RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

KARNATAKA, BANGALORE- 78

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

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|1 |NAME OF THE CANDIDATE AND ADDRESS |Ms.PRIYA N CHACKO |

| | |1ST YEAR M.Sc.NURSING, |

| | |N.D.R.K COLLEGE OF NURSING, |

| | |B.M ROAD ,HASSAN |

| | |KARNATAKA |

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|2 |NAME OF THE INSTITUTION |N.D.R.K COLLEGE OF NURSING |

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|3 |COURSE OF THE STUDY AND SUBJECT |MASTER OF SCIENCE IN NURSING, |

| | |MEDICAL SURGICAL NURSING. |

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|4 |DATE OF ADMISSION TO THE COURSE |2nd MAY 2008 |

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|5 |TITLE OF THE TOPIC |“EFFECTIVENESS OF INFORMATIONAL BOOKLET REGARDING THE KNOWLEDGE ON MODES OF |

| | |TRANSMISSION AND PREVENTION OF SEXUALLY TRANSMITTED DISEASES (STD) AMONG THE |

| | |ADOLESCENTS” |

INTRODUCTION

A sexually transmitted disease (STD) is an illness that transmits between human by means of sexual contact. It is also known as Sexually Transmitted Infections (STI) or Venereal Diseases(VD), caused by viruses, bacteria and parasites. Once acquired, it can be passed onto other sexual partners. STIs have been well known for hundreds of years. Nearby, 25 different STDs with a range of different symptoms are found in the world. STD can be spread through sexual contact including vaginal intercourse, oral sex and anal sex. (Wikipedia-2008)1

Sexually transmitted diseases are a major health issue in both industrialized and developing countries. Multiple sexual partners increase the incidence of STD. They tend to be more severe for women than men. STD causes long term or permanent damage including infertility if left untreated. STD can be easily passed on to sexual partners and from the mother to her unborn child. STD also aids in the transmission of human immunodeficiency virus(HIV) infections. These diseases exert a high emotional toll on our health care system. More than 25 STDs including Chlamydia, gonorrhea, syphilis, genital warts, genital herpes and viral hepatitis have now been identified as affecting men and women of all back grounds and economic levels.(Info please 2008)2

C Chirandonna (2008) stated in the article by WHO, “ The Chlamydia Cascade and enhanced STD prevention strategies for adolescents” , that the rising trends in Chlamydia, the prevalence in the adolescent female population and the relevance of STD continue to be a burden in the United States. he most common cause of STDs is Chlamydia trachomatis and it is a worldwide concern. It is also estimated that the disease burden for treating Chlamydia patients is very costly. The adolescent females in the urban setting exhibits an incidence as high as 30%.STD awareness and the need for more STD prevention education in young adolescents are more important. WHO targets healthcare providers and educators for this. 3

6 BRIEF RESUME OF INTENDED WORK

6.1 NEED FOR THE STUDY

Sexually transmitted diseases (STDs) are infectious diseases that spread from person to person through intimate contact. STDs can affect guys and girls of all ages and back grounds who are having sex. Unfortunately STDs have become common among teens.6

E Filipp etal (2008) conducted a study on “Chlamydia trachomatis infection in sexually active teenagers”. 243 sexually active teenage girls attending the out-patient clinic were selected. A questionnaire containing information such as age, purpose of visit, level of education, age at first intercourse, numbers of sexual partners, use of contraceptive methods etc was administered and pelvic examination was performed. The prevalence of Chlamydial infection in the studied group was 29%. Adolescent females infected by Chlamydia less frequently admitted to the use of condoms and more often did not use any contraceptives at all.4

N Kumarasamy etal (2008) conducted a prospective longitudinal study on “prevalence and incidence of sexually transmitted diseases among South Indians at risk of HIV infection in Chennai, India”. Participants were selected from a STD clinic and a confidential HIV testing and counseling programme. The most common prevalent STDs were Herpes Simplex Virus (HSV-2) infections, syphilis and trichomonas vaginalis. The study revealed that South Indian men and women has a high back ground prevalence of HSV-2. With the highest incidence of STDs, targeted prevention and clinical management strategies among individuals practicing high risk behaviors are needed to slow the continued spread of HIV in India.5

M Kihara etal (2006) conducted a study on “sexual behaviors and awareness of students in transition with implied risk of sexually transmitted diseases and HIV infection in Chinese university”. A self administered questionnaire survey with cross-sectional design was conducted among 22,439 undergraduate students. 17.6% of male and 8.6% females reported being sexually active. Condom was reported never or rarely used by 35% of sexually active students in both genders. The study revealed that sexual behaviors of Chinese-University students are poorly protected and sexual behaviors and awareness may have been undergoing rapid change becoming more risky. If this trend continues, there will be more expansion of sexually transmitted diseases and HIV. 13

Prevention and education are important aspect of nursing care in any setting. As nurses are recognized as authorities of health, they can educate the individuals, groups and communities about the modes of transmission and prevention of STDs.

