RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCESBANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

“A COMPARATIVE STUDY ON KNOWLEDGE AND

ATTITUDE REGARDING MENOPAUSE BETWEEN URBAN

AND RURAL MARRIED WOMEN IN SELECTED AREAS OF

DAVANGERE DISTRICT”.

Mrs. VEENA. V. NAIK.FIRST YEAR M.Sc. NURSING,

OBSTETRICS AND GYNECOLOGICAL NURSING

BAPUJI COLLEGE OF NURSING DAVANGERE – 577 004.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA, INDIA.

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. NAME OF THE CANDIDATE AND

ADDRESS (IN BLOCK LETTERS)

Mrs. VEENA. V. NAIK.

FIRST YEAR M.Sc. NURSING,

BAPUJI COLLEGE OF NURSING,

DAVANGERE – 4,

KARNATAKA.

2. NAME OF THE INSTITUTION BAPUJI COLLEGE OF NURSING,

DAVANGERE - 4.

3. COURSE OF STUDY AND

SUBJECT

FIRST YEAR M.Sc. NURSING,

OBSTETRICS AND GYNECOLOGICAL

NURSING.

4. DATE OF ADMISSION TO

COURSE

19-06-2009

5. TITLE OF THE TOPIC “A COMPARATIVE STUDY ON

KNOWLEDGE AND ATTITUDE

REGARDING MENOPAUSE BETWEEN

URBAN AND RURAL MARRIED

WOMEN IN SELECTED AREAS OF

DAVANGERE DISTRICT.”

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6. BRIEF RESUME OF THE INTENDED WORK :

6.0 INTRODUCTION :

Changes in health and illness of individuals create a process of transition, and

client in transition period tend to be more vulnerable to be risks that may in turn affect

their health, uncovering these risks may be enhanced by understanding the transition

process. Menopause may be viewed as a transition from middle age to old age by may

women and women fear this period because of the anticipated losses. Although

menopause is a universal experience for women. The experience is not universal (Mc

Graw 1990). There is no fixed pattern and no chain of events that must transpire. The

onset and end are unpredictable. The duration is indefinite and the experiences are

different for every woman as she passes through it.1

The ward menopause derives from a Greek word. ‘Men’ which means ‘month’

and ‘pausis’ which means ‘cessation’ (Leon 1990). Thus menopause refers to permanent

cessation of menstruation at the end of reproductive life due to ovarian follicular

inactivity.2 Suzann (2000) opinioned that menopause usually occurs between the ages of

45 – 55 years. A women may experience an early menopause because of surgery if both

ovaries are removed. Other causes of a premature menopause include ovarion failure as

a result of chemotherapy radiation therapy to the pelvis autoimmune diseases.3

Susan (1996) reported that approximately 75% of women experience some

advers symptoms surrounding menopause that are thought to be caused by the loss of

estrogen. The most commonly reported symptoms are hot flushes and atropic vaginitis.

Other problems that may be associated with menopause include osteroporosis, increased

risk of cardiovascular disease, skin changes sleep disturbances, decreased libido and

psychological difficulties.4

Menopause is a very complex time in women’s life during which unpridectable

and wide fluctuations in ovarian function. A greater understanding of these

physiological events in women’s life is important, but what is of greater importance for

medical personnel is how women persive these events (Lobo 1998).5

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Menopause does cause radical alternations in women’s physiological functioning

and can cause anxiety in women who do not understand the changes that are taking

place (Choi, 1995). Thus it is important that women during menopausal period should

have adequate knowledge regarding the menopausal transition that may enable them to

accept inevitable changes and losses and recognize qualities and capabilities.6

6.1 Need for the study :

Menopause is an extremely important yet complex period of time during which

many changes occur in a women in an unpredictable way. It is essential to ensure that a

woman understands that the menopause represents a change of life and not end of life,

and that unless she allows it to do so it will not result in her suddenly becoming aged

and unattractive.

