Professional Documents
Culture Documents
AKHILA.P
College of Nursing,
2015
i
KNOWLEDGE AND BARRIERS OF HEALTH SEEKING BEHAVIOUR ON
By
AKHILA.P
Thrissur
In
And
2015
ii
DECLARATION BY THE CANDIDATE
women” is a bonafide and genuine research work carried out by me under the
Date:
Place: Pariyaram AKHILA.P
iii
CERTIFICATE BY THE GUIDE
bonafide research work done by Akhila.P in partial fulfillment of the requirement for
Gynaecological Nursing,
College of Nursing,
College of Nursing,
iv
ENDORSEMENT BY THE HOD, PRINCIPAL/HEAD OF THE
INSTITUTION
bonafide and genuine work carried out by Akhila.P in partial fulfillment of the
Gynaecological Nursing).
Date: Date:
v
COPYRIGHT
I hereby declare that the Kerala University of Health Sciences, Kerala shall
have the rights to preserve, use and disseminate this dissertation/thesis in print or
Date:
Place : Pariyaram AKHILA.P
vi
ACKNOWLEDGMENT
Though only my name appears on the cover of this dissertation, a great many
people have contributed to its production. I owe my gratitude to all those people who
have made this dissertation possible and because of whom my post graduate
Senior Lecturer, College of Nursing, Academy of Medical Sciences, Pariyaram for her
Professor, Mrs. Celine Thomas VT, Mrs.Soumya George and Mrs. Mini Mol Joseph,
The investigator extends her special thanks to all faculty members of College
of Nursing, Academy of Medical Sciences, Pariyaram for their motivation and support
The investigator recalls Mrs. Sucharitha Suresh for her valuable guidance and
vii
The investigator extends her heartfelt gratitude to the Panchayat President of
all the study subjects for their willingness to participate and the co-operation rendered
Medical Sciences, Pariyaram for their sincere help and wholehearted cooperation.
A word of appreciation to the chief librarian and library staff of Govt. College
of nursing Kozhikode, Govt. Medical college library, learning resource centre for their
The investigator expresses her heartful thanks to all the non teaching staff of
College of Nursing, Academy of Medical Sciences, Pariyaram for their support, help
and co-operation.
A word of sincere thanks to the staff of Rajendra Printers, Payyannur for their
help in formatting and setting of this work into its present elegant form.
colleagues for their constant encouragement, untiring support and prayers which
viii
Above all, she is indebted to God almighty for the gracious blessing that
Date :
ix
ABSTRACT
millions of women worldwide is uterine prolapse and uterine prolapse impairs the
health related quality of life of individuals. The present study is intended to assess the
married women in the selected rural areas of Kannur district .The objectives of the
study are to assess the knowledge regarding uterine prolapse among married women,
identify the barriers of health seeking behaviour on uterine prolapse among married
women, find the correlation between knowledge and barriers of health seeking
behaviour on uterine prolapse among married women, find the association between
knowledge regarding uterine prolapse and selected socio-personal variables, find the
prolapse and its prevention. The conceptual framework adopted was based on
approach and descriptive survey design was used for the study. The tool used were an
interview schedule and five point rating scale to assess the knowledge and barriers of
health seeking behaviour on uterine prolapse. The sample consisted of 371 married
Kannur district. Data collection period was from 31.01.15 to 18.03.15. The
information booklet was distributed to all subjects. The data were analysed using
descriptive and inferential statistics. The results revealed that the subjects have
x
among married women. (r = -0.325 p<0.001). A significant association between
knowledge score regarding uterine prolapse and selected socio personal variables such
of health seeking behaviour and selected socio personal variables such as education,
giving proper and timely health education, can transform an individual/family’s health
beliefs, attitudes and concepts. Hence effort to address the problem of uterine prolapse
is very important for its prevention and to overcome barriers in early treatment
seeking behaviour.
Women.
xi
TABLE OF CONTENTS
List of tables
List of appendices
1 INTRODUCTION 2-24
3 METHODOLOGY 50-64
5 RESULTS 90-95
REFERENCES 115-120
APPENDICES 123-178
xii
LIST OF TABLES
married women.
women.
xiii
LIST OF FIGURES
Sl No. Figures Page No.
of family
children
uterine prolapse.
prolapse
xiv
LIST OF APPENDICES
Sl No. Appendices Page No.
Section A- English
A List of Abbreviations 123
B List of experts for content validity of the tool 124
C Approval letter of ethics committee 125
D Letter seeking permission to conduct pilot study 126
E Letter seeking permission to conduct actual study 127
F Letter seeking expert guidance for content validation of the 128
tool
G Acceptance form for validation of tool 129
H Criteria checklist for validation of the tool 130
I Informed consent 134
J Tool I - Structured interview schedule to assess the knowledge 135
on uterine prolapse among married women
K Answer Key 142
L Blue print of Tool I 143
M Tool II-Rating scale to assess the barriers of health seeking 144
behaviour on uterine prolapse among married women.
N Scoring and rating. 148
Section B- Malayalam
O Informed consent 149
P Tool I-Structured interview schedule to assess the knowledge
150
on uterine prolapse among married women
Q Tool II-Rating scale to assess the barriers of health seeking
159
behaviour on uterine prolapse among married women.
R Information booklet on prevention and management of uterine
163
prolapse.
xv
1
CHAPTER 1
INTRODUCTION
· Objectives
· Operational definitions
· Assumptions
· Hypotheses
· Conceptual/theoretical framework
2
CHAPTER 1
INTRODUCTION
Health in the broad sense of the world does not merely mean the absence of
the disease or provision of diagnostic, curative and preventive services. The state of
positive health implies the notion of perfect functioning of the body and mind.
Reproductive health has been defined by the WHO as the state of complete physical,
mental and social wellbeing and not merely the absence of disease or infirmity in all
1
matters relating to the reproductive system and to its functions and processes.
contribute to the health and productivity of whole family, community and for next
3
generation.
3
A healthy reproductive system makes the miracle of life possible.
countries. It accounts for 21.9% of the disability-adjusted life years lost by women
4
aged 15–45 years .
5
behavioural factors.
protrudes or slips out from its normal position on the pelvic floor. Commonly women
are keeping this condition secret because of the shame, as it is affecting a sensitive
6
part. So it is considered as a “hidden tragedy for women”.
uterine prolapse is a significant health problem among women and has affected
6
woman all over, in the mountains, hills, plains and the villages.
Tract Infections, uterine prolapse, the myths, misconceptions and various cultural
beliefs associated with these problems, prove to be major hurdles in seeking health
care. This could aggravate the existing gynaecological conditions and force women to
7
suffer silently in misery.
prolapse remains an important condition especially, since the majority of women may
8
now spend third of their life in the postmenopausal state.
urgent need to increase the knowledge about various gynaecological problems like
reproductive tract infections, uterine prolapse among the women in the reproductive
age group. The women self-help groups, mahila mandals and basic health workers are
affects women all over the world and this has not received sufficient attention despite
9
its high prevalence.
Uterine prolapse has been proven to seriously affect the quality of life of the
women with prolapse, costing them not only their physical health, but also sexual
dysfunction and their skill to work ultimately affecting their living. Being a hidden
condition, women did not feel comfortable discussing about it openly and only
6
preferred to discuss with people whom they had confidence.
The word prolapse is derived from Latin word procedure, which means “ to
the vaginal canal due to weakening or damage to pelvic support structures. Female
slipping down of the genital organs like the uterus, urinary bladder and rectum from
their normal anatomical position and either protrude into the vagina or press against
8
the vaginal wall.
Uterine Prolapse means uterus descended from its normal position in the
9
pelvis further down the vagina along with other pelvic organ can also descend.
Uterine prolapse has been prevalent since ages and it is proven by the fact that
it was mentioned in the writing of Hippocrates and Galen. Its many fragments were
6
discovered by Flinder Petrie in 1889. Medical records indicating diagnosis and
treatment dating back over 4000 years to the Kahun Papyrus in 1835 BC. A
transcription of the Kahun Papyrus states, “Of a wo man whose posterior belly and
branching of her thighs are painful, say thou it is the falling of the womb” (Griffiths
10
translation).
5 Documentation exists of multiple treatments Hippocrates utilized for Pelvic Organ
Prolapse (POP) such as inserting a pomegranate into the vagina to hold the
uterus in position or suspending women upside down from a ladder with legs tied
together and shaking for 3 to 5 minutes to “encoura ge” the uterus to return to its
.10
normal position
and its treatment. In 98 BC Soranus of Rome first described the removal of the
10
prolapsed uterus when it became black.
Uterine prolapse occurs when pelvic floor muscles and ligaments stretch and
weaken, providing inadequate support for the uterus. Loss of normal vaginal support
2
can be seen, to some degree or another, in as many as 43% to 76% of women.
First-degree prolapse, descend of the uterus to any point in the vagina above
the hymen.
Second degree prolapse, descend of the uterus till the hymen and
11
Third-degree prolapse, descend of the uterus halfway past the hymen.
The condition where the entire uterus may protrudes outside the vulva,
12
bringing with it both the vaginal walls, is called procidentia or complete eversion
Organ Prolapse (POP). The system is called the Pelvic Organ Prolapse Quantification
System (POP-Q). The descent of the anterior, posterior wall and the apex of the
vagina (cervix/vaginal cuff) are measured using the hymen as the point of reference
13
while the patient is straining.
6 Causes and risk factors for uterine prolapse are complex and deeply embedded in
the cultural, economic, and social conditions of women. They range from early
marriage and childbirth to malnutrition, work overload, and lack of rest in the pre and
postnatal period multiparty, having child at very young age and having children at less
interval. Other conditions which can cause uterine prolapse are constipation, obesity
and chronic cough, loss of the tone of vagina, prolong labour giving birth to large
baby, difficult labour, working immediately after child birth. Furthermore, there is a
2
lack of knowledge and access to antenatal medical care.
work, infections, and pain), uterine prolapse can also trigger psycho-social problems.
Emotional isolation, risk of violence and discrimination, and facing social stigma are
2
only some such problems.
due to the protruding prolapse becoming ulcerated. The psycho-social problems faced
husband or divorce, ridicule and shame, inability to work, lack of economic support,
.2
risk of violence and abuse and more notably discrimination
which impairs the health-related quality of life of affected individuals. Despite the
7
lack of robust evidence, selective modification of obstetric events or other risk factors
2
could play a central role in the prevention of prolapse.
And also include rest during postpartum period, not doing heavy work during
food, care during antenatal, intrapartum and postpartum period, women should go
hospital for treatment when she suffers from uterovaginal prolapse. Pessary also
from a great variety of materials and have been used since ancient time, modern
pessary, usually made of silicone, in a range of shapes and sizes. It also considered to
be a relatively safe method of managing pelvic organ prolapse without serious side
13
effects .
Once the prolapse is established it is much more difficult to control with only
medication or exercise or pessaries. Surgical trends are currently changing due to the
controversial issues surrounding the use of mesh and the increasing demand for
uterine preservation. The evolution of laparoscopic and robotic surgery has increased
2
the use of these techniques in pelvic floor surgery. Ultimately surgical restoration of
6
the vagina or the hysterectomy is required.
Uterine prolapse can be prevented and is treatable but majority of the women
6
do not have knowledge about it which makes the situation even more heartbreaking.
About 80% of the Indian women are residing in rural areas and these problems
are most commonly seen among them. Prevention of the risk factors play a vital role.
healthy weight through diet, avoiding constipation and smoking. Conditions that increase the
6
should be treated for the primary or secondary prevention of the prolapse.
