality of life regarding menopausal transition & it’s symptoms among perimenopausal women.

18. 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.

19.   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.

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

21. 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.

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

23. Methodology

24. 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.

25. 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 Checklist INTERPITATION DATA ANALYSIS Thematic Statistical Analysis DATA ANALYSIS

26. 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 & Thematic Analysis Qualitative Research Design

27. 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.

28. 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.

29. EXCLUSION CRITERIA Women already treated with Hysterectomy. Women already had Gynecological problem. 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.

30. 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

31. 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 50 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.

32. 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.

33. 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.

34. Tools:- Related to Quality of life

35. 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

36. 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 and will prepare Thematic analysis with tools.

37. ETHICAL CLEARENCE Ethical clearance can be obtained from the RDC, Swami Vivekanand Subharti University. Information will be collected from the samples after obtaining the informed consent.

38. CONSENT FORM SEEKING PARTICIPATION IN THE STUDY   I understand that I have asked participate in the study conducted by PhD in Nursing student of Subharti Nursing College, Swami Vivekananda Subharti University as a requirement for partial fulfilled of PhD in Nursing degree. The study topic is “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.” I am aware that fill the self- structured knowledge questionnaire and structured Quality of life Checklist at selected rural women and this will take 40-50 minutes. I understand that the study aims to assess the knowledge and quality of life regarding menopausal transition and its symptoms among women residing in selected rural community at Dehradun. The self-structured questionnaire and Structured Checklist method is entirely voluntary which means it allows you to refuse to oneself any specific question or reject the structured questionnaire form at any point. The responses will be used for the research purpose only. The successful completion of the study largely depends on your active co-operation and in this regard will be highly appreciated.   Signature of the participant Date:

39. 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

40. REFERENCES INTERNET https://www.acog.org/womens-health/experts-and-stories/the-latest/my-periodshave-changed-is-menopause-around-the-corner https://medlineplus.gov/ency/article/004016.htm https://my.clevelandclinic.org/health/diseases/21841-menopause https://www.nia.nih.gov/health/whatmenopause#:~:text=Menopause%20is%20a%20point%20in,between%20ages%204 5%20and%2055. https://www.mountsinai.org/health-library/report/menopause https://www.who.int/news-room/factsheets/detail/menopause#:~:text=changes%20in%20the%20regularity%20and,depre ssion%2C%20and%2For%20anxiety.

41. Journals-: 7. Greenblum CA, Rowe MA, Neff DF, et al. Midlife women: symptoms associated with menopausal transition and early postmenopause and quality of life. Menopause 2013; 20:22–27. [PubMed] [Google Scholar] 8. Arwinder Kaur, Sushma Kumari Saini, Amarjeet Singh Prevalence of Menopausal symptoms among peri- Menopasual women in Suburban area of Chandigarh, India. Volume - 9, Issue - 1, Year - 2021, DOI: 10.5958/2454- 2660.2021.00017.X International Journal of Nursing Education and Research. 9. Hoga L, Rodolpho J, Gonçalves B, et al. Women’s experience of menopause: a systematic review of qualitative evidence. JBI Database System Rev Implement Rep 2015; 13(8): 250–337. 10. National Institute for Health Care Excellence (NICE). Menopause: diagnosis and management [Internet]. NICE, 2015, https://www.nice.org.uk/guidance/ng23 11. Local Government Association. Menopause factfile , 2021, https://www.local.gov.uk/our-support/workforce-and-hr support/wellbeing/menopause/menopause- factfile 12. World Health Organization (WHO). Research on the menopause in the 1990s: report of a WHO scientific group. World Health Organ Tech Rep Ser 1996; 866: 1–107. 13. Santoro N. Perimenopause: from research to practice. J Womens Health ( Larchmt ) 2016; 25(4): 332–339

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