A study to evaluate the effectiveness of planned teaching programme on impact of early marriage, pregnancy among adolescent girls in selected rural high schools of Belgaum, Karnataka

Mrs. Uma Kole¹, Dr. S. Anuchitra²

¹Lecturer, Department of OBG (N), KLEU’s Institute of Nursing Sciences, Belgaum.

²Vice Principal cum Head of the Department, Dept. of OBG (N), P.D. Bharatesh College of Nursing, Belgaum.

*Corresponding Author Email: koleuma@gmail.com

ABSTRACT:

Marriage is found in all cultures. It is a process by which individuals select their life partners. In India adolescents girls face number of problems such as dropout of school, malnourished, working in vulnerable situations, misguidance from peer group and siblings, more prone for early marriage and are sexually active. Early (child) Marriage is one of the burning problems of Indian society. In India, despite amended laws advocating 18 as the legal minimum age at marriage for females, a substantial proportion i.e. every third adolescent girl in the age group of 15-19 year is married and every second married adolescent girl has given birth to a child.

OBJECTIVES: To assess the knowledge and attitude, also to design and implement and to know the effectiveness of planned teaching programme on impact of early marriage, pregnancy among adolescent girls. To correlate, find the association between knowledge and attitude with selected demographic variables on impact of early marriage, pregnancy among adolescent girls.

MATERIALS AND METHODS: This was a true experimental study conducted to assess the effectiveness of planned teaching programme among 60 adolescent girls (aged between 13year to 17year, either married and unmarried) who were studying in 8th, 9th and10th standard from selected rural high schools of Belgaum, Karnataka using Probability-simple random sampling technique. A questionnaire was designed to tap the information about on impact of early marriage, pregnancy and planned teaching program was been conducted to assess the knowledge and attitude of adolescent girls.

RESULTS: the present study showed that significant gain in knowledge of experimental group after the planned teaching programme on impact of early marriage, pregnancy. The mean score of knowledge of experimental group is 33.03± 1.86 and mean score of knowledge of control group 23.86±3.44.The mean attitude score of experimental group is 37.93±4.78. It indicates that the knowledge of adolescents girls on impact of early marriage, pregnancy is positively correlated with attitude (r = 0.386 P>0.05).

CONCLUSION: The findings of this study support the need of delaying early marriage for the better health of the mother as well as baby. The study proved that there was a significant correlation between knowledge and attitude of adolescent girls.

KEY WORDS: Adolescents Girl, Early Marriage, Early pregnancy; Planned Teaching programme, Rural High-School.

INTRODUCTION:

I've always held that early marriage is a sure indication of, Second-rate goods that had to be sold in a hurry."

-“Martin Harris”

The term adolescence is derived from the Latin word “adolescere” meaning to grow, to mature. It is considered as a period of transition from childhood to adulthood. They are no longer children yet not adults. It is characterized by rapid physical growth, significant physical, emotional, psychological and spiritual changes. Adolescents constitute 22.8% of population in India as on 1st march 2000. They are not only in large numbers but are the citizens and future of the country. The problems of adolescents are multi- dimensional in nature and require holistic approach.

Need For Study

Marriage is a social institution that unites people in a special form of mutual dependence for the purpose of founding and maintaining a family. As a social practice entered into through a public act, religious or traditional ceremony, it reflects the purposes, character, and customs of the society in which it is found. Many societies have norms that limit the age of young girls to enter into marriage, but in some cases the age limit does not take into consideration their physiological readiness for childbearing.

Early marriage is the marriage of children and adolescents below the age of 18. Among those marrying early, some are forced into this union, others are simply too young to make an informed decision. Throughout the world, marriage is regarded as a moment of celebration and a milestone in adult life. Sadly the practice of early marriage gives no such cause for celebration. All too often, the imposition of a marriage partner upon a child means that a girl or boy’s childhood is cut short and their fundamental rights are compromised⁴.

According to the news report published in the leading newspapers of the world, each year there are around 80 million unwanted pregnancies, out of which 30 millions of these are aborted. There are so many social and psychological causes leading to teenage pregnancies all over the globe. Early marriage of the teenagers is one of the main reasons for teenage pregnancies. Lack of proper sex education and counseling as well as poverty can be the major reasons as well⁵. Furthermore, reports indicate that nearly 7% of girls were found to be married before reaching the age of 10 years.

Complications of teenage pregnancy and delivery are the main causes of death for girls aged 15 to 19. Each year almost 5.5 million girls aged 15 to 19 give birth. They have higher levels of unwanted pregnancy and more than one billion have unsafe abortion (WHO, 2004). Mortality and morbidity rates are higher among infants born to young mothers; especially those under 15 years have higher rates of premature labour, spontaneous abortion, stillbirth, and low birth weight infants (Demographic and health survey, 2006).