Efforts are needed at the grass root and addressing uterine prolapse at the community
6
level can have a positive impact on the women’s lives
health care and also provide people friendly services, preventive and curative care,
1
free or at genuinely nominal cost.
and Development (ICPD) in Cairo discussed reproductive health and women’s health
in a holistic way. ICPD delegates reached a consensus that the equality and
throughout the world. The goals are to improve maternal health, reduce the maternal
2
mortality ratio by three quarters by the year 2015.
Maternal death is only the tip of the iceberg, pregnancy related complications
that do not lead to death but women suffer from severe lifelong disabilities are much
more prevalent than maternal death. For every maternal death there are up to 30
9
women with complications that will affect them for rest of their lives (World Bank,
2
1999.
The health of women are also affected by problems that are not related to
pregnancy or child birth. Hence focusing more on mortality indicators may ignore
secrecy and millions of women in every country around the world suffer in silence is
.10
Pelvic Organ Prolapse (POP)
Pelvic organ prolapse is a global women’s health concern and is the leading
10
cause of gynaecological morbidity among married women in India.
Women with UP often suffer in silence for decades; stigma impacts their
personal, family, and socio dynamic aspects on physical, emotional, and intimate
levels. Despite a lot of attention, the exact scenario of uterine prolapse is still hidden
and expanding as these issues are not openly shared due to shyness, stigma and
2
discrimination.
The incidence of uterine prolapse in U.S.A is 11.4%, Egypt 56%, Italy 5.5%, Iran
53.6%, California 1.9%, and Pakistan 19.1%. It is found that in India one in every five
women visiting private clinics in Bengal, Delhi, Punjab and Uttar Pradesh are
10
suffering from uterine prolapse. The incidence of uterine prolapse is 7.6% in Northern
15
India, 20% in Eastern India, 3.4% in Karnataka and 0.7% in Tamilnadu.
It is estimated that about half of the parous women lose their pelvic floor
support and this results in some degree of prolapse and among them only 10-20 %
10
seek medical treatment for the problem .
morbidity among postmenopausal women aged 50 years. The results shows that the
prevalence of gynaecological morbidity was 44.4%, whereas the prevalence was only
25.9% of at least one gynaecological symptom. Genital prolapse was the most
.5
common morbidity which was present in 18.8 % of women
WHO reported that nearly one third of all healthy life lost among adult
substantial impact on female reproductive ability, mental health ability to work and to
1
perform routine physical activities.
The causative factor for pelvic organ prolapse is globally universal and
6
multiple. Every causal factor the women experience increases the risk of uterine
16
prolapse as well as its degree of severity.
Many studies done regarding cause and risk factors of uterine prolapse, show
that the main risk factors are immediate heavy work after delivery, heavy work load
during pregnancy, child birth injury, multiple birth, multiparity, lack of care during
Nepal among women suffering from the problem of uterus prolapse. The result shows
that causes of uterine prolapse include excessive physical labour during and
immediately after pregnancy, a lack of skilled attendants during delivery, frequent and
11
numerous pregnancies, early childbirth, and/or a lack of nutritious food during maternity.
Pelvic floor damage can occur where there is “overstretching of the perineum, obstructed
Uterine prolapse presents with multiple symptoms, the degree of severity and
types of activity mean women’s symptoms have aspects of uniqueness and aspects of
2
similarity with variables day today and women to women.
However, uterine prolapse directly affect other aspects of life as well. In fact it
severely affects the quality of life of women, causing physical, social, psychological,
2
occupational, domestic and sexual limitations on their lifestyle.
A qualitative study on Uterine prolapse and quality of life among women with
uterine prolapse at Nepal shows that physical effects of prolapse are listed as pain,
discharge and itching, ulceration and bleeding, difficulty in sitting, walking and
lifting, urination and defecation problems, and reduced food intake. Psychological
effects of prolapse are grouped as anxiety, depressive feelings and guilt, fear of death,
cancer and surgery. Social aspects are expressed as responses of husband, family and
friends, and implications on sexual, economic and social activities. Barriers and
facilitators to accessing health care, quality of care received, and the success and
Women who suffer from pelvic floor disorders like uterine prolapse (UP)
endure symptoms that decrease their quality of life, but rarely result in morbidity or
12
mortality. The symptoms are not only socially embarrassing but also disabling to the
2
women.
Many studies shows that the treatment options to support a prolapse include
physiotherapy, pessaries and surgery but that simple lifestyle changes, such as losing
weight, smoking cessation, treatment for a chronic cough, treatment for constipation
and avoiding heavy physical activities can reduce symptoms of pelvic organ prolapse
and reduce the chances of a prolapse returning after surgery, Eat estrogen rich food
7
plenty of high-fiber foods such as whole grains, fruits, and vegetables every day.
prolapse remains the first line treatment as it provides benefit to the patient and has a
favourable safety profile. For patients seeking treatment for pelvic organ prolapse
who do not desire surgical management, two options are available. Pelvic floor
physical therapy and pessary provide nonsurgical options that have distinct
18
advantages. Both treatments are non-invasive and can be discontinued at any time.
organ prolapse fitted with a pessary, 73 women retained the pessary two weeks later.
After two months, 92% of these women were satisfied with the pessary; virtually all
symptoms of prolapse and 50% of urinary symptoms had resolved, although occult
19
stress incontinence was unmasked in 21% of the women.
13 Health seeking behaviour or treatment seeking behaviour depends upon the
perception of individual and when they think it is normal or non-serious they do not
2
take treatment.
domestic responsibility for the family. Despite this fact, they do not have the decision
making power to determine when they are to start a family and at what time intervals
6
they will have children.
In India, married woman are reluctant to seek medical advice because of lack
of privacy, lack of female doctor at the health facility, the cost of treatment and the
social status of their sub ordinates. Many women considered most reproductive
9
morbidities to be normal and may not seek treatment.
Despite the fact that uterine prolapse is a matter of discomfort for women
which affect many aspects of daily living, they hesitate to seek medical assistance due
10
to the social positioning and conditioning.
Stigma prevents women from disclosing Pelvic Organ Prolapse (POP); the
universal impact of stigma to women’s lives has kept pelvic organ prolapse shrouded
countries remain silent about Pelvic Organ Prolapse (POP) because of embarrassment
Prolapse (UP) may result in a woman being ostracized from her husband, family, or
10
community.
value of programs that have been initiated till date. There is a need to address this
Women with prolapse can often recall the exact scenario they first felt their
10
prolapse occur, but fear of stigma keeps them from revealing it to anyone.
all circumstances make it difficult for women to discuss this extremely private,
2
personal, condition with healthcare facilitators when access to health camps occurs.
Many studies shows that women believe or are made to believe that
reproductive health problems are part of women’s fate and that the falling of uterus is
just part of being a woman. Women often won’t admit to uterine prolapse because
screened for uterine prolapse by a man must be considered; female assistants should
be in screening rooms during pelvic examination many did not report the condition to
3
their doctor due to being ashamed.
Due to less data and surveillance, the prolapsed uterus has become a scourge
goes practically unnoticed in the public health debate raised in the country. For
aspects of daily living, but social conditioning often deters women from seeking
4
medical assistance even if it is available.
disparity must be addressed in order to achieve success in long term initiative to deal
with uterine prolapse. A program that integrates multiple factors and dissects and
evaluates the outcome of each aspect is pivotal to achieve long term reproductive
health ballast for women. There is considerably less value in humanitarian aid than a
well balanced program which provides healthcare while educating and empowering
2
women to help themselves and their families.
Education always enlightens the mind of people and helps them to think freely
and take decisions, and enable them to avoid becoming victim of this hidden
1
morbidity uterine prolapse.
wash out the stains of misconceptions and barriers. The need of the hour is setting up
women, identify the barriers of health seeking behaviour and try to reduce the
1
barriers.
Nurse must be sensitive while assessing the female patient so that their care needs
can be intervened and quality of life improved. There is need to educate women on
different symptoms of reproductive infection and need for treatment so that women
1
can themselves identify the symptoms and seek timely treatment.
Many women are silent victims of uterine prolapse. Despite of lots of focus, still
hidden and expanding is the exact scenario of uterine prolapse as these issues are not
openly shared due to shyness, stigma and discrimination . Hence effort to address the
problem of uterine prolapse is very important for its prevention and to overcome
10
barriers in early treatment seeking behaviour.
16 Investigator during her clinical experience also found that the majority of
uterine prolapse cases admitted in hospital are of third degree prolapse. Even though
the symptoms appeared in early stages, they are not seeking hospital care due to
vaginal hysterectomy. Based on the degree of prolapse and pelvic organ involvement
Based on the reviews and facts, the investigator felt the need to assess the
booklet on uterine prolapse and its management in order to aware of the symptoms, to
increase service utilization at early stages of uterine prolapse and thereby might
uterine prolapse among married women in selected rural areas in Kannur District.
Objectives
married women.
variables.
Operational definition
actively seeking ways such as regular check up, avoidance of risk factors of uterine
prolapse, life style changes and utilization of health care services in order to move
Barriers: Refers to the factors that hinder the health seeking behaviour on uterine
Assumptions
Hypotheses
Conceptual framework
health belief model and this model is based on motivational theory. Health belief
model is a health behaviour change and psychological model for studying and
Health belief model is the most commonly used theory in health education and
promotion. In the 1950s Rosenstock (1974) proposed a Health Belief Model (HBM)
intended to predict which individual would or would not use such preventive
measures. They address the relationship between a person’s beliefs and behaviours. It
provides a way of understanding and predicting how clients will behave in relation to
their health and how they will comply with the health care therapies. Becker (1974)
19
modified the health belief model to include these components: individual perceptions,
The following four perceptions serve as the main constructs of the model;
explain health behaviour. More recently, other constructs have been added to the
HBM; thus, the model has been expanded to include cues to action, motivating
Individual perceptions
22
powerful perceptions in promoting people to adopt healthier behvaviour. Awareness of
personal high risk lifestyle behaviours also increases perceived susceptibility. A family
history of a certain disorder diabetes or heart disease may make the individual
20
feel at high risk.
prolapse which include multiparity, child birth trauma, big baby, lack of rest in
uterine prolapse.
Modifying factor
The four major constructs of perception are modified by other variables, such
as culture, education level, past experiences, skill and motivation, to name a few.
20
These are individual characteristics that influence personal perceptions. Factors that
·
Demographic variables:- Demographic variables include age, sex, race,
20
ethnicity etc.
In the present study the socio personal variables such as age, religion,
children,
socioeconomic class, cultural factors and peer group pressure can encourage
21
health behaviours even when individual motivation is low also shows any risk
20
taking behaviour.
·
Structural variables:- Knowledge about the target disease and prior contact
20
behaviour.
regarding uterine prolapse, history of uterine prolapse among sample and family
Cues to action:- Cues can be either internal or external. Internal cues include
an ill person who is close. External cues are mass media, advice from others,
reminder post card from the health team member, illness of family members or
21
friends, newspapers or magazine article .
In the present study, cues to action include mass media, medical camp, health
Likelihood of action
health actions depends on the perceived benefits of its action minus the perceived
prevention.
In this study, the barriers may include lack of knowledge and awareness on
uterine prolapse, embarrassment and fear related to screening, negative attitudes and
beliefs, lack of support and peer pressure, lack of time and cost, cultural factors and
The belief in one’s own ability to do something is self efficacy. Positive self
efficacy means married women’s belief in her ability to adopt a new healthy
behaviour. Then only she can overcome perceived barriers. Hence self efficacy refers
to women’s ability to adopt healthy life style changes including well balanced diet,
adequate hydration, pelvic floor exercises and adoption of measures which promote
genital health in order to prevent the occurrence of uterine prolapse and thus to
21
achieve optimal reproductive and sexual health.
