Indian Medical Gazette

Original Article

AUGUST 2013

287

Effectiveness of Planned Teaching Programme on Reproductive Health Among Adolescent Girls

Gouri Kumari Padhy, Associate Prof., Dept. of Community Medicine, Anasuya Pattanayak, Vice Principal Hi-Tech Medical College of Nursing. Dhaneswari Jena, Assistant Prof., Dept. of Community Medicine, MKCG Medical College.

Abstract Introduction: WHO defines adolescence as the period of life between 10-19 years. It is a period of rapid physical and biological changes, which may lead to confusion, tension, frustration, and feeling of insecurity.Adolescence is a prime time for health promotion and to encourage them to establish healthy patterns of behavior that will influence their development and health in later years. Adolescents are at high risk for nutritional morbidity. It is seen that adolescent groups have negative attitude towards balanced diet and it was found that they were not aware of nutritional requirement, personal hygiene, menstrual hygiene, etc. Feeling this need a planned teaching programme (PTP) was conducted on reproductive health education to enable an adolescent girl to develop skill, competencies and ability to deal with varied aspects of adolescence and to attain a safe motherhood in future. Objective: To assess the impact of planned teaching programme on family life education. Methodology: The study sample consisted of 144 adolescent girls of a high school in Ankuli, Berhampur. A structured questionnaire was used as a tool for data collection. Data was collected before and after planned teaching programme and it was analyzed using percentage and Wilcoxan paired sign rank test. Result: It was found that there was gain in knowledge in various aspects after conduction of PTP. Regarding nutrition the average score

increased from 39.24% to 88.85% (before and after PTP respectively). Regarding knowledge of high risk behavior the score increased from 19.44 % to 82.87%. The knowledge on Anatomy and physiology of reproduction, AIDS and STD,reproductive health and personal hygiene etc also improved significantly after PTP. Conclusion: Imparting PTP on reproductive health among adolescent girls is quite effective if done in a well organized and scientific way. Keywords reproductive health, adolescent girls Introduction WHO defines adolescence as the period of life between 10-19 years6. It is a period of rapid physical and biological changes, which may lead to confusion, tension, frustration, and feeling of insecurity. Adolescence is said to be a period of stress and strain .It is the period in which foundations can be laid for a long and healthy life. Adolescence is a prime time for health promotion and for establishment of healthy behavior that will influence health in later years. Adolescents are at high risk for nutritional morbidity. It has been seen that adolescents have negative attitude towards balanced diet and it was also found that they were not aware of nutritional requirement, personal hygiene, menstrual

Address for correspondence: Dr Gouri Kumari Padhy, Flat - 203, Subhadra Enclave, Palasuni, Bhubaneswar, Odisha - 751 025. E-mail: gouripadhy@gmail.com

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hygiene, etc. Adolescent pregnancies constitute 10-15% of total pregnancies in India. This is largely attributed to early marriage, a culture widely prevalent in the whole of the Indian sub-continent2,13. Among adolescents, girls are biologically more susceptible to sexually transmitted diseases (STDs), including HIV infection. Thus, in order to lead a healthy, responsible, fulfilling life and to have protection from reproductive health problems, adolescents need to have sound information about the physical, psychological and social changes that take place through childhood and adolescence1,11. Feeling this need, a study was conducted to assess the effectiveness of a planned teaching programme (PTP) on reproductive health. Health Education was given to enable adolescent girls to develop skill, competencies and ability to deal with varied aspects of adolescence and to attain a safe motherhood in future. Objective I. To assess the knowledge regarding reproductive health among adolescent girls (pre-test).

A total of 144 students participated in the pre-test assessment. A pre-tested questionnaire was administered which included baseline characteristics of the study population (Section-I) and questions related to knowledge on nutrition during adolescence, physical, physiological and psychological changes during adolescence, menstruation, menstrual hygiene regarding pregnancy, antenatal care and contraception (Section-II). Intervention A comprehensive health education program was organized for this group of students. A session of 45 min duration was conducted once wkly for consecutive 3 months (preferably on every Wednesday). The training methods included a didactic lecture followed by interactive sessions. Audio visual aids such as chalk and blackboard, charts, posters and video films were also used. Some examples and stories related to above things were delivered to make the session interesting. Feedback was collected in letter box approached in order to clarify the doubt related to this topics. The topics included were nutrition during adolescence( for prevention of low birth weight baby) physical, physiological and psychological changes during adolescence menstruation, menstrual hygiene pregnancy, antenatal care and various methods of contraception/ Reproductive health & personal hygiene (for better reproductive health) high risk behavior adolescent sexuality (STD / HIV / AIDS & Substance abuse)

II. To develop, validate and conduct Planned Teaching Programme (PTP) on reproductive health. III. To evaluate the effectiveness of planned teaching programme on reproductive health in terms of gain in knowledge in post test. Methodology: This interventional study was carried out in the year 2009-2010 among students of standard X of Sarojini High School, Ankuli, Berhampur to assess the effectiveness of planned teaching programme on reproductive health.The study sample consisted of 144 adolescent girls. Baseline data regarding knowledge about reproductive health was collected from students in pretest period with privacy and confidentiality, intervention was done by giving health education regarding adolescent nutrition, reproductive health and personal hygiene, adolescent sexuality, high risk behaviors and adverse effects of premarital sex. Post intervention knowledge assessment was done again by using same questionnaire. Pre-test: A 24-item structured questionnaire was used as a tool for data collection. To ensure confidentiality, students were asked not to furnish their names. Willingness to participate in the study was obtained by a verbal consent from the students after explaining the objectives of the study.