Statement of the Problem

“A study to evaluate the effectiveness of planned teaching programme on impact of early marriage, pregnancy among adolescent girls in selected rural high schools of Belgaum, Karnataka.”

Objectives of the study

1. To assess the knowledge and attitude on impact of early marriage, pregnancy among adolescent girls.

2. To design and implement planned teaching programme on impact of early marriage, pregnancy among adolescent girls.

3. To assess the effectiveness of plan teaching program on impact of early marriage, pregnancy among adolescent girls.

4. To correlate the knowledge and attitude on impact of early marriage, pregnancy among adolescent girls.

5. To find out the association between the knowledge and attitude with selected demographic variables on impact of early marriage, pregnancy among adolescent girls.

Operational definitions

1. Effectiveness:

In this study Effectiveness refers to the improvement in terms of knowledge and attitude of adolescent girls after implementation of planned teaching programme on impact of early marriage, pregnancy.

2. Planned teaching program:

In this study planned teaching program refers to prepared teaching on impact of early marriage, pregnancy with set of objectives for adolescent girls.

3. Early Marriage:

In this study, the term early marriage refers to those girls who get married before 18 years of age.

4. Early Pregnancy:

In this study early pregnancy refers to pregnancy before age of 18 years.

5. Adolescent Girls:

In this study adolescent girl refers to that girl who falls in the age group of 13-17 years.

6. Rural High Schools:

In this study, the term rural high school refers to the place where adolescent girls are been educated as well they reside in a particular rural area.

Inclusion criteria

Adolescent Girls:

ü Whose age group is in between 13 to 17 years either married and unmarried.

ü Who are studying in 8^th, 9th and10^th Standard

ü Available at the time of the data collection.

ü Who knows to read and write Marathi, Kannada, and English.

Exclusion criteria

ü Adolescent Girls :

§ 18 years and above

§ Studying below 8^th std

ü Adolescent Girls who are not available during the data collection.

Assumption

The researcher assume that: Adolescent Girl’s

Ø May co-operate well for the data collection.

Ø Will posses some knowledge on effects of early marriage, pregnancy.

Ø May have positive attitude on impact of early marriage, pregnancy

Delimitation

Ø 30 adolescent girls in experimental group and 30 in control group.

Ø Study is limited on those who understand and know to read and write Marathi, Kannada and English.

Conceptual Framework

General Systems Theory by Von Bertalanffy in 1968

The review of literature:

A cross -sectional, observational study was conducted to assess the prevalence of early marriage and the associations between early marriage and women's fertility and fertility-control outcomes in India 2005-06. The study findings showed 44.5% of women aged 20-24 years were married before age 18 years, 22.6% were married before age 16 years and 2.6% were married before age 13 years. Early marriage was significantly associated with no contraceptive use before first child birth (95% ), high fertility (three or more births) (7.40%), a repeat child birth in less than 24 months (3%), multiple unwanted pregnancies (2.36%), pregnancy termination (1.48%), and female sterilization (6.68%). The study concluded that improved family-planning education, access, and support are urgently needed for women married as earlier, their husbands, and their families to reduce the high fertility and poor fertility-control outcomes of this practice¹⁹

A descriptive study was conducted to determine early marriage among women in developing countries. Data was obtained from 40 demographic and health surveys revealed that a substantial proportion of women in developing countries continue to marry as adolescents. The study findings revealed that: 20-50% of women marries or enters a union by age 18, and 40-70% does so by their 20th birthday. Women aged 20-24 are less likely to get married by age 20 than are women aged 40-44; the differential is at least 10 % points in most countries and reaches 30-40% points in some countries. Education and age at first marriage are strongly associated both at the individual level and at the societal level. Thus study concluded that a woman who has attended secondary school is considerably less likely to marry during adolescence, and in countries with a higher proportion of women with a secondary education, the proportion of women who marry as adolescents is lower²⁰. A descriptive study was undertaken to evaluate the incidence of adolescence pregnancy, consequences and considerations. The sample included 61 girls aged between 15-17 years, mean age 16 years. Study findings revealed that: 65.6% were students. 85.2% were opted for voluntary abortion and 77% chosen to continue pregnancy came from small town. The researcher concluded as the percentage of pregnancies in adolescence has remained unchanged over the year in spite of the numerous health and contraception campaigns represents a strong stimulus to investigate the countless facets of this problem²⁵.