Knowing what aspect of the Health Belief Model, patients accept or reject can
factors for diseases, we can direct teaching toward informing the patient about
personal risk factors. If the patient is aware of the risk, but feels that the behaviour
management and prevention helps the women to overcome the perceived barriers and
achieve perceived benefits to develop actions which lead them to take good health
The conceptual frame work based on Rosen stock and Becker’s Health
Optimum
24
Figure 1: Conceptual frame work based on Rosen stock Rep
and Becker’s Health Belief Model rodu
ctiv
e
and
Se
xu
al
H
ea
lth
25
CHAPTER 2
REVIEW OF LITERATURE
CHAPTER 2
REVIEW OF LITERATURE
about a particular practice problem and includes what is known and not known about
the problem on a topic of interest, often prepared to put a research problem in context
23
or as the basis for an implementation project.
This chapter deals with selected studies which are related to the objectives of
the proposed study. A review of literature relevant to the study was undertaken, which
helped the investigator to develop a deeper insight into the problem and gain
Review of literature for the present study has been organized and presented
prolapse.
uterine prolapse.
prolapse.
27
prolapse.
in Bhaktapur, Nepal using Systematic random sampling technique and by using semi-
structured interview schedule. The result shows that the majority of the respondents
were <40 years (69.6%), were literate (65.3%), all respondents were Newar, and
Hindu religion. Major occupation of the mothers was house work (63.6%) and 15.3%
showed that the causes of uterovaginal prolapse ( UVP) by carrying heavy loads
during postnatal periods (72.2%), by multiparty (63.9%), having child at very young
age (60.8%), having children at less interval (<5yrs) (57.7%), other condition like
constipation, obesity and chronic cough (55.7%), by loss of the tone of vagina
(53.6%), by prolonged labour (52.8 %) and by giving birth to large baby (39.2%) It
state that uterovaginal prolapse is because of child bearing at an early age (43%),
carrying heavy loads during pregnancy (43%), working immediately after child birth
(37%), lack of care during postnatal period (32%), pressure on lower abdomen during
14
(9%).
Eleje GU, Udegbunam OI, Ofojebe CJ, Adichie CV conducted a five year
modalities of pelvic organ prolapse with retrospective data collection in women who
attended the gynaecologic clinic , and were also diagnosed with pelvic organ prolapse
results show that there were 199 cases of pelvic organ prolapse, out of a total
28
gynecologic clinic attendance of 3082, thus giving an incidence of 6.5%. The mean
age was 55.5 (15.9) years with a significant association between prolapse and
advanced age (P < 0.001). The age range was 22-80 years. The leading determinants
pressure (IAP) and prolonged labour. Out of the 147 patients with uterine prolapse,
majority, 60.5% (89/147) had third degree prolapse. Vaginal hysterectomy with pelvic
floor repair was the most common surgery performed. The average duration of
hospital stay following surgery was 6.8 (2.9) days and the most common complication
was urinary tract infection, 13.5% (27/199). The recurrence rate was 13.5% (27/199).
Most of the patients who presented initially with pelvic organ prolapse were lost to
24
follow-up.
4,693 married women aged 15–49 years at 25 district s representing all five
administrative regions, three ecological zones, and urban and rural settings in Nepal
using structured questionnaire .The result shows that mean age of participants was 30
years, 67.5% were educated, 48% belonged to the advantaged Brahmin and Chhetri
groups, and 22.2% were Janajati from the hill and terai zones. Fifty-three percent
(53%) had never heard about uterine prolapse (UP). Among women who had heard
about uterine prolapse (UP), 37.5% had satisfactory knowledge. Knowledge about
uterine prolapse(UP) was associated with both urban and rural settings, age group,
25
and education level.
symptoms of uterine prolapse experienced by Nepali women. The results shows that
the prevalence of uterine prolapse was found to be in the range of 10-40%. The grass
29
root causes are poverty, illiteracy, male dominated social structure, gender based
pregnancy, multi parity in the need of son, work load during pregnancy and postnatal
period, domestic violence, home deliveries, lack of awareness about uterine prolapse,
shyness to explain about reproductive health related problems which in turn leads to
2
uterine prolapse.
factors of uterine vaginal prolapse among 300 married women aged 30-60 year in
selected villages of Udupi district, Karnataka. Villages for this study selected by
simple random sampling and subjects by purposive sampling and tool was knowledge
questionnaire. The result shows that majority (59%) of the married women had
moderate knowledge on uterovaginal prolapse ,6% had good knowledge and 35% had
poor knowledge. The risk factors identified were(77%) had at least one vaginal
(35.7%) had 3 and more than 3 children 30(10%) of the women delivered a baby
weighing more than 3.5kg, 86(28.7%) women delivered at home ,147 (49%) of the
women had 1-2 years gap between pregnancies 6(2%).Women took less than two
weeks of rest in postnatal period 16(5%) of them had constipation, no one had chronic
cough,10(3.3%) women BMI was more than 30kg/m2. There was significant
26
association between knowledge with education and monthly income.
prevalence of uterus prolapse and its associated factors among the 360 women in Doti
district of Nepal using three stage probability sampling technique by using structured
interview schedule. Result revealed that nearly half of the respondents were over age
35 years with one in every five belonging to age group 21-25 years; and 33.3% were
30
housewives. Nearly 96% of the respondents were married before 20 years of age. Literacy
status, caste, age of respondents, age at marriage, parity and time to resume work after
delivery were independently and significantly associated with Uterus prolapse (p<0.05)
where strongest variation was observed due to parity. Moreover, the type of delivery at
first, second, third and fourth child birth, age at marriage, numbers of children, parity, age
27
factors; that explained 40 percent variations of uterus prolapse.
regarding prevalence of uterine prolapse and its associated factors among 300 women
of the Kaski district of Nepal who have experienced at least one time pregnancy
during her life using multistage sampling technique, by using face to face interview
and semi structured interview schedule. The results show that the prevalence of
uterine prolapse was reported to be 11.7%, the mean age of the respondents was 38.83
only 3.3% were below 20 years .Majority Of the respondents were Brahmin having 39
primary level (49%) and least with bachelor degree. Half of the respondents were
indulging in agriculture and a quarter of them were housewives. The major source of
more than half (51%) of the respondents was agriculture and 52.3% were living in
28
joint families.
vaginal prolapse in Tamil Nadu, India .The result revealed that clinical examination
31
wage labourers in agriculture. The mean age at which the women had developed
symptoms of the condition was 26.2yrs, and roughly 40 per cent of the women
reported to be suffering from uterine prolapse after their very first or second
deliveries. The finding show that strenuous manual work after delivery was an
important factor associated with uterine prolapse, alongside factors such as frequent
seriously compromises the quality of life of the women affected. There were a series
of barriers to medical help for uterine prolapse, ranging from women’s reluctance to
seek treatment and lack of familial support, to ineffective treatment and high
29
monetary and opportunity costs.
prolapse (UP), the associated risk factors and documentation of the traditional
remedies used among 368 women for the treatment of uterine prolapse in a mid
western hilly part of Nepal Manma by using designed questionnaires and simple
random sampling technique . Result revealed that the prevalence of uterine prolapse
(UP) was 22.6 %. The risk factors for uterine prolapse (p value < 0.05) were
illiteracy, multi parity, poverty, home delivery, early age at marriage, less rest time
period after delivery and smoking. Results also showed that the majority of women
Commonly used herbs reported were Cedrus deodara, Butea monosperma, Oxalis
13
latifolia, and Canabis sativa.
district of Nepal using systematic random sampling .The results show that majority of
the respondents were in the age group 30-34(20.6%), lacked formal education
(47.2%) and more than three fourths (74.2%) were involved in farming. The
prevalence of the uterine prolapse, based on self report as well as diagnostic cases,
was found to be 24.7%. Diagnostic here means women who have had own self
diagnosed by the staff at the health center. Of this, nearly 50% had undergone
30
treatment for uterine prolapse.
discussion. The study reveals that uterine prolapse is a major public health issue in
Nepal with little attention given to the problem. It is clear that women lack knowledge
about uterine prolapse. Uterine prolapse is prevalent among women from across the
country irrespective of their geographical locations. Teenage pregnancy and too many
that most of the women delivered their babies at home assisted by untrained persons,
and most of the parturient mothers or delivering women resumed work soon after
31
delivery and had very poor nutrition.
33
knowledge, attitude and preventive measures of uterine prolapse among 267 married
questionnaire and focused group interview. The results show that the prevalence of
uterine prolapse was 24.7%. Women had a moderate level of knowledge regarding
uterine prolapse (51.9%). The results show that knowledge in about the preventive
measures is less as compared risk factors, signs and symptoms therefore showing that
more awareness programs are needed in the area. Focus group revealed that though
women had knowledge about uterine prolapse, they could not practice it due to lack of
2
help from family members including her husband.
find out the risk factors of uterine prolapse among women in Nepal. The results reveal
that during three months, 96 women were diagnosed and treated with uterine prolapse
and the risk factors for prolapse was age 50 yrs, smoking, postmenopausal 35%,
hypertension 16%, diabetic mellitus 5%, COPD 16%, heavy working during
pregnancy and puerperium, maternal weight, and majority of women were of Newari
early management of uterine prolapse should be the first steps to reduce this
32
significant, social and public health problem .
34
uterine prolapse.
structured interview schedule. The result shows that majority of the respondents
(68%) reported that foul vaginal discharge and 64.9% reported feeling of something
coming out per vagina and backache/abdominal pain, 63.9% reported difficulty in
voiding or urinary incontinence, 62.9% and 56.7% reported difficulty in walking and
feeling of pelvic heaviness. However more than half of the respondents were unaware
of the sign and symptoms of uterovaginal prolapse such as constipation and less desire
for intercourse. Majority of the respondents (84.5%) who responded that uterovaginal
followed by 83.5% who reported that medical attention should be sought as soon as
problem is noticed, 81.4% replied that nutritional diet, regular exercise and hygiene
should be maintained in the antenatal period and 79.4% replied delivery should be
done by trained health personnel. In same way 74.2% reported problem such as
constipation, obesity and chronic cough should be cured in time followed by 72.2% of
the respondents who reported that food rich in fibre and intake of plenty of water can
prevent uterovaginal prolapse, 56.7% of respondent were aware about keeping tight
pessary in vagina and more than 50% were not aware that regular exercise of pelvic
organ can prevent uterovaginal prolapsed. Thirty nine percentage (39%) reported
having rest during postpartum period, not doing heavy work during pregnancy and
postpartum period (36%), marrying at appropriate age (31%), having nutritious food,
hospital for treatment when she suffers from uterovaginal prolapse. And 62.9%
reported that drugs alone cannot cure the uterovaginal prolapse. Most of the
muscle training and watchful waiting (no treatment and no recommendation)on pelvic
floor symptoms among 287 women age of 55 years or over with symptomatic mild
prolapse in Dutch primary care The participants,145 women was allocated to pelvic
floor muscle training and 142 to watchful waiting..The result shows that of 287
women who were randomized to pelvic floor muscle training (n=145) or watchful
group improved by (on average) 9.1 (95% confidence interval 2.8 to 15.4) than did
participants in the watchful waiting group (P=0.005). Of women in the pelvic floor
from the start of the study compared with 13% (18/142) in the watchful waiting group
groups. Women with mild prolapse who received pelvic floor muscle training showed
symptoms of uterine prolapse experience by Nepali women. The results shows that
the women suffering from uterine prolapse presented with a variety of physical
passing stool. The study also shows that psychological dimensions of life is also
inability to work, lack of economic support, risk of violence and abuse and more
2
notably discrimination.