Post-test: The effect of the intervention was evaluated immediately following intervention (after 3 months of health education) with a post-test questionnaire. The pre-test and post-test scores were expressed in the form of percentages and proportions. Data collected before and after planned teaching programme were analyzed using Wilcoxan paired sign rank test.

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Result The total number of subjects in this study was 144. Table 1 reflects the socio demographic profile of adolescent girls. Most of the adolescent girls were found in age of 15 yrs and no one was in age of 17 years. Most of the girls (94.4%) were Hindu. Majority of girls (60.4%) were of general caste.51.3% of adolescent girls had family income less than Rs.5, 000/-. Tables 2 and 3 shows the number of students who

gave right answers to various points (sections 2) in the questionnaire during pre-test and post-test. It is seen from (Table 2) that, though most of the students (73.6%) were aware of the relation of high calorie diet and obesity,but their knowledge regarding role of iron, calcium and iodine rich diet was poor (30.5%, 16.6% and 36% respectively). There was significant improvement in knowledge in all aspects related to nutrition during post test period. Table 3 shows that though the students had a good knowledge regarding ovulation, the knowledge regarding age at first menses and genital hygiene was poor at pretest. Almost half the students were aware of the term ovulation. Their knowledge regarding menstruation and menstrual hygiene improved significantly from 36.1% to 79. 1% respectively after intervention. Missed period as the first sign pregnancy was known only to around 12.5% of the students. The intervention significantly improved participants knowledge by a margin of 64%. Regarding contraception, the average score for correct answers was 33 % before and 88 % after the PTP respectively. Twenty percent students were aware of safe period as a method for contraception which was increased to 86.1% after the education. Regarding the high risk behavior the average score increased from 19.44 % to 82.87 % after the PTP . Wilcoxan paired rank test shows the significant difference in score while evaluating knowledge regarding adolescent reproductive health during pre and post test period in almost all aspects. (especially in questions / knowledge related to nutrition, anatomy and physiology of reproductive system, Reproductive health and personal hygiene, adolescent sexuality, high risk behavior, AIDS and STD there was significant improvement).

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Discussion This study examined the effect of health education on students knowledge towards reproductive health. The package was effective in improving knowledge level of adolescent girls on various issues related to reproductive health. Various other studies have also shown the effectiveness of interventions in increasing knowledge of reproductive health10,11,12,13. Pre-marital sex and teenage pregnancy are increasing in most of the countries like India and there is lack of sufficient knowledge about the available contraceptive devices in the younger population14. Studies conducted in India revealed poor knowledge among girls regarding contraception and the present study concurs with these findings 5,8,3. Similar findings have been noted in other developing countries as well 9,7,4.

Imparting health education on reproductive health among adolescent girls is quite effective if done in a well organized and scientific way. It creates an increased awareness among them, which can empower them to take care of their own health as well as protect themselves from possible reproductive health problems. An integrated and collective approach by teachers, nurses, health personnel, parent and Govt. should be carried out for a holistic development of adolescent health. It ensures a sound mind in a sound body which can enable the individual having a safe mother hood in future . References 1. 2. Adolescence the Critical Phase, The Challenges and The Potential. World Health Organization; 1997. Bhatia B.D., Chandra K. Adolescent mother and

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an unprepared child. Indian J Mat Child Health. 4: 67-70,1993. 3. Bhatia V., Swamy H.M. Fertility Control methods: Knowledge of adolescent girls in schools of Chandigarh. Ind J Med Sci. 54342-54346, 2000. Buga G.A., Amoko D.H., Ncayiyana D.J. Sexual behaviour, contraceptive practice and reproductive health among school adolescents in rural Transkei. S Afr Med J. 86:523-527, 1996. Gupta N., Mathur A.K., Singh M.P., Saxena N.C. Reproductive health awareness of school-going unmarried adolescents. Indian J Pediatr. 71:797-801, 2004. INCLEN International Clinic Epidemiology Network. 1998-2001. [last accessed on 2003 Jun 2]. Available from: http:// www. inclen.org. Kibret M. Knowledge, attitude and practice on reproductive health among high school students in Bahir Dar, Ethiopia. Afr J Reprod Health. 7:39-45, 2003. Kumar R., Raizada A., Agarwal A.K., Kaur M. Adolescent behaviour regarding reproductive health.

Indian J Pediatr. 67:877-882, 2000. 9. Lema V.M., Hassan M.A. Knowledge of sexually transmitted diseases, HIV infection and AIDS among sexually active adolescents in Nairbi, Kenya and its relationship to their sexual behaviour and contraception. East Afr Med J. 71:122-128, 1994.

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10. Mandal K. Teaching adolescent school girls about menstrual hygiene. Indian J Nursing Midwifery. 1:1926, 1998. 11. Parwej S., Kumar R., Walia I., Aggarwal A.K. Reproductive health education intervention trial. Indian J Pediatr. 72:287-291, 2005. 12. Russell-Brown P., Rice J.C., Hector O., Bertrand J.T. The effect of sex education on teenagers in St. Kitts and Nevis. Bull Pan Am Health Organ. 26:6779, 1992. 13. Shetty P., Kowli S. Family life education for nonschool going adolescents: An experiment in an urban slum. J Fam Welfare. 47:51-58, 2001. 14. Tiwari V.K., Kumar A. Premarital sexuality and unmet needs of contraception among youth: evidence from two cities of India. J Fam Welf. 50:62-72, 2004.

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