A survey was designed to ascertain views of public high school students on preventing teen pregnancy. 75-question anonymous survey was administered in six Boston high schools. Study findings revealed that: 63% student had sexual intercourse; 72% of males and 54% of females. Of these 35% were consistent contraceptors and 65% were inconsistent. 52% of students believed in having more information on pregnancy and birth control, 33% education about relationships, 32% parental communication, and 31% improved contraceptive access, 30% education about parenting realities to prevent teen pregnancy. Abstinent teens were more likely (58%) to say that information on pregnancy and birth control was important (p<0.05), whereas consistently contracepting teens 40% to identify greater access to birth control (p<0.01). The researcher concluded as teen’s report that having more information from parents, school, and health arenas can prevent pregnancy²⁶.

Research methodology:

Research approach and Research design

An Evaluative approach and True-experimental, i.e., pre-test post-test control group design was used in the study.

Setting

The study was conducted in the selected rural High School of Belgaum city, Karnataka (Swami Vivekananda High School and Malekarani High School-Uchgaon, Belgaum).

Population

In the present study the population comprised of adolescent girls aged between 13-17 years studying in rural high schools of Belgaum district.

Independent variable:

In this study independent variables of adolescent girls are Age, economic status, education, area of residence, sex, religion, parental education, occupation of father and mother, parental age on marriage.

Dependent variable:

In this study dependent variables are Knowledge and Attitude regarding impact of early marriage and pregnancy.

Sample and sample size:

The present study was conducted among 60 adolescent girls studying in 8^th, 9^th, and 10^th from selected rural high-schools at Belgaum.

§ Expérimental group : 30

§ Control group : 30

Sampling technique

In this study, Probability-simple random sampling with lottery method was used.

Description of the tool

The tools were divided into five parts;

§ Part A: Demographic data of adolescent girls. It consists of 12 items of demographic variables.

§ Part B (i): Knowledge questionnaire on impact of early marriage.

§ Part B (ii): Knowledge questionnaire on impact of early pregnancy.

§ Part C: Attitude scale on Impact of Early Marriage, Pregnancy

§ Ethical clearance

Ethical clearance was obtained.

Reliability:

· The reliability co-efficient of the whole test was then estimated by using Spearman-Brown Prophecy formula.

· The knowledge questionnaire on early marriage was found reliable ((r =0.57).

· The knowledge questionnaire on early pregnancy was found reliable (r = 0.76).

· The attitude questionnaire on early marriage, pregnancy was also found reliable (r = 0.98).

Results:

Major findings of the study:

Finding related to demographic variable of adolescent girls studying in 8^th, 9^th, 10^th from selected rural high-schools at Belgaum.

With regard to their age majority 51 (85%) of the Adolescent girls were between 14 to 15 years, 12 to 13years 6 (10%) and3 (5%) were between age of 16 to 17 (Fig.3). Considering the marital status of adolescent girls, majorities 59 (98.33%) were un-married, 1 (1.67%) were married (Fig.4).While considering the adolescent girl’s parental age of marriage, majority 41 (68.33%) of adolescent girls fathers got married at the age between 23 to 27 years, 7 (11.67%) were between 18 to 22 years and 2 (3.33%) lies between 13 to 17 years (Fig.5).

Regarding the adolescent girl’s parental age of marriage, 47 (78.33%) of adolescent girl’s mother got married at the age between 18 to 22 years were as 7 (11.67 %) were in >23 years, 5 (8.33%) at 14 to 17 years and <13 years at 1 (1.67%) (Fig.6).

And regarding the educational status of adolescent girls 20 (33.33%) were studying in 8th / 9th /10^thstandard (Fig.7). Considering their religion majority 57 (95%) of the adolescent girls were belong to Hindu religion, 3 (5%) were Muslims (Fig.8).Considering the occupation of fathers majority 38 (63.33%) was working as a field worker, 13 (26.67%) were doing job and 13.33 were in business,8 (1.67%) were unemployed (Fig.9) and majority of the mothers 60 (100%) were house wife’s (Fig.10). Regarding their monthly family income, 13 (55 %) between i.e. Rs. <3000, were as 17 (28.33%) were in 3001-6001 and 7 (11.67%) were 6001-10000(Fig.11).Regarding their type of family majority 32(53.33%) is from nuclear family, 27(45%) were from joint family and 1(1.67%) were in extended family (Fig.12).

Fig.3: Percentage Distribution of Age of Adolescent Girls

Fig.4 Percentage Distribution of Marital Status of Adolescent Girls

Fig.5: Percentage Distribution of Age of Father at their Marriage

Fig. 6: Percentage Distribution of Age of Mother at their Marriage

Section II: Assessment of level of knowledge on Early Marriage, Pregnancy among Adolescent girls

Table 1: Distribution of Pre-test and Post-test Mean Score of knowledge on Early Marriage.