Jeffcoate (2001) commented that menopausal changes vary considerably and

depend largely on the make up of an individual and on her previous outlook on the

menopause and its significance. Thus in turn influenced by whether the women is single

or married and whether she is childless, grand childless or surrounded by a happy

family. In a well adjusted and well informed women psychological changes are few and

insignificant, amounting to not more than a period of slight emotional instability.7

Menopausal symptoms may become more dominant concerns for some women

requiring interventions for symptom relief, and personal knowledge from their

experience about to expect and how the symptoms will affect their physical and role

functioning. (Tish – 2001).8

Standberg (1997) conducted a study on women’s knowledge and attitude about

the climacteric period and its treatment. The results showed that 45% of the women

considered menopause as a sort of relief from childbearing. Approximately 60% had

negative attitude towards menopause. While 80% of the wanted to know more about

menopausal symptoms which suggest increased need for giving more information on

menopause than what has been given already.9

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Menopause is a natural event which involves physical physiological and

psychological changes among women. The average age at which menopause occurs is

45-55 years. The menopausal period can be divided into premenopause. Perimenopause

and postmenopause according to the symptoms. The first and foremost sign of

menopause is irregularities in the menstrual periods. The other changes or symptoms

include hot flush urinary changes. Sexual changes genital changes and psychological

changes. The management of these changes include selfcare abilities of the woman as

well as developing a positive attitude towards menopause.5

The experience of the investigation supports the view that women lack the

necessary information related to menopause and management of the menopausal phase

of life. The researcher noticed that women had less knowledge regarding menopause. So

this study was undertaken to compare the knowledge and attitude of married women

regarding menopause in urban and rural areas.

6.2 Review Of Literature :

According to Polit and Hungler (1999) literature review refers to the activities

involved in identifying and searching for information on a topic. An extensive review of

the research and non research literature was done to gain the maximum information and

thus to build the foundation of the study.10 The relevant literature reviewed has been

organized and presented under the following headings.

Literature related to ;

1) Menopause

2) Knowledge and attitude regarding menopause

3) Menopause and associated variables.

Literature related to menopause

Moore (1996) described that menopause is a natural process involving the gradual

depletion of ovarian follicle that occurs with advancing age, because estrogen is

produced primarily in ovarian follicles, responsiveness to follicle stimulating hormone

results in reduction of circulating estrogen. As production of estrogen declines,

production of FSH increases initially causing rapid follicular development that results in

shortened menstrual cycles. Over a period of several years estrogen production

eventually decreases to a level too low to initiate a leutinising hormone (LH) production;

ovulation becomes irregular and then ceases. Serum FSH and LH levels continue to rise

because there is no estrogen feedback from the ovary.12

4

Woods and Mitched (1997) in their study on “pattern of depressed mood in

midlife women” reported that depression is the most common mental health problem for

which women seek health information. They further reported that midlife women

experiencing depression during menopause is mainly due to endocrine changes that

occur during perimenopause. Management of these changes requires additional effort by

a women towards maintaing her own health. Considering menopausal changes as a

normal phenomenon, will help the women to develop more coping abilities than

considering them as abnormal.11

Literature related to knowledge and attitude regarding menopause :

Paul (2000) conducted a study in Kerala to identify the problems related to

menopause of unmarried women living in groups as perceived by them. A sample of 100

women were selected by purposive sampling method. These women consisted of 50

unmarried women in menopausal period and 50 unmarried women in premenopause

period who were living with them. The finding of the study indicated that both the

groups of unmarried women, religious sisters in menopausal period and premenopausal

period had experienced problems related to menopause. If they were equipped with

adequate knowledge and information about the changes during menopausal period, they

could have adjusted themselves with mutual understanding, which could promote better

healthy living in religious society.13

Appling, Allen, Van-Zandt, Olsen, Brager and Hallerdin (2000) conducted a

descriptive cross sectional survey of 215 perimenopausal and post menopausal low

income urban women. This study was carried out to characterize knowledge of

menopause and hormone replacement therapy (HRT) as well as the factors associated

with knowledge level, sociodemographic characteristics and patterns of HRT use.