There are very few a studies on STDs. The investigator has not come across this type of Pre-University based study. Hence, this is to provide necessary information to the adolescents to develop their skill. Hence the investigator felt in assessing the learning needs of adolescent students in selected Pre-University colleges and to develop an informational booklet to increase their level of knowledge regarding mode of transmission and prevention of STDs.

Therefore, the researcher selected this topic for study out of her own interest and curiosity and hopes that this study will help those students to plan effective preventive strategies. Keeping in view all these, the investigator plans to conduct a study to evaluate the effectiveness of informational booklet on modes of transmission and prevention of STD, among adolescents in selected Pre-University colleges of Hassan.

2. REVIEW OF LITERATURE

Review of literature is divided into three parts:

1. Literature related to incidence and prevalence of STD

2. Literature related to modes of transmission and prevention of STDs.

3. Literature related to informational booklet.

1. Literature related to incidence and prevalence of STD based on global, national and regional.

GLOBAL: An article in Wikipedia (2006) by WHO states that 340 million new cases of syphilis, gonorrhea, Chlamydia and trichomonasis occurred throughout the world in men and women aged 15- 49 years. The largest number of new infections occurred in the region on South and South East Asia, followed by Sub-Saharan Africa, Latin America and the Caribbean. It is estimated that around 92 million Chlamydia infections occurred worldwide in 1999, affecting more women (50million) than men (42 million). Studies in South America found rates of 1.9% amongst teenagers in Chile and 2.1 amongst pregnant women in Brazil. An estimated 62.35million case of gonorrhoea and 12.22 million cases of syphilis occurred worldwide in 1999. Over the past decade, there has been a substantial increase in the diagnosis of most STDs in the UK. 6

NATIONAL: V K Jain etal (2008) conducted a retrospective study on “changing trends of sexually transmitted diseases at Rohtak Medical College, Hariyana.” 1542 patients were selected with STDs. The male-female ratio was 5.17:1. Herpes genitalis was the most common STD (31.26%) followed by condylomata acuminate (27.30%), syphilis (16.67%), gonorrhoea (12.06%) and other diseases. The incidence of herpes genitalis in Ahemedabad, Davengere and Kottayam were 32.37%, 13.04% and 24.40% respectively. Syphilis was found to have higher incidence in Kottayam (42.1%) whereas in Davangere, it was 15.95%. it is evident that viral STDs are on a rise in India.7

REGIONAL: S Jayaram etal (2007) conducted a retrospective study on “The socio-demographic profile and risk behavior pattern of seropositive attendees in the Voluntary Counseling and Testing Centre ( VCTC), in Kasturba Medical College, Mangalore, Karnataka.” 539 and 330 seropositive attendees were included in the study to assess the trend of HIV. Statistical test and Chi-square test were done. The study revealed a gradual increase in the number of attendees in VCTC and there was a sharp increase in the number of seropositives 33.64%. Male seropositivity constituted 60-63% and 81-91% of seropositive attendees belonged to the age group of 15 – 50 years. Among them 25% were exposed to commercial sex workers, another 21-23 % were involved in premarital sex and 28% were indulging in heterosexual activities.8

2. Literature related to modes of transmission and prevention of STDs.

DT Doreto etal (2007) conducted a cross-sectional study to examine “female adolescents’ knowledge concerning STDs and transmission, condom use and health care.” 90 adolescents were selected and data were collected through house hold interviews using a structured questionnaire. Most adolescents were single, sexually active and with limited knowledge concerning STDs. 35.2% of the sample reported always using condom. Teenagers did not consider themselves at risk of STDs (65.5%) and 36.7% had never undergone gynaecological examination. The result point to the need for special attention to adolescent health care. The lack of effective protection makes them vulnerable to STDs, including AIDS.11