Maharashtra (India), in the year 2013, by analyzing the case records of affected
women for the last 20 years. During the analysis period, 4831 women underwent
hysterectomy. Of these, 911 (21.6%), had vaginal hysterectomy for genital prolapse
(study subjects). Eighty percent (80%)women who had vaginal hysterectomy for
genital prolapse were over 40 years of age. Only 4 (0.4%) women had not given birth,
874 (96%) women had had two or more births, and 383 (42%) had 5 or more births.
Having given birth was the major factor responsible for genital prolapse. In all, 94.2%
of women presented with something coming out of the vagina.” Some women
conducted a study to explore women’s experiences of uterine prolapse and its effect
on daily life, its perceived causes, and health care-seeking practices in a hill district of
interviews and convenience sampling. The results shows that twenty-four percent
were literate, 47.2% had experienced a teenage pregnancy, and 29% had autonomy to
37
make healthcare decisions. Most participants (>85%) described the major physical
and lifting. They also reported urinary incontinence (68%) bowel symptoms (42%),
and difficulty in sexual activity (73.9%). Due to inability to perform household chores
and torture by their husbands and other family members, causing severe emotional
separated from the marital relationship. The study concluded that uterine prolapse
adversely affects daily life and negatively influences their physical, mental, social
35
wellbeing.
one individualized pelvic floor muscle training for reducing prolapse symptoms
among 824 women at 23 centers in the UK .The eligible patients (447) were
randomized to the intervention group (n=225) or the control group (n=222). Three
months and 295 (66%) for questionnaires at 12 months. The results show that the
significantly greater reduction in the Pelvic Organ Prolapse Symptom Score [POP-
SS]) at 12 months than those in the control group (mean reduction in POP-SS from
baseline 3·77 [SD 5·62] vs 2·09 [5·39] . Eight adverse events (six vaginal symptoms,
one case of back pain, and one case of abdominal pain) and one unexpected serious
adverse event, all in women from the intervention group, were regarded as unrelated
36
to the intervention or to participation in the study.
38
Good MM, Korbly N, Kassis NC, Richardson ML, Book NM, Yip S, et al
conducted a cross-sectional study to describe the basic knowledge about prolapse and
attitudes regarding the uterus among 213 women seeking care for prolapse symptoms
questionnaire. The result revealed that the overall mean knowledge score was 2.2 ±
1.1 (range, 0-5); 44% of the items were answered correctly. Participants correctly
responded that surgery (79.8%), pessary (55.4%), and pelvic muscle exercises
(34.3%) prolapse treatment options for prolapse. Prior evaluation by a female pelvic
medicine and reconstructive surgery specialist and higher education was associated
with a higher mean knowledge score. For attitude items, the overall mean score was
15.1 (4.7; range, 6-30). A total of 47.4% disagreed with the statement that the uterus is
important for sex. The majority disagreed with the statement that the uterus is
important for a sense of self (60.1%); that hysterectomy would make me feel less
feminine (63.9%); and that hysterectomy would make me feel less whole (66.7%).
convenience sampling technique and group discussions and interview. The result
revealed that patriarchy, gender discrimination, and cultural traditions such as early
marriage and pregnancy make it difficult for people to discontinue risk behaviour of
uterine prolapse risk behaviours. Women are aware of risk factors, prevention, and
treatment, but are powerless to change their situations. Health professionals and
women are fond of surgery as treatment, but opinions on the use of ring pessaries and
38
pelvic floor muscle training are split.
39
randomised trials study in women with pelvic organ prolapse to determine the effects
women with pelvic organ prolapse in comparison with no treatment or other treatment
options (such as mechanical devices or surgery). Two reviewers assessed all trials to
inclusion or exclusion and methodological quality. Data were extracted by the lead
reviewer onto a standard form and cross checked by another. Disagreements were
for Systematic Reviews of Interventions. Three trials of relevance to this review were
identified. The largest of these, of pelvic floor muscle training in preventing anterior
prolapse from worsening, had significant limitations which affect the generalisability
and rigor of the findings. A small feasibility study (which is to be followed up with a
larger trial) randomised 47 women to pelvic floor muscle training or control and
physiotherapy for women undergoing surgery for prolapse and/or incontinence. The
authors report that urinary symptoms, pelvic floor muscle function and quality of life
were improved more in the treatment group than the control group, but data were not
women, at Switzerland which stated that 51 women (47.66%) were educated about
pelvic floor exercises and 56 women (52.33%) were not imparted knowledge
regarding pelvic floor exercises. The women who had the knowledge of pelvic floor
uterovaginal prolapse compared with women who did not have knowledge of
40
uterovaginal prolapse.
conducted a comparative study to review the experience with pessary use for
advanced pelvic organ prolapse at Albert Einstein College of Medicine, Bronx, USA
using Charts of patients treated for Stage III and IV prolapse. Comparisons were made
between patients who tried or refused pessary use. Thirty-two patients tried a pessary;
45 refused. Patients who refused a pessary were younger, had lesser degree of
prolapse, and more often had urinary incontinence. Most patients (62.5%) continued
pessary use and avoided surgery. Unsuccessful trial of pessary resorting to surgery
included four patients (33%) with unwillingness to maintain, three patients (25%)
with inability to retain and two patients (17%) with vaginal erosion and/or discharge.
The findings suggest that pessary use is an acceptable first-line option for
41
treatment of advanced pelvic organ prolapse.
prolapse among patients under 50 years of age with genital prolapse represent about
per cent of these women, all fewer than 35, have isolated hysterocele and a
hypertrophic uterine cervix. It focuses on the etiology, prevention and new surgical
treatments of genital prolapse in young women. Etiologies include late age at first
pregnancy, chronic lung disease, and perineal damage during delivery. New surgical
procedures include vaginal repair with synthetic mesh. Laparoscopic sacropexy is still
floor muscle training for women with symptoms or urodynamic diagnoses of stress,
options.. The study concludes that pelvic floor muscle training was better than no
treatment or placebo treatments for women with stress or mixed incontinence. Pelvic
floor muscle training appeared to be an effective treatment for adult women with
analyze the incidence, diagnosis, treatment and management given, morbidity and
mortality amongst the female patients aged 60 years and above admitted in one of
three units of the department of OBG Safdarjang Hospital New Delhi . Among the
1175 admitted patients ,78 were selected after diagnosis. Out of them 79.7% were
between 60-65 years, 16.66% were between 65-70 years of age and only 3.7% were
more than 70 years of age. Findings were 44.8% with genital tract malignancies,
34.2% with uterovaginal prolapse and 21 .2 % with other benign disorders. The study
prolapse and stated that cases of uterine prolapse can be markedly reduced by proper
obstetric care. Finally study concluded that health care personnel who interact with
women during menopause may play a great role by in corporating them into the
subjects in the control group and 330 subjects in the experimental Group. The
experimental group received training in pelvic floor exercise and were asked to
perform the exercises 30 times after a meal, every day for 24 months. After 24 months
of pelvic floor exercises, the rate of worsening of uterine prolapse was 72.2% in the
control group and 27.3% in the experimental group. A 24 months pelvic floor excise
programme was effective to prevent worsening of uterine prolapse in the women who
45
had severe uterine prolapse.
prolapse among women using a pessary among 56 consecutive women fitted with a
pessary for at least one year. Nineteen (19) continued its use under our care of at least
1 year. The researcher compared baseline and follow-up examination, using the
had worsening in stage of prolapse. These study suggest that there may be a
46
therapeutic effect associated with the use of a supportive pessary.
interventional study to evaluate the effect of pelvic floor muscle training among 46
evaluation of the pelvic floor muscle was performed by digital vaginal palpation using
the strength scale described by Ortiz and by a perineometer . The results shows that
the functional evaluation of the pelvic floor muscles showed a significant increase in
pelvic floor muscle strength during pregnancy in both groups (P < .001). However, the
magnitude of the change was greater in the exercise group than in the control group
(47.4% vs. 17.3%, P < .001). The study also showed a significant positive correlation
assessment in the strength of pelvic floor muscles .Pelvic floor muscle training
resulted in significant increase in pelvic floor muscle pressure and strength during
47
pregnancy.
with a diagnosis of genital prolapse among women in the ages of 40 and 80years using
convenience sampling and in-depth interviews . The result shows that quality of life
and social behaviour may be negatively influenced. The self-image of a woman with
genital prolapse is affected and emotions that include anxiety, aggression, frustration
respondents to wear sanitary pads, and often restricted their social lives. Urinary
incontinence is one of the most common symptoms of genital prolapse, but urinary
prolapse
treatment with uterine prolapse among 160women between age group of 26-86 years
the pencil and paper based semi- structured questionnaire. The result shows that
barriers for access to treatment were individual like lack of knowledge and perception
about Uterine Prolapse as normal due to heavy work load, weakness, no pain, it would
go inside itself etcetera. They found more concern about the household autonomy and
much careless was about their health. Some of them were much scared of surgery.
44
Many of them did not know what it was. There is association between knowledge and
49
visiting Health Facility.
conducted a study to explore women’s experiences of uterine prolapse and its effect
on daily life, its perceived causes, and health care-seeking practices in a hill district of
and convenience sampling. The results show that the causes of uterine prolapse were
unsafe childbirth, heavy work during the postpartum period, and gender
discrimination. Prior to visiting these camps some women (42%) hid uterine prolapse
for more than 10 years. Almost half (48%) of participants sought no health care; 42%
ingested a herb and ate nutritious food. Perceived barriers to accessing health care
included shame (48%) and feeling that care was unnecessary (12.5%). Multiple
responses (29%) included shame, inability to share, and male service provider, fear of
stigma and discrimination, and perceiving uterine prolapse. as normal for childbearing
women. The study concluded that the effective development of uterine prolapse
and thereby might contribute to both primary and secondary prevention of uterine
35
prolapse.
among 2,990 married women of Dadu Majra colony, Chandigarh, India. Result
revealed that among the 2,990 women surveyed, 227 (7.6%) reported symptoms of
uterine prolapse. Of the 227 women with self-reported uterine prolapse, 128 (57%)
had not taken any treatment, 28 went to a traditional birth attendant (TBA), and 47
(21%) consulted a doctor. Thirty-eight women were advised to have an operation, but
45
only eight complied. Other treatments used by small numbers of women included the
use of a ring pessary or alcohol-soaked swab and heel pressure technique. Reasons for
lack of time (80; 63%) and lack of money (74; 58%). The prevalence of prolapse was
significantly higher in women with higher parity. More than 7% of the women
50
reported symptoms of uterine prolapse.
reproductive morbidities and treatment seeking behaviour among 200 married women,
in the age group of 15-44 years in Jamalpur Awana rural health center of Christian
Medical College and Hospital Ludhiana, Punjab by using convenience sampling and
interview schedule. The study explored that one fourth of the woman (24.5%) suffered
menses in 9% of the population. The study also reported health seeking behaviour on
treatment seeking behaviour depend upon the perception of individual and when they
think it is normal or non serious they do not take treatment In India, married woman
are reluctant to seek medical advice because of lack of privacy, lack of female doctor
at the health facility, the cost of treatment and their subordinates social status .The
reason for not seeking treatment among 45% women was that they did consider these
the reproductive health of 1046 ever married women of reproductive age group (15-
49) at slums of Rajkot city ,Gujarat using a pre-tested, structured interview schedule
women using two stage cluster sampling. The result shows that cost and
46
societal barriers were the reasons for not seeking care, whereas poor provider‘s
attitude, poor quality of services and long waiting time were the reasons for not
utilizing public health facilities. Women from low socio economic status, minority
group and distance of health facility more than two km, had lesser access to
reproductive health services compare to their counterparts. There were also other
reasons mentioned by women related to cultural practices, norms and beliefs. Many
51
reported that there was no time to go hospital because they were not decided.