Knowledge about menopause and HRT were collected through a structured interview.

Results revealed, general lack of knowledge about menopause and HRT, particularly

related to heart disease and role of HRT in prevention. Major independent predictors of

increased knowledge were having talked with a health care provider about HRT, having

at least high school education and being less than 60 years of age.14

5

Arathi (1999) conducted a study in Mangalore to evaluate the effect of a

menopause developed for a group of women working in a selected bank of south Kenara

district with specific reference to their knowledge and attitude. The data was collected

from 30 women employed in corporation bank head office Mangalore and the samples

were selected using purposive sampling technique. The findings of the study revealed

that the post test knowledge scores were higher than the pre test knowledge scores and

the difference between the pre test and post test scores was statistically significant at

0.05 level (t(29) = 2.04, p < 0.05, 2.76 < 0.06). The post test attitude scores were higher

than the pretest attitude scores and the difference was statistically significant at 0.05

level t(29) = 2.04 P < 0.05, 2.76 P < 0.01, The findings indicated that the self instruction

module was found to be an effective teaching strategy in increasing the knowledge and

attitude of women towards menopause.15

Fox-Young (1999) conducted a study on women’s knowledge about the physical

and emotional changes associated with menopause. Two groups of midlife women: a

random sample (n = 381) and a sample of women who attended menopause seminars (n

= 95) were asked to select from a test of 39 changes those they thought were directly

caused by menopause. Information from readily available books written for general

audience was used to construct the marking guide for a commonly available knowledge

score. A template for a biomedical knowledge score based on an estrogen deficiency

perspective of menopause was derived from recently published medical literature. The

mean score for the commonly available knowledge item was 27 out of 39 (69.2%

correct). The mean biomedical knowledge score was lower 19.3 out of 35 (55.1%

correct). There was no difference between the 2 groups in the mean commonly available

knowledge or biomedical knowledge scores. This finding challenges the widely held

assumption that active information seekers are more interested and have a better level of

knowledge than the general populations.16

Vasundhara (1992) conducted a study to determine the knowledge and attitude of

selected groups of women in Andra Pradesh towards menopause and its relationship

with selected variables. Descriptive correlational survey was used for the study. A

sample of 120 women were selected by simple random sampling technique. These

women consisted of 40 school teachers. 40 office workers and 40 house wives. The

findings of the study revealed that :

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1) In general women lacked knowledge about menopause.

2) Negative attitudes were profound in certain areas of menopause.

3) The knowledge of the women was influenced by their education occupation and

income.

4) Income and occupation had influenced the attitudes of the women where as

education had on effect on attitude formation.

5) Knowledge and attitude had inverse relationship.17

Aber and Arathuzik (1998) conducted a study to explore the following questions.

What are the perceptions of midlife women as to the care they receive from a variety of

health care providers ? What are the issues and concerns that influence their decision

making about hormonal therapy ? what are the knowledge perceptions and role of the

partner during the menopausal transition ? The nonrandom convenience sample

consisted of 320 midlife women 46-55 years of age were the samples of the study. Data

were gathered via mailed self administered menopause questionnaire. Descriptive

statistics were used to analyse the surveyed data. The findings were, that respondents (1)

were in conflict about hormone therapy (HT), yet they had read extensively about

menopause and used a variety of strategies to cope with symptoms (2) reported that they

received conflicting information and advice about menopause from a variety of sources

and expressed concerns about not being fully informed by their health care providers

and (3) who received care from nurse practitioners (NPs) were quite satisfied with their

care.18

6.3 Statement of problem :

“A comparative study on knowledge and attitude regarding menopause between

urban and rural married women in selected areas of Davangere district”.

6.4 Objectives of the Study :

1. Determine the level of knowledge of urban and rural married women regarding

menopause.

2. Determine the attitude of urban and rural married women regarding menopause.

3. Compare the knowledge and attitude of urban and rural married women

regarding menopause.

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6.5 Operational definitions :

1. Knowledge : Refers to correct responses of married women on a structured

interview schedule regarding menopause as evidenced from knowledge scores.