K T Romero etal (2007) conducted a cross sectional study on “adolescent females’ knowledge about prevention methods and sexually transmitted diseases in Sao Paulo, Brazil.” 506 teenagers were selected and semi-structured questionnaire was administered. The Chi-square test was used to verify the association between variables. Adolescents from the rural zone looked for more information about sexually (81.2%), compared to those from the urban zone. AIDS was the best known STD by girls from the rural (43%) and urban (39%) zones. Most of the surveyed female adolescents had inadequate knowledge about STD and contraceptive methods.12

6.2.3 Literature related to Informational booklet,

M M Berner etal (2008) has done a study on “the effectiveness of written informational material on help seeking behavior in patient with erectile dysfunction.” 8000 men received a first survey, which asked about intention to seek treatment and to discuss the sexual problem with a physician or partner. A second follow up questionnaire asked for the implementation of these interventions. 443 men participated in both surveys. Nearly 90% of them became active after reading the informational material. More than half talked with their partner (57.8%) and a physician (65%) and one third sought treatment. Overall, the results demonstrate that written information is a useful resources for men with erectile dysfunction because it evokes a high help seeking behavior. 9

K Auret, etal (2008) conducted a study on “effectiveness of Structured Clinical Instruction Module (SCIM) in teaching palliative care to undergraduate medical students, at The University of Western Australia.” A 2-hour SCIM workshop was designed and implemented to address certain shortcomings in the palliative care attachment of the students. Pre-workshop and post-workshop questionnaire showed a marked increase in the self rates competence and suggested this improvement was directly attributed to the workshop. The study revealed that the SCIM was an effective instructional format in small group setting, and it was cost-effective with minimal use of resources. 10

❖ STATEMENT OF THE PROBLEM

“ A study to determine the effectiveness of Informational Booklet regarding the knowledge on modes of transmission and prevention of Sexually Transmitted Diseases(STD) among the adolescents in selected Pre-University Colleges of Hassan”

3. OBJECTIVES OF THE STUDY

1. To assess the pretest knowledge level of adolescents on modes of transmission and STD among experimental and control groups.

2. To develop and administer the Informational Booklet on modes of transmission and prevention of STD to the experimental group.

3. To compare the posttest knowledge scores on modes of transmission and prevention of STDs between experimental and control groups to evaluate the effectiveness of Informational Booklet.

4. To find out the association between the knowledge of adolescents with their selected demographic variables.

❖ HYPOTHESIS

Ho = There will not be any significant association between the knowledge levels of

adolescents with their selected demographic variables.

H1 = There will be a significant increase in the posttest knowledge scores of experimental

group than the posttest knowledge scores of control group.

❖ ASSUMPTIONS:

1. The adolescents will have less than adequate knowledge regarding the modes of transmission and prevention of STD.

2. The adolescents will gain adequate knowledge on modes of transmission and prevention of STD.

❖ OPERATIONAL DEFINITIONS:

1.EFFECTIVENESS:- It refers to the gain in knowledge achieved by adolescents regarding modes of transmission and prevention of STD after the administration of Informational Booklet.

RMATIONAL BOOKLET:- In this study, it refers to the systematically developed learning material on modes of transmission and prevention of STD.

3.KNOWLEDGE:- It is the ability to recall the instructions given in the Informational Booklet and to respond towards the questionnaire.

4.ADOLESCENTS:- It refers to those who are between puberty and maturity. In the males, the age group is 14-20 years and in females, it is 12-18 years.

5.SEXUALLY TRANSMITTED DISEASES :- They are diseases mainly passed from one person to another during sex.

7. MATERIALS AND METHODS

1. SOURCE OF DATA :

Data will be collected from the Pre-University college students in selected Pre-University colleges of Hassan.

2. METHODS OF COLLECTION OF DATA

7.2.1 RESEARCH APPROACH

Evaluative approach.

7.2.2 RESEARCH DESIGN

Pretest, posttest with control group design.

An experimental study with two groups is mention below:

| | | | |

|GROUP |PRETEST |INTERVENTION |POSTTEST |

| | | | |

|E |O1 |X |O2 |

| | | | |

|C |O1 |______ |O2 |

KEY

E = Experimental group

C = Control group.

O1 = Assessment of pretest knowledge in the experimental and control groups.

X = Informational Booklet on modes of transmission and prevention of STD

O2 = Assessment of posttest knowledge in the experimental and control groups.

7.2.3 POPULATION

The adolescent students studying in the Pre-University colleges of Hassan.

5. SAMPLE

The adolescent students studying in selected Pre-University colleges of Hassan.