Summary
health condition that affects women all over the world and this has not received
sufficient attention despite its high prevalence. Uterine prolapse affects daily life and
From the literature review it is clear the causes and risk factors of uterine
prolapse include multiparty ,early age at marriage, carrying heavy work load during
pregnancy, giving birth to large babies, working immediately after child birth,
pressure on lower abdomen during child birth and also poverty, home delivery,
obesity and constipation . The studies also pointed out that sternous manual work
soon after delivery was an important factor associated with uterine prolapse.
heaviness. Studies shows that both physical and psychological symptoms have direct
surgery (vaginal hysterectomy with PFR), pessary, pelvic floor muscle training. The
prolapse and appears to be an effective treatment for women with stress or mixed
incontinence. There may be therapeutic effect associated with the use of supporting
pessary. Studies also revealed that uterovaginal prolapse can be prevented by having
rest during postpartum period, not doing heavy work during pregnancy and
postpartum, nutritious diet, regular exercise, care during antenatal intrapartum and
Studies also shows that secondary infection, malignancy are the problem
followed by prolapse.
From the literature review it is evident that perceived barriers for seeking
treatment include shame, feeling that care was unnecessary, lack of family support,
inability to share, male service provider, fear of stigma and discrimination and cost of
early management of uterine prolapse should be the first step to reduce this significant
social and health problem. The health care personnel who interact with women may
play a great role by entering them into regular health care system, maintenance of
continuity of care, appropriate referrals when needed and supervision of cost effective
care.
have in depth understanding and deep insight into the problem under study. It also
helped the researcher to establish need for the study, preparation of the tool, designing
48
the conceptual model and research design, planning for data analysis and for good
discussion. The investigator has made exclusive search for the literature related to the
study and it was found that there is a dearth of studies in this area of concern
CHAPTER 3
METHODOLOGY
· Research approach
· Research design
· Variables
· Population
Inclusion criteria
Exclusion criteria
· Tools/Instruments
· Content validity
· Pilot study
CHAPTER 3
METHODOLOGY
it indicates the general pattern for organizing the procedure for collecting valid and
23
reliable data for investigations.
This chapter deals with the methodology adopted for the present study. It
briefly explains the research approach, research design, and variables, setting of the
tool, description of the tool, pilot study, data collection process and plan for data
analysis.
The present study was aimed to assess the knowledge and barriers of health
seeking behaviour on uterine prolapse among married women in selected rural areas
in Kannur District.
Research Approach
In view of the nature of the problem under study and to accomplish the
most appropriate.
51
Research Design
Research design can be defined as an overall plan or blue print the researchers
54
select to carry out their study.
The main objective of the study was to assess the knowledge and barriers of
health seeking behaviour on uterine prolapse among married women. The researcher
did not want to manipulate any variables. These made the researcher to select a
Variables
52
Figure 2 : Schematic representation of the study
53
Setting refers to the physical locations and conditions in which data collection
56
has taken place.
(ward 9 ). Areas –Vattoli (ward 2), Chittariparamba ( ward 8), and P oovathinkeezhil
· Availability of sample
Population:
Population is the set of people or entities to which the results of a research are
52
to be generalized.
In the present study, population is referred to married women in the age group
of 30-60 years.
Sample
Sample is a subset of population elements, which are the most basic units
55
about which data are collected.
The sample size of present study was 371 married women residing in
Chittariparamba panchayat. They were selected as per inclusion criteria of the study
N = Z 2 × (1-P) 2
54
P :- estimated proportion
N :- Number of sample.
= 371.7
Inclusion Criteria
Women
Exclusion Criteria
Women:
Sampling Technique:
Tool/ instruments:
55
A technique is a procedure used to accomplish a specific activity or task.
56
An instrument is the device used to collect data.
The technique used for data collection was self report (interview). The
instrument/ tool used was structured interview schedule to assess the knowledge
55
regarding uterine prolapse and five point rating scale to assess barriers of health
The most appropriate tool was selected based on the utility with respect to the
research problem.
The following steps were taken for the development of items and preparation of
tool.
· Formal discussion were held with guide, co-guide, experts of Obstetrics and
Medicine.
· The final tool was prepared with guidance and suggestion of the guides.
Tool I
This section consists of age, religion, education, occupation, marital status ,type
The maximum score for interview schedule is 20 and each right answer was
In order to achieve the objectives of the study, opinion from statistician, guide,
and experts were taken to categorize the sample according to their knowledge. The
Table 1
2 7 – 13 31 -65% Moderate
3 14 – 20 66 - 100% Adequate
As represented in the table 1, the knowledge scores of married women 0-30% was
Tool II
It is a five point rating scale to assess the barriers of health seeking behaviour
women. The seven areas of barriers of health seeking behaviour on uterine prolapse
are:
The investigator rate the barrier statement according to the agreement on each
five to one with a maximum total score scale is 120 and minimum score is 24.
In order to achieve the objectives of the study, opinion from statistician, guide,
and experts were taken to categorize the sample according to their barriers of health
Table 2
As represented in the table 2, the barrier score 20-46% was considered as mild
barrier, 47-73% moderate barrier and 74-100% considered as strong barriers of health
items. It depicted the distribution of items according to the content areas on three
aspects of uterine prolapse among married women. The knowledge domain had 9
items (45%), comprehension had 4 items (20%), and application domain had 7 items
relevance, and appropriateness of the content. Criteria check list consisted of four
columns namely very relevant, somewhat relevant, and not relevant. Experts were
59
requested to give their valuable suggestions and opinions. Based on the suggestions
Content validity
Content validity of the structured interview schedule and rating scale was
Psychiatric Nursing .The experts were requested to judge the items for accuracy,
experts were incorporated in to the tool and the tool was modified accordingly.
The final draft of the tool consisted of 20 items related to anatomy of female
prolapse and 24 statements under seven areas in five point rating scale to assess
Ethical clearance:
Approval was obtained from the institutional ethics committee to conduct the
research study. Permission was also obtained from the panchayat president of
Chittariparamba panchayat to conduct the study. Individual consent was taken from
than study sample. Reliability coefficient of the interview schedule was established by
60
split half method using Spearman-Brown Prophecy formula and was found to be 0.65.
The reliable coefficient of rating scale was estimated using Cronbach’s alpha
The final draft of the tool was prepared incorporating the modifications
suggested by experts.
Tool I and II was translated to Malayalam and retranslated to English with the
help of language experts. It was found that the tool was valid regarding language and
The pretesting of the validated tool was done among five married women at
determine the clarity of item, feasibility, ambiguity and time required to complete the
items. The researcher herself collected data using structured interview schedule and
five point rating scale. The language was clear and simple. The women were able to
understand and respond to items clearly. The average time taken for the interview was
20-30 minutes.
Pilot study
A pilot study is a small -scale version or a trial run done designed to test the
55
methods to be used in a larger, more rigorous in preparation of the complete study.
Mangattidam Panchayat and approval from the ethics committee, a pilot study was
61
After explaining the purpose of the study and willingness to participate in the
study, 30 married women were interviewed using interview schedule and barrier
rating scale. The data collected were tabulated and analyzed using descriptive and
inferential statistics.
and comprehensiveness of the tool and information booklet. The collected data were
The study was conducted after getting approval from the institutional ethics
president. The investigator selected ward 11,12 and ward 9 of Manandheri and
using convenience sampling and descriptive survey approach. The rural areas were
particular areas.
The purpose of the study was explained and confidentiality was ensured. After
obtaining written informed consent, data was collected using interview schedule and
62
rating scale. It took 20-30 minutes for conducting interview for each subject.
Investigator had interviewed 10-15 samples per day. The investigator took 5-13 days
for the interview in one area. After interview has completed, both individual and
group health education was given on the causes, symptoms, management and
Group health education was given with the help of kudumbasree workers of the
meeting where health education was given to all married women who have undergone
data collection. This pattern was followed during entire data collection period.
conducted interview for five days and collected data from 70 subjects.
Chittariparamba panchayat. Here the investigator spent 6 days for interview and
panchayat. Here the investigator spends 2 days for interview and obtained data from
20 subjects.
The investigator took 10 days for interview and collected data from 68
All the subjects were co-operative, they were able to understand and respond
to items clearly and clarified their doubts. Investigator was able to complete data
63
collection, and health education without much difficulty with the help of kudumbasree
which is easily understood and helps to improve awareness regarding uterine prolapse
and its causes, symptom, management and preventive aspects after reviewing various
books, journals, web and research studies. The content was validated by experts in
Obstetrics and Gynaecology and Obstetrics and Gynaecological Nursing and also by
the Proof editors. It was distributed to all the subjects after interview and health
education.
percentage.
correlation.
64
women and selected socio personal variables would be analysed using chi-
square test.
CHAPTER 4
CHAPTER 4
Interpreting the findings is the most challenging and least structured step in
56
the findings which requires the investigator to be creative.
This chapter deals with the analysis and interpretation of data collected to
assess the knowledge and barriers of health seeking behaviour on uterine prolapse
among married women in selected rural areas in Kannur. The data collected from 371
women using a structured interview schedule and rating scale was organized,
The findings of the study have been presented under the following sections:-
married women.
women.
percentage.
This section deals with the distribution of subjects according to socio personal
history of uterine prolapse, history of uterine prolapse among sample and family
members affect with uterine prolapse. The data was analyzed using frequency and
Table 3
Age
Religion
b) Muslim 62 16.7
c) Christian - -
d) Others - -
Education
c) Higher Secondary 63 17
d) College 70 18.9
Occupation
Data presented in table 3shows that 45.3% of subjects are in the age group of
30-40years,36.9% belongs to the age group of 41-50 years and 17.8% are in the age
69
group of 51-60years. Majority of the sample (83.3%) belongs to the Hindu religion,
16.7 % of the sample are Muslims. Forty two percentage (42%) women had high
school education, 18.9% had college education, 18.6% had primary education, 17%
and 3.5% of the sample had higher secondary education and professional /technical
qualifications. Most of the sample (45.80%) are homemakers, 20.80% are manual
a. Marital status
1.60%
8.60%
Married
Widow
Seperated /Divorced
89.90%
Data presented in figure 3 shows that majority of the sample (89.90%) are
b. Type of family
4.30%
31.30%
Nuclear family
Joint family
Extended family
64.40%
Data presented in figure 4 shows that 64.40% of the sample belongs to nuclear
3.50%
11.10%
≤ 5000
5001-10,000
10001-20,000
>20001
26.40%
59.00%
Figure 5 depicts that most of the sample (59.0%) have monthly income
Rs≤5000, 26.40 % of the sample belongs to the income group of Rs. 5001 -10,000,
11.1% have and income of Rs 10001-20,000 and 3.50% have more than Rs 20,000 as
d. Number of children
60 56.1%
50
40
Percentage
30
20
15.6% 16.2%
10 7.5%
4.6%
0
Nil One Two Three Four/more
Figure 6: Distribution of sample according to number of children
Figure 6 reveals that most of the samples (56.1%) have two children, 4.6%
have no children.