2. Attitude : Attitude refers to woman’s verbal expression of feelings toward

menopause and is measured in terms of scores on an attitude scale.

3. Rural : Rural refers to large and isolated areas with low population.

4. Urban : It refers a city or densely populated area.

5. Married women : Refers to married women between 45 – 55 years of age.

6.6 Hypothesis :

The following hypotheses will be tested at 0.05 level of significance.

H1 : There will be a significant difference between the mean knowledge scores of rural

and urban women regarding menopause.

H2 : There will be significant difference between the mean attitude scores of rural and

urban women regarding menopause.

6.7 Assumption :

1) Women may have some knowledge of menopause.

2) Women may have willingly participate and give reliable information

needed for the study.

3) Knowledge of menopause can be measured by structured interview

schedule.

4) Attitude towards menopause can be measured by an attitude scale.

6.8 Limitation :

Study is limited to

1. Selected rural and urban areas of Davangere District.

2. Only those women who can understand English or Kannada.

3. Married women aged 45 – 55 years.

4. Only those women who are willing to participate in the study.

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7. MATERIALS AND METHODS :

7.1 Source of Data collection :

A structured interview schedule to determine the knowledge regarding

menopause and attitude scale to determine the attitude towards menopause were used for

the data collection.

Research design :

A descriptive comparative design was used to compare the knowledge and

attitude of urban and rural married women.

Setting :

The study will be conducted in the selected rural and urban areas of Davangere

District.

Population :

In this study the target population comprised of all married women aged between

45 – 55 years belonging to the selected rural and urban areas.

Sample size :

In this study the total sample size will be 100 married women aged between 45 –

55 years. Belonging to the urban and rural areas.

Inclusion criteria :

Married women who are,

1. In menopausal age group (45 – 55 years)

2. Communicating in English or Kannada.

3. Willing to participate in the study.

4. Available at the time of data collection.

Exclusion criteria :

Women who are

1. Health professionals

2. Chronically ill

3. Not willing to participate in the study.

4. Not available at the time of data collection.

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7.2 Methods of collection of data :

Sampling technique : Purposive sampling technique will be used to select the samples.

Instrument intended to be used :

A structured interview schedule to determine the knowledge regarding

menopause and an attitude scale to determine the attitude towards menopause were used

for the data collection.

Variables :

Dependent variables : In this study are knowledge and attitude of married women

regarding menopause in rural and urban areas.

Independent variable : The other variables included are age, religion, education,

occupation and family income.

Data collection method :

The investigators introduce herself to women. The structured interview will be

conducted at urban and rural areas. Urban area – Nittuvally, H.K.R. Colony, Rural Area

– Kurki village The data gathered from 100 subjects were analyze using descriptive and

inferential statistics.

Plan for data analysis plan :

The data will be analyze by both descriptive and inferential statistics on the basis

of objectives and hypothesis of the study. The compute the data a master data sheet will

be prepared by the investigator. Data will be interpreted in terms of figures and tables.

7.3 : Does your study require any investigation or interventions to conduct on

patients or other humans or animals ? If so, please describe briefly.

Yes, A comparative study will be done on knowledge and attitude regarding menopause

between urban and rural married women in Davangere.

7.4 : Has ethical clearance been obtained from your institution in case of 7.3?

Yes, written permission will be obtained from college as well as from District Health

Officer, Davangere.

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8. LIST OF REFERENCES :

1) M.C. Graw, R.K. 1990. “Psychosexual changes associated with the perimenopausal

period”. Journal of Nurse Midwifery 36(1):

2) Leon S. Robert H.G. and Nathan G.K. Clinical gynaecology and infertility, A

walter’s Kluwer Company 1999.

3) Suzanne. M.M. and Melanie, W. 2000. “Information needs regarding menopause”.

Cancer Nursing.

4) Susan, W. and Frances, M.Z. 1996. “Continuing education / menopause”. American

Journal of Nursing 96(1):

5) Lobo, R.A. 1998. “The perimenopause” Clinical Obstetrics and Gynecology. 41(1).