5. SAMPLE SIZE

The sample consists of 60 adolescents and equally distributed in the experimental group (N=30) and the control group (N=30).

6. SAMPLING TECHNIQUE

Simple random sampling technique.

7. SELECTION OF TOOL

Structured questionnaire consist of two sections

Section A: Demographic variables

Section B: Knowledge questionnaire on STDs

8. CRITERIA FOR SELECTION

Inclusion Criteria

1. Who are willing to participate in the study

2. Who are present during the period of data collection.

Exclusion criteria

1. Who are on leave or vacation.

2. Who are not willing to participate in the study.

7.2.9 SETTING OF THE STUDY

The study will be conducted in selected Pre-University colleges of Hassan.

7.2.10 PILOT STUDY

The pilot study is planned with 10% of the population which will be conducted in the selected Pre University colleges of Hassan and that will be excluded in the main study.,

7.2.11 VARIABLES

1. Independent Variable: Informational booklet on modes of transmisssion and prevention of STDs

2. Dependent variable: Knowledge of adolescent students regarding modes of transmisssion and prevention of STDs

3. Extraneous variables: Socio- demographic variables such as age, gender, educational back ground, type of family, area of residence, religion, pocket money received and previous information of adolescent students

7.2.12 DATA ANALYSIS METHOD

It includes descriptive and inferential statistics.

Descriptive Statistics: The descriptive statistics analysis includes percentage, frequency, mean and standard deviation.

Inferential Statistics: It includes Paired t-test and Chi-Square test.

7.2. DATA ANALYSIS METHOD

The researcher will use appropriate descriptive and inferential statistical methods.

2. DOES THE STUDY REQUIREANY INTERVENTIONS TO BE

CARRIED OUT ON PATIENTS OR OTHER HUMANS OR

ANIMAL?

Yes, the Informational Booklet is used as an intervention on adolescent students in P.U Colleges.

3. HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR

INSTITUTION?

Permission will be obtained from the research committee of the N.D.R.K college of Nursing and authorities of selected P.U Colleges in Hassan informed consent will be obtained from the subjects who are willing to participate.

DURATION OF THE STUDY - December 2008- February 2010

7. LIST OF REFERENCES

JOURNALS

1. Wikipedia; “Sexually Transmitted Disease”, 2008

2. Ifoplease; “Sexually Transmitted Disease”, 2008

3. C Chiradanna; “the Chlamydia cascade: Enhanced STD prevention strategies for adolescents in college of nursing, University of South Florida”, Journel-Pediatr Gynecol, October 2008, 21(5);233-241.

4. E Flipp etal, “Chlamydia Trachomatis infection in sexually active teenagers”, Article in polish, Ginekal pol, April 2008, 79(4), 264-270.

5. N Kumarasamy etal, “Prevalence and incidence of sexually transmitted infections among South Indians at increased risk for HIV infection”, Journal-AIDS patient care and sexually transmitted diseases, august, 2008, 22(8):677-682.

6. AVERT, “STD statistics world wide”, 2008.

7. V K Jain etal, “Changing trends of STDs at Rohtak”, Article in Indian journal of Sexually Transmitted Diseases, 2008, 23-25.

8. S Jayarama etal, “socio-demographic profile and risk behavior pattern of seropositive attendees in the voluntary counseling and testing centre of Kasturba Medical college, Mangalore” Article in Indian Journal of Community Medicine, 2008, 33(43-46).

9. M M Berner etal, “effect of written information material on help seeking behavior in patients with erectile dysfunction: a longitudinal study”, Journal-Sex med , February 2008, 5(2):436-447

10. K Auret ,etal, “Using structured clinical instructional modules(SCIM) in teaching palliative care to undergraduate medical students”, journal-Cancer Educ, 2008, 23(3) :149-155

11. D T Doreto etal, “Knowledge on sexually transmitted diseases among low income adolescents in Ribeirao Preto, Sao Paulo state, Brazil” , Article Cad Saude Publica, October 2007, 23,251-256.

12. K T Romero etal,“Adolescent females’ knowledge about pregnancy prevention methods and STDs” Article in Rev Assoc Med Bras, January-February 2007, 53(1): 14-19.

13. M Kihara etal, “Sexual behavior and awareness of Chinese University students in transmission with implied risk of sexually transmitted diseases and HIV infection: a cross-sectional study”, Article in BMC public health, sep, 2006, 18; 16:232.

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