73
47.20% yes
52.80% No
on uterine prolapse
uterine prolapse.
74
25.00%
18.30%
20.00%
15.00%
10.00%
5.00%
0.00%
Hea lth personnel Friends /relatives Media /magazine
Figure 8: Distribution of sample based on source of information regarding
Uterine prolapse.
care personnel being their major source of information, 46.3% of sample received
information from frie nds / relatives and 18.3% considered maga zine and medias as
g. History of uterine prolapse among sample and family members affected with
prolapse
3.50%
Yes
No
96.50%
Figure 9 shows that of 371 sample ,3.5% of the women have history of uterine
Sample
23.10%
30.80% Sister
23.10% Mother
23.10% Mother in law
Figure 10: Distribution of sample based on history of uterine prolapse and family
Figure 10shows that of 371 sample only 13 reported uterine prolapse and also
their family members affected with uterine prolapse. Of the 13 subjects, four (30.8%)
reported to be affected with uterine prolapse and having undergone surgery. Nine
(three sample each) reported that their sister (23.10%), mother (23.10%) and mother
married women.
women.
women.
Table 4
women ( n=371)
Data presented in table 4 shows that majority of the subjects (76.8%.) have
moderate knowledge, 17.5% of them have adequate knowledge and 5.7% have
B:- Analysis of knowledge score regarding uterine prolapse among married women
Table 5
Mean ,SD and mean percentage of knowledge score regarding uterine prolapse
(n=371)
Uterine prolapse
From table 5 it is clear that the mean percentage of total knowledge score is
54.99% with mean± SD of 11.0±2.638. Hence it is evi dent that knowledge regarding
percentage.
78
Table 6
( n=371)
From the table 6 it is evident that majority of sample (70.4%) have mild
barriers, 26.4% have moderate barriers and 3.2% of sample have strong barriers of
B:-Area wise analysis of barrier score of health seeking behaviour on uterine prolapse
Table 7
Area wise mean, SD, mean percentage of barrier of health seeking behaviour on
(n = 371)
Sl No Barrier area Mean SD Median Mean
Percentage
pressure
facility
The data presented in the table 7 shows that the mean percentage of the total
women is 40.33 with mean ± SD of 48.39 ±18.367. Are a wise mean percentage of
barriers of health seeking behaviour score is 35.60% with mean± SD of 5.34 ± 2.791
in the area of knowledge and awareness. In the area of embarrassment and fear, mean
percentage of barrier score is 38.58% with a mean ± SD of 7.72± 3.440 in the area
80
related to attitude and beliefs .In the area related to lack of support and peer pressure,
the area of time and cost, mean percentage of barrier score is 36.66% with a mean ±
8.65±3.908 in the area of cultural factors. In area related to accessibility to health care
facility, mean percentage of barrier score is 44.99% with a mean ± SD of 4.50± 2.737.
From the above findings, it is evident that the married women in rural area
findings also reveal that area wise analysis of seven areas of barriers of health seeking
behaviour on uterine prolapse reveal that mean percentage of barrier score is more in
the area of embarrassment, fear (46.77%) when compared to other areas. Hence it is
inferred that embarrassment and fear act as moderate barriers of health seeking
behaviour on uterine prolapse among married women, a null hypothesis and research
significance.
H1:- There is significant correlation between knowledge and barriers of health seeking
The Hypotheses are formulated and are tested using Karl Pearson’s correlation
coefficient test.
Table 8
(n=371)
Variables Pearson correlation df P value
(r) coefficient
uterine prolapse
0.325 is greater than that of critical value (table value-0.194) at p< 0.001 level of
significance. The test is found to be statistically significant as the computed p< 0.001
among married women. This shows that as the knowledge regarding uterine prolapse
women and selected socio personal variables, the following hypotheses are
The hypotheses are formulated and tested by using Chi- square test (χ2). The
below median and above median. The median is 11. The value of χ2 is calculated to
find the association between knowledge score regarding uterine prolapse among
married women and selected socio personal variables such as age, education,
Table 9
n= 371
2
Sl No Socio Personal variable χ value df P value Inference
members
2 2 2 2
Table value=χ 0.05 (2) =5.99,χ 0.05 (4 )=9.49,χ 0.05 (3) =7.810,χ 0.05(1)=3.84
***Highly significant at p< 0.001 level.
* Significant at p< 0.01 level.
* Significant at p< 0.05 level.
NS - Not Significant p>0.05 level
Data presented in table 9 reveals that all the chi square values related to
information on uterine prolapse are larger than the critical value(tabled value) at
p<0.001, p<0.01 and p< 0.05 level of significance. Hence, the test is found to be
significance. Therefore, the researcher accepts the research hypothesis. Thus, it can be
2 2
p<0.001), occupation (χ =14.494;p<0.01), type of family (χ =6.258; p<0.05),
2
monthly income of family (χ =11.565; p<0.01),and exposure to source of
2
information regarding uterine prolapse (χ =4.508;p<0.05).
uterine prolapse among sample and family members, are smaller than that of critical
value (tabled value) at p> 0.05 level of significance. Therefore the test is not found to
significance. Hence, the null hypothesis is accepted, and it can be concluded that there
2
(χ =8.193;p>0.05),and history of uterine prolapse among sample and family
2
members (χ =3.790;p>0.05).
86
prolapse among married with selected socio personal variables the following
on uterine prolapse among married women and selected socio personal variables .
on uterine prolapse among married women and selected socio personal variables.
The hypotheses are formulated and are tested by using Chi- square test (χ2).
The barriers of health seeking behaviour score regarding uterine prolapse among
married women is classified as below median and above median. The median is 43.
The value of χ2 is calculated to find the association between barriers of health seeking
behaviour score regarding uterine prolapse among married women with selected socio
personal variables such as age, education, occupation, type of family, monthly income
Table 10
uterine prolapse among married women and selected socio personal variables
n= 371
2
Sl No Socio Personal variable χ value df P value Inference
members
Tabled value= χ2 0.05 (2) =5.99, χ2 0.05 (4 )=9.49, χ2 0.05 (3) =7.810,χ2 0.05 (1)
=3.84,
***Highly significant at p< 0.001 level.
* Significant at p< 0.01 level.
* Significant at p< 0.05 level.
NS - Not Significant p>0.05 level
The data presented in the table 10 reveals that the Chi-square values related to
and exposure to source of information on uterine prolapse are greater than that of
critical value (tabled value) at p<0.001,p<0.01 and p< 0.05 level of significance.
88
Hence the tests is found to be statically significant as computed p<0.001, p<0.01 and
p<0.05 level. The null hypothesis is rejected and research hypothesis is accepted.
seeking behaviour on uterine prolapse and socio personal variables such as education
2 2
(χ =.24.211;p<0.001), occupation (χ =.27.326;p<0.001), type of family
2
(χ =12.419 ;p<0.001),monthly income of family (χ2=22.677;p<0.001),number of
(χ2=4.460;p<0.05).
However chi square value related to socio personal variables such as age and
history of uterine prolapse among sample and family members are less than that of
critical value (tabled value) at p>0.05 level of significance. Test is not found to be
between barriers of health seeking behaviour on uterine prolapse and socio personal
variables such as age (χ2=.529, p > 0.05) history of uterine prolapse among sample
CHAPTER 5
RESULTS
· Objectives
· Hypotheses
· Results
90
CHAPTER 5
RESULTS
This chapter present the major result of the study. The chapter is organized
under three headings; objectives, hypotheses and major results of the study.
married women.
Hypotheses
The findings of the study have been organized and presented under the
following sections:-
Among the sample, 45.3% are in the age group of 30-40 years, 36.9% are in
the age group of 41-50 years and 17.8% belongs to age group of 51-60 years.
Among the sample, 42% had high school education,18.6% had primary school
education, 18.9% had higher secondary, 17% and 3.5% had college and
professional/technical qualifications.
Most of the sample (45.3%) are homemakers, 20.80% are manual labour
Among the subjects, 64.4% come from nuclear family, 31.3% belong to joint
family.
prolapse
Among the sample, 35.4% got information on uterine prolapse from contact with
health care personnel 46.3% from friends / relatives, 18.3% from magazine and
medias.
92
Among the sample 3.5% of the women have history of uterine prolapse in
their family
Of 371 sample, only 13 sample reported uterine prolapse and also their family
surgery. Nine sample (three sample each) reported their sister (23.10%),
married women.
uterine prolapse.
moderate.
Majority of sample ( 70.4%) have mild barriers, 26.4% have moderate and
Area wise mean percentage of the total score on barriers of health seeking
of 7.72± 3.440 in the area related to attitude and beliefs .In the area related to
lack of support and peer pressure, the mean percentage of barrier score is
33.26% with a mean ± SD of 4.99±2.390. In the area of time and cost mean
The findings indicate that married women in rural area have mild barriers of
uterine prolapse reveal that mean percentage of barrier score is more in the
The study reveals that 76.8% of married women have moderate knowledge
and 70.4% married women have mild barriers of health seeking behaviour on
women.
larger than the critical value (tabled value) at p<0.001,p<0.01 and p<0.05 level
uterine prolapse
prolapse among sample and family members, are smaller than that of critical
value (tabled value) at p> 0.05 level of significance. Therefore the test is not
such as age, number of children, and history of uterine prolapse among sample
p<0.001,p<0.01 and p< 0.05 level of significance. Hence the tests is statically
Chi square value related to socio personal variables such as age and history of
uterine prolapse among sample and family members are less than that of
such as age and history of uterine prolapse among sample and family
members.
96
CHAPTER 6
· Discussion
· Summary
· Conclusion
· Nursing implications
· Limitations
· Recommendations
97
CHAPTER 6
This chapter presents the discussion, summary of the study, major findings,
Discussion
The study was conducted to assess knowledge and barriers of health seeking
The findings of the study are discussed below in relation to the findings of
The first objective of the study is to assess the knowledge regarding uterine
The present study reveals that most of the women (76.8%) have moderate
Vidhyalatha to assess the knowledge and risk factors for uterovaginal prolapse among
300 married women aged 30-60 year in selected villages of Udupi district, Karnataka,
which shows that majority (59%) of the married women had moderate knowledge on
26
uterovaginal prolapse, 6% had good knowledge and 35% had poor knowledge.
The study is incongruent with a study conducted by Goman HM, Fetohy EM,
Alexandria the results revealed that more than two thirds of cases (70.4%) had poor
(36.4%) or fair knowledge (34%) and only 29.6% had satisfactory knowledge. The
majority of women having positive perception to diagnosis and symptoms for genital
98
Nepal, which shows that women had a moderate level of knowledge regarding uterine
6
prolapse (51.9%).
parous women in Bhaktapur Municipality in Bhaktapur, Nepal, shows that only 39%
.1
of respondents were aware regarding the uterine prolapse
In the present study shows that majority of sample (70.4%) have mild barriers,
3.2% of sample have strong barriers, 26.4% have moderate barriers of health seeking
behaviour on uterine prolapse among married women. The total mean percentage of
study among 1046 ever married women of reproductive age group (15-49) at slums of
Rajkot city, Gujarat using two stage cluster sampling and the result shows that cost
and societal barriers were the reasons for not seeking care, whereas poor provider‘s
attitude, poor quality of services and long waiting time were the reasons for not
51
utilizing public health facilities.