6) Choi, M.W. 1995. “The menopausal transition; change, loss and adapatation” (CD-

ROM) Holistic Nursing Practice 9(3):53-62:

7) Jeffcoate N.S. Principly of gynecology Edinbrugh. Batter worth and co-publishers

1983.

8) Tish K. 2001. “The menopausal symptom experience in young midlife women with

breast cancer”. 24(3):

9) Standberg E. 1997. “Womens attitude and knowledge about the climacteric period

and its treatment”. Maturitas 27(2).

10) Polit DF, and Hungler BP. Nursing research principles and methods, Philadelphia;

Lippincott Company 1999.

11) Woods, Fugate, Nancy, Mitchell. Sullivan and Ellen. 1996. “Pattern of depressed

mood in midlife women”. Research in Nursing and Health.

12) Moore A.A. and Nooman, MD. 1996. “A guide to hormone replacement therapy”.

Journal of obstetrics, gynecology and neonatal nursing.

11

13) Paul C. A study to identify the problems of unmarried women related to menopause

living in groups as perceived by them. (Master of science in nursing thesis, Rajiv

Gandhi University of Health Sciences. Bangalore 2001).

14) Appling S.E., Allen. J.K, Van-Zandt. S, Olsen. S, Brager, R. and Hallerdin J. 2000.

“Knowledge of menopause and hormone replacement therapy use in low-income

urban women”. Journal of womens health gend-based-medicine. 9(1):

15) Arathi, A.N. A study to evaluate the effect of a self instructional Module (SIM) on

menopause developed for a group of women working in a selected bank of South

Kanara district with specific reference to their knowledge and attitude, (Master of

science in nursing thesis. MAHE University, 1999).

16) Foxyong, S., Sheehan, M., O’Connor. V., Cragg. C. and Delmar, C. 1999.

“Womens knowledge about physical and emotional changes associated with

menopause” womens health, 29(2):

17) Vasundhara. R. A study to determine the knowledge and attitude of selected groups

of women in Andhra Pradesh towards menopause and its relationship with selected

variables. (Master of Science in Nursing thesis, University of Delhi, 1992).

18) Aber, C.S., Arathuzik, D. aAnd Righter. A.R. 1998. “Womens perceptions and

concerns about menopause” Clinical – Excell – Nurse practitioner, 2(4):

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9. SIGNATURE OF THE CANDIDATE

10. REMARKS OF THE GUIDE

11. NAME & DESIGNATION OF (IN BLOCK LETTERS)11.1 GUIDE

11.2 SIGNATURE

11.3 CO-GUIDE (IF ANY)

11.4 SIGNATURE

11.5 HEAD OF THE DEPARTMENT

11.6 SIGNATURE

12. 12.1 REMARKS OF PRINCIPAL

12. 2 SIGNATURE

13

ETHICAL COMMITTEE CLEARANCE

1. TITLE OF THE DISSERTATION : “A COMPARATIVE STUDY ON

KNOWLEDGE AND ATTITUDE

REGARDING MENOPAUSE BETWEEN

URBAN AND RURAL MARRIED

WOMEN IN SELECTED AREAS OF

DAVANGERE DISTRICT.”

2. NAME OF THE CANDIDATE : Mrs. VEENA. V. NAIK,

1st year M.Sc Nursing,

Bapuji College of Nursing.

3. SUBJECT : OBSTETRICS AND GYNECOLOGICAL

NURSING

4. NAME OF THE GUIDE : Mrs. LEELAVATHY. R.H.Head of the Department, Department ofObstetrics and Gynecological Nursing,Bapuji College of Nursing,Davanagere-4.

5. APPROVED/NOT APPROVED

(If not approved, suggestion)

:

Prof. S.F.BILLALLI,Principal and HOD,Medical Surgical Nursing,Bapuji College of Nursing,Davanagere-4.

Mrs. LEELAVATHY. R.HHead of the Department, Department ofObstetrics and Gynecological Nursing,Bapuji College of Nursing,Davanagere-4.

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