J M among 300 women, between 30-60 years of age who were residing in Madayi
99
rural community area in Kannur district, shows that greater percentage (41.3%) of the
sample have very strong barriers, 35 % have strong barriers, 19.7% have moderate
Singh A to estimate the prevalence of self reported uterine prolapse and to determine
the treatment-seeking behaviour among 2,990 married women of Dadu Majra colony,
Chandigarh, India. The results shows, of the 227 women with self-reported uterine
prolapse, 128 (57%) had not taken any treatment, 28 went to a traditional birth
included shyness (80; 63%), lack of cooperation by the husband, lack of time (80;
50
63%) and lack of money (74; 58%).
Third objective of the study are to find the correlation between knowledge and
among300 women, between 30-60 years of age who are residing in Madayi rural
community area in Kannur district, which shows that there is an intermediate level of
score regarding uterine prolapse among married women and selected socio personal
100
score regarding uterine prolapse among married women and selected socio personal
variables such as age, number of children, and history of uterine prolapse among
parous women in Bhaktapur Municipality in Bhaktapur, Nepal. The results shows that
14
there is statistically significant association between knowledge and occupation.
The present study is also incongruent with the above study, which shows that
14
there is no significant association between knowledge and education.
Eleje GU, Udegbunam OI, Ofojebe CJ, Adichie CV to determine the incidence, risk
factors and management modalities of pelvic organ prolapse among women who
Newi, South-east Nigeria and the results shows that there is significant association
24
between prolapse and advanced age (P <0.001).
uterine prolapse among 4,693 married women aged 15– 49 years at urban and rural
settings in Nepal and the result shows that there is significant association between
.25
knowledge and education
uterine prolapse among 4,693 married women aged 15– 49 years at urban and rural
settings in Nepal and the result shows that there is significant association between
25
knowledge and age.
assess the knowledge and risk factors of uterine prolapse among married women in
Karnataka, which shows that there is significant association between knowledge with
26
education and monthly income .
Fifth objective of the study to find the association between barriers of health
In the present study, there is significant association between the barrier score
regarding uterine prolapse among married women with selected socio personal
uterine prolapse and socio personal variables such as age , history of uterine prolapse
reproductive morbidities and treatment seeking behaviour among 200 married women
from Jamalpur Awana rural health center of Christian Medical College and Hospital,
Ludhiana and the result shows that there is no significant association between barriers
1
of health seeking behaviour and age.
The present study is also incongruent with the above study, which shows that
Summary
prevalence, awareness and seeking treatment for these problems varies from region to
region. In the Indian scenario women face social and economic barriers in seeking
care. Uterine prolapse is one of the main gynaecological problem. Uterine prolapse
(UP), also known as pelvic organ prolapse or genital prolapse, is a reproductive health
problem .In this condition, failure of ligamentous and fascial supports causes the
uterus to descend into or beyond the vagina, resulting in protrusion of the vagina, the
uterus, or both. It may seriously influence the physical, psychological and social well
infection and need for treatment so that women can themselves identify the symptoms
The present study was conducted to assess the knowledge and barriers of
health seeking behaviour on uterine prolapse among married women in selected rural
Objectives
married women.
Assumptions
Hypotheses
structured interview schedule and five point rating scale at 0.05 level of
significance
personal variables.
The conceptual framework used for the study is based on Rosenstock and
Becker’s Health Belief Model and this model is based on motivational theory. Health
belief model is a health behaviour change and psychological model for studying and
promoting the uptake of health services. The major concepts of this model are
Quantitative non experimental study with descriptive survey design was used
for the study. The research variables are knowledge regarding uterine prolapse and
refers to selected socio personal variable such as age, religion, education, occupation,
prolapse.
subcentres –Manandheri (ward 11, 12), Kannavam (war d 9 ). Areas–Vattoli (ward 2),
panchayat.
The sample consisted of 371 married women who fulfilled the inclusion
criteria. Non probability Convenience sampling technique was used for the study.
The technique adopted was self reporting and the tool developed for data
uterine prolapse among married women and five point rating scale to assess the
aspects of uterine prolapse among married women. The knowledge domain had 9
items (45%), comprehension had 4 (20%), and application domain had 7 items (35%)
The content validity of the tool was done by seven experts. Reliability
coefficient of the interview schedule was established by split half method using
of rating scale was estimated using Cronbach’s alpha correlation coefficient formula
and was found to be 0.75.Tool I and II was valid regarding language and equally
105
semantic. Pre testing of the tool was done to determine the clarity of item, feasibility,
The study was conducted after getting approval from the institutional ethics
president. The investigator selected ward 11,12 and ward 9 of Manandheri and
using convenience sampling and descriptive survey approach. The purpose of the
study was explained and written informed consent was obtained after the assuring
confidentiality.
It took 20-30 minutes for conducting interview for each subject .Investigator had
interviewed 10-15 sample per day. The investigator took 5-13 days for the interview
in one area. After the interview was completed, both individual and group health
education was given on the causes, symptoms, management and prevention of uterine
uterine prolapse
contact with health care personnel, 46.3% from friends / relatives and
their family.
Of 371 sample only 13 sample reported uterine prolapse and also their
undergone surgery. Nine sample (three sample each) reported their sister
prolapse.
Mean percentage of total barriers score is 40.33% which shows that the
prolapse.
members.
age and history of uterine prolapse among sample and family members.
108
Conclusion
Based on the findings of the present study ,the following conclusions are made
Majority of the married women in the rural area have moderate knowledge
Rural women have moderate barriers of health seeking behaviour in the area
children and history of uterine prolapse among sample and family members
behaviour on uterine prolapse and socio personal variables such as age and
which can empower them to take care of their own health as well as protect
intervention is mandatory.
Nursing Implications
Nursing practice
Nursing is the profession within the health care sector focused on the care of
individual, families, and communities. They may help to maintain, recover, and attain
optimal health and quality of life. In the interest of safe and effective practice, nurses
and midwives are expected to maintain a current knowledge base and are responsible
for ongoing education in their chosen areas of practice. The status of nursing as a
profession is important because it reflects the value society places on the work of
nurses and the centrality of this work to the good of society. The study findings
problem. Hence they need to know about risk factors, symptoms and management of
uterine prolapse.
Nurses are considered as key persons to bring desired changes at the work
practice. As a health care professional, the nurse must place emphasis on those
110
activities, which promote the health of women and protected them from disease as
well as improve their health seeking behaviour. Professional nurses can organize
incontinence and pelvic organ prolapse),having undergone a special course, can assess
these patients and provide care and educate them regarding management of prolapse
and incontinence. Nurses who initially assess the women should pursue this aspect of
care beyond handling patients on a sheet of paper with instructions for performing
kegel exercises.
Nursing personnel should be give special concern to plan and administer the
This will help to empower women and protect their life in a healthy way.
Nurse with the unique knowledge and skill to assess these women with uterine
prolapse can provide health education to overcome barrier and promote early health
Nursing education
revolve around ideas and innovations because it will be extremely essential to learn
The purpose of nursing education is to prepare a person who can fulfil the
role, functions and responsibilities of a professional nurse within the society and
plan and implement programmes for women with Gynaecological morbidities along
women aware of those hidden Gynaecological morbidities and promote early health
seeking behaviour.
Nursing administration
Nurses are the major human resource in health service management at all
levels and they are called upon to manage the health care delivery system. They can
understand the magnitude of the problem and should recognize the need for
educational programmes in this topic. The nurse administrator can arrange health
education regarding uterine prolapse. The administrator can use the findings of the
study to report to the concerned authority the need for effective communication and
recommended to implement a clinic based health campaign to screen cases along with
a treatment and prevention program. Today nurses are called upon to take part in the
management of health care delivery system, as they are the major qualified human
resource agents responsible for health service management at all levels. In health care
institutions today nurses are involved not only in the management of individual
patients in the ward or unit or department but are also made to shoulder the
organizations should involve mass media in order to spread awareness about the
Nursing research
increasingly are expected to adopt an evidence based practice which is defined as the
best clinical evidence in making patient care decisions. Nurse researchers can conduct
research studies to assess the causes and risk factors of uterine prolapse and also
effect of non surgical interventions like pelvic floor exercises, and use of pessary for
can make valuable contribution in these areas through research and clinical practice.
By this study, it is evident that rural area women are having moderate
knowledge regarding the uterine prolapse. With a strict regulatory frame work,
prospective clinical study, scientific progress could be secured for promotive patient
safety and care with uterine prolapse. Nurses should take initiation to conduct more
researchers in their working field so that they can provide better improvised care to
practice in nursing has been regarded as means of ensuring that quality care is
provided.
113
Limitations
The investigator took more time to complete the interview for some subjects.
Some subjects did not show interest in completing the interview schedule.
Recommendations
A study can be conducted to assess the prevalence and risk factors of uterine
Kannur.
A cross sectional study can be done to assess the knowledge and preventive
Kannur.
114
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115
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APPENDIX A
List of Abbreviations
UP Uterine Prolapse
n number of sample
SD Standard Deviation
P Probability
df degree of freedom
124
APPENDIX B
Thrissur. ACME,Pariyaram.
THQ Govt.Hospital
Taliparamba .
125
APPENDIX C
APPENDIX D
APPENDIX E
APPENDIX F
APPENDIX G
APPENDIX H
Criteria checklist to validate the tool to assess the knowledge regarding uterine
Kindly review the items in the research tool and give your valuable
suggestions. Please put a tick mark against the specific column. If there are any
1
2
3
4
5
6
7
8
9
9a
10
10a
131
women.
10
11
12
13
14
15
16
132
17
18
19
20
Tool II- Five point Rating scale to assess the barriers of health seeking behaviour
1.
2.
3.
4.
5.
6.
7.
10
11
12
13
133
14
15
16
17
18
19
20
21
22
23
24
134
APPENDIX I
Informed consent
CODE NO
Consent Form
2nd year MSc Nursing student, College Of Nursing, ACME, Pariyaram, to participate
in the research study of her MSc Nursing course titled, “assess the knowledge and
barriers of health seeking behaviour on uterine prolapse among married women in the
I have been explained and made understood the need and importance of this
I have been ensured that the study doesn’t include any foreseeable risk or harm
Date:
APPENDIX J
2. Put a tick mark (√ ) in most appropriate space as per response given by the participants
Section A
b) 41-50 [ ]
c) 51-60 [ ]
2. Religion
a) Hindu [ ]
b) Christian [ ]
c) Muslim [ ]
d) Others [ ]
3. Education
a) Primary [ ]
b) High school [ ]
c) Higher secondary [ ]
d) College [ ]
e) professional/technical [ ]
136
4. Occupation
a) home maker [ ]
b) manual labour [ ]
c) private employee [ ]
d) govt. employee [ ]
5. Marital status
a) married [ ]
b) widow [ ]
c) Divorced/ Separated [ ]
6. Type of family
a) nuclear [ ]
b) joint [ ]
c) extended [ ]
a) ≤ 5000 [ ]
b) 5001- 10000 [ ]
c) 10001- 20000 [ ]
d) > 20001 [ ]
8.Number of children
a) Nil [ ]
b) One [ ]
c) Two [ ]
d) Three [ ]
e) four or more [ ]
137
a) yes [ ]
b) no [ ]
a) health personnel [ ]
b) friends /relatives [ ]
c) media/magazines [ ]
10. Do you or any of your family members have a history of Uterine prolapse ?
a) yes [ ]
b) No [ ]
married women
a) fat tissue [ ]
c) pelvic girdle [ ]
d) vertebral column [ ]
138
a) tilted backward [ ]
b) tilted to right [ ]
c) tilted forward [ ]
d) tilted to left [ ]
a) rectum [ ]
b) cervix [ ]
c) bladder [ ]
d) intestine [ ]
a) ovarian tumour [ ]
c) tubal pregnancy [ ]
d) use of contraceptive [ ]
a) caesarean birth [ ]
b) early menarche [ ]
d) obesity [ ]
139
a) Stroke [ ]
d) bladder cancer [ ]
a) doing heavy work during pregnancy and after delivery increases risk
of prolapse [ ]
a) cancer [ ]
c) infertility [ ]
a) Frequent voiding [ ]
a) to support uterus and pelvic organ to stop them from coming down[ ]
b) as a contraceptive [ ]
c) soak in chemicals [ ]
d) boiling [ ]
a) every month [ ]
d) after 1 year [ ]
141
a) allergic reactions []
c) narrowing of vagina []
19. The following are self care measure to prevent prolapse except
APPENDIX K
Answer key
1 d 11 b
2 b 12 c
3 c 13 b
4 c 14 d
5 a 15 a
6 b 16 a
7 d 17 b
8 b 18 b
9 b 19 b
10 a 20 d
143
APPENDIX L
Blue print of Tool I
APPENDIX M
The following are the few statements reflecting barriers of health seeking
· Please read the statement and put a ( √ ) mark against five point scale
Code No:
NO Agree Disagree
consider as serious to be
treated
problems
3 Gynaecological examination
menopause
145
Embarrassment, fear
embarrassment
me from undergoing
examination
6 Gynaecological procedure
is too painful
8 Reluctant to do
Gynaecological
violation of confidentiality
uterine prolapse
146
prevalent in low
socioeconomic status
11 There is no need to
12 Uterine prolapsed is an
embarrassing disease
pressure
13 I feel embarrassed to
disclose my gynaecological
problems
interested in my health
problem
15 No one to accompany me
to seek healthcare
expensive.
147
Cultural factors
heath care
me to go outside alone.
seek services
communicating symptoms
to doctor.
Accessibility to health
care Facility
from home.
examined.
148
APPENDIX N
SCORING
0-6 Inadequate
7 – 13 Moderate
14 – 20 Adequate
Tool II -Five point rating scale to assess the barriers of health seeking behaviour
Strongly Agree – 5
Agree – 4
Uncertain – 3
Disagree - 2
Strongly Disagree – 1
24-56 Mild
57-88 Moderate
89-120 Strong
149
APPENDIX O
k½X]{Xw
]cnbmcw \gvknwKv tImtfPv c−mw hÀj Fw.Fkv.kn
Xo¿Xn:
t]cv:
APPENDIX P
tImUv \¼À:
hn`mKw F:
1. {]mbw
a) 30þ40 hbÊv [ ]
b) 41þ50 hbÊv [ ]
c) 51þ60 hbÊv [ ]
2. aXw
a) lnµp [ ]
b) {InkvXy³ [ ]
c) apÉow [ ]
d) aäpÅh [ ]
3. hnZym`ymk tbmKyX
a) {]mYanI hnZym`ymkw- [ ]
b) sslkvIqÄ hnZym`ymkw- [ ]
c) lbÀsk¡âdn [ ]
d) tImtfPv hnZym`ymkw- [ ]
4. sXmgnÂ
a) Krl`cWw [ ]
b) Iqen¸Wn [ ]
c) Khs×âv tPmen [ ]
d) kzImcytaJebn tPmen [ ]
5. hnhmlmhØ
a) hnhmlnX [ ]
b) hn[h [ ]
c) hnhmltamN\w t\SnbhÀ/ [ ]
6. GXpXcw IpSpw_w
a) AWpIpSpw_w [ ]
b) Iq«pIpSpw_w [ ]
c) hnkvXrXamb IpSpw_w [ ]
7. amkhcpam\w
b) 5001þ15000 [ ]
c) 15001þ25000 [ ]
d) 25000\v apIfn [ ]
8. Ip«nIfpsS F®w
a) CÃ [ ]
b) H¶v [ ]
c) c−v [ ]
d) aq¶v [ ]
e) \mtem AXne[nItam [ ]
152
Adnhv In«nbn«pt−m?
a) D−v [ ]
b) CÃ [ ]
a) BtcmKzhnZKvZÀ [ ]
b) _\v[p¡Ä/ kply¯p¡Ä [ ]
c) Zyiy{ihyam[ya§Ä [ ]
d) aäpÅhhyIvXam¡pI [ ]
a) D−v [ ]
b) CÃ [ ]
hn`mKw: _n
a) AWvUmib§Ä,BKvt\b{K\vYn,IpSÂ,
AWvUhmln\n¡pgepIÄ [ ]
b) AWvUmib§Ä,hy¡,IcÄ,KÀ`mibw [ ]
c) AWvUmib§Ä, ¹ol,KÀ`mibw,h³IpS [ ]
d) AWvUmib§Ä, AWvUhmln\n¡pgepIÄ, [ ]
KÀ`mibw, tbm\n
a) sImgp¸v]mfnIÄ(sImgp¸vIeIÄ) [ ]
b) CSp¸nset]inIfpw X´p¡fpw [ ]
c) CSps¸Ãv [ ]
d) \s«Ãv [ ]
a) ]pdIntem«vsNcnªv [ ]
b) heXvhit¯¡vsNcnªv [ ]
c) apt¶m«v sNcnªv [ ]
d) CSXvhit¯¡v sNcnªv [ ]
a) aemibw [ ]
b) KÀ`mibapJw [ ]
c) aq{Xmibw [ ]
d) IpSÂ [ ]
154
DuÀ¶phcp¶ AhkvY [ ]
a) AÞmib¯nse apg [ ]
b) P\\kab¯p−mIp¶ apdnhv [ ]
c) AÞhmln\n¡pgense KÀ`[mcWw [ ]
a) kntkdnb³ ikv{X{Inb [ ]
b) t\ct¯bpÅ BÀ¯hw [ ]
d) s]m®¯Sn [ ]
a) DZcthZ\, O˱n [ ]
b) XethZ\, ]\n [ ]
d) BÀ¯hkw-_ÔambAkzØXIfpw [ ]
P\t\{µnb¯nse ---{hW§fpw
155
9. Xp½pt¼mgpwNncn¡pt¼mgpwNpabv¡pt¼mgpwA\nb{´nXambn
aq{Xwt]mIp¶XnsâImcWw
a) ]£mLmXw [ ]
b) CSp¸nset]inIfpsS _e¡pdhv [ ]
c) kpjpav\m\mUnbn apdnhv [ ]
d) aq{Xmib¯nse AÀ_pZw [ ]
a) AÀ_pZw [ ]
b) tbm\n`mK¯pÅ AÄkÀ [ ]
c) hÔyX [ ]
a) s]kdn [ ]
b) ikv{X{Inb [ ]
c) acp¶pIÄ [ ]
Hgnhm¡pI [ ]
c) k¼qÀ®amb hn{iaw [ ]
a) ASn¡SnbpÅ aq{Xsamgn¡Â [ ]
c) CSp¸nset]inIfnepÅ hymbmaw [ ]
15.s]kdn D]tbmKn¡p¶Xv
b) KÀ`\ntcm[\amÀKvvKambn [ ]
c) CSp¸nset]inIÄ _es¸Sp¯p¶Xn\v [ ]
d) CSp¸vthZ\ Ipdbv¡p¶Xn\v [ ]
157
b) kpK\v[apÅhkvXp¡ÄD]tbmKn¨vIgpIpI [ ]
c) cmk]ZmÀXvY¯n ap¡nshbv¡pI [ ]
d) Xnf¸n¡pI [ ]
a) FÃmamkhpw [ ]
c) 4‐ 6 amk¯n Hcn¡Â [ ]
d) Hcp hÀj¯n\ptijw [ ]
a) AeÀPn [ ]
b) tbm\nbnseAWp_m[bpw{hWhpw [ ]
c) tbm\o`mKw Npcp§p¶Xv [ ]
a) Kply`mKwipNnbmbpwCuÀ¸clnXambpw kq£n¡pI [ ]
b) kaoIrXmlmcw Ign¡pI [ ]
APPENDIX P
KthjI\pÅ \nÀt±i§Ä
klImcn¡pÅ \nÀt±i§Ä
]qÀ®ambnhntbmPn¡p¶p
hntbmPn¡p¶p
XoÀ¨bnÃ
tbmPn¡p¶p
\w {]kvXmh\IÄ
Adnhv, t_m[y§Ä
BhiyanÃ
Fs¶\n¡dnbnÃ
3 BÀ¯hhncma¯n\ptijw kv{XoP\y
]cntim[\bpsS BhiyanÃ
160
\mWt¡Sv, `bw
hnapJX tXm¶p¶p.
ImWn¡p¶Xv
kao]\hpw hnizmk§fpw
ImWs¸Sp¶p.
Cd§p¶Xv ImWs¸Sp¶p.
¡fpsS k½À±w
kabhpw, km¼¯nIhpw
16 BtcmKyImcy§Ä¡pth−n sNehgn¡m³
F\n¡v kabanÃ
kmwkvImcnI LSI§Ä
tXSp¶XnÂ\n¶pw Fs¶XSÊs¸Sp¯p¶p.
\n¡m³ t{]cn¸n¡p¶p.
24 kv{XotcmK ]cntim[\tI{µ¯nÂ
hfsct\cw Fsâ Dugw Im¯v
\nÂt¡−nhcp¶p.
163
APPENDIX Q
INFORMATION BOOKLET
(ssI¸pkvXIw)
amÀ¤§fpw
Prepared by, Suggestions B y,
Prof.(Mrs).Sre eja
Akhila.p
G.Pillai And
nd
II year MSc Nursing Mrs.Mollykut ty Joyichan
BapJw
KÀ`-]m-{X-t¯bpw \s«-Ãn
sâ Iogv`m-Ks¯ km{I-s¯bpw _Ôn-
¸n-¡p¶ ensÜâmWv bqt{Sm-km-
{IÂ ensÜâv. Cu ensÜâp-I-fmWv
KÀ`-]m-{Xs¯ Dd-¸n¨p \nÀ
\mev L«§fp−v.
s{]mem]vsk¶pw ]dbp¶p.
168
ImcW§Ä
s]m®¯Sn
· ]mc¼cy LSI§Ä
· P·\mbpÅ sshIeyw
e£W§Ä
· AkzØX tXm¶pwhn[w tbm\nbn \n¶pw F t´m ]pdt¯¡v
XÅnhcp¶Xpt]mepÅ tXm¶emWv BZyw A\p`hs¸ SpI
· ASnhbÀ `
mcapÅXmbpw \ndªp \nÂ
¡p¶Xp t]mepÅ tXm¶Â
· aq{Xmib¯nse AWp_m[
hymbmaw
hymbmaw 1
KÀ`]m{Xw X mtg¡v Cd§nbXv Ipdª tXmXnemsW¦n CSp¸nse
t]inIfpsS hymbmaw ^e{]ZamWv. CXp KÀ`
hymbmaw 2
· s]kdn D]tbmKn¡Â
ikv{X{Inb coXnIÄ
ikv{X{Inbbv¡v tijw
Ccp¶psIm −v ho«ptPmenIÄ
sN¿pI
InS¡pt¼mÄ
· ssewKnI_Ô ¯n\ptijw
· kaoIrXmlmcw Ign¡pI.
· ae_Ôw Hgnhm¡pI
kw-{Klw