(N=60)

	Pre-test		Post-test
Vari-ables	Experi-mental group (N=30)	Control group (N=30)	Experi-mental group (N=30)	Control group (N=30)
	M	M	M	M
Early Marriage	12.1	12.73	16.43	12.86
Early pregnancy	11.5	10.56	16.53	11

The data presented in table 1 show that the pre-test and post-test mean early marriage score of experimental group were: 12.1, 16.43 respectively, indicating gain in mean early marriage score after planned teaching progremme. It was also observed that the mean early pregnancy score was 11.5 in pre-test is gained to 16.53 in post-test, indicates that there was significant gain in knowledge score on early pregnancy after the administration of PTP.

For control group mean early marriage score in pre-test was 12.73 whereas in the post-test the mean early marriage score was 12.86 indicating that there were no gains in knowledge score. It was also observed that the mean knowledge score on early pregnancy in pre-test (10.56) was same as the score of the post-test (11).

The same finding as presented in table 2 are in shown in figure 1 and 2 as bar graph , representing pre-test ,post-test mean score of early marriage and early pregnancy of experimental and control group respectively.

Fig.13: Bar graph showing Pre-test and post-test Mean Score of early marriage and early pregnancy of experimental group.

Table 2: Distribution Pre-test and Post-test Mean Score of attitude on Early Marriage.

(N=60)

	Pre-test		Post-test
Variables	Experimental group (n=30)	Control group (n=30)	Experimental group (n=30)	Control group (n=30)
	M	M	M	M
Attitude	35.63	36.46	37.93	39.6

Figure 14: Bar graph showing pre-test and post test mean score of early marriage and early pregnancy of control group.

Section III: Assessment of Attitude on Early Marriage, Pregnancy of Adolescent girls

Fig: 15. Bar graph showing pre-test and post-test Mean Score of early marriage and early pregnancy of experimental group.

Section IV: Assessment of effectiveness of Planned Teaching Programme (PTP) on Impact of Early Marriage, Pregnancy among Adolescent Girls

H1: There will be a significant increase in knowledge and attitude on impact of early marriage, Pregnancy after the implementation of planned teaching programme.

Table 3: Effectiveness of PTP on impact of early marriage, pregnancy (N=30)

Areas	Statistics									Paired ‘t’ value
	Pre test(x)			Post test (y)			Effectiveness (y-x)
	Mean	SD	Mean %	Mean	SD	Mean %	Mean	SD	Mean %
Knowledge	23.6	13.5	59	33.03	3.84	82.57	9.43	9.66	23.57	11.41*
Attitude	35.63	3.14	59.38	37.93	4.80	63.21	2.3	1.66	3.83	11.31*

t (29) 2.060 ; *significant(p>0.001)

Figure 17: Shows median of pre and post test Attitude scores of Experimental Group

Figure 16: Shows median of pre and post test knowledge scores of Experimental Group

The data presented in the above table shows that the total mean knowledge score is increased by 23.57% with mean +SD of 9.43+9.66, the total mean attitude score is increased by 3.38% with mean +SD of 2.3+1.66 and after the administration of PTP.

The ‘t’ value of knowledge (11.41), attitude (11.31) scores were found more than the table value 2.060, p>0.001 with degree of freedom 29. Hence the PTP was found to be effective in terms of knowledge and attitude. Hence the first research hypothesis is accepted

The post-test ogive lies to the right of the pre-test ogive over the entire range showing that post-test knowledge score is higher than the pre-test score. Gain in the knowledge score has be shown by comparing the pre-test and post-test median of the knowledge score which is 23.57 and 24 respectively.

The post-test ogive lies to the right of the pre-test ogive over the entire range showing that post-test attitude score is higher than the pre-test score. Gain in the attitude score has been shown by comparing the pre-test and post-test median of the attitude score which is 36 and 37 respectively.

Section V: Correlation between level of Knowledge and Attitude on Impact of Early Marriage, Pregnancy among Adolescent girls

To test the statistical significance, the following hypothesis was stated

H2: There will be a positive correlation between knowledge and attitude on impact of early marriage, pregnancy among adolescent girls.

Table 5: Correlation Co-efficient between Knowledge and Attitude on Impact of Early Marriage, Pregnancy of pretest and post test of experimental group and control group (n=60)

Correlation ‘r’ value
Variables Correlation between	Experimental Group (K and A)	Control Group (K and A)
Knowledge and Attitude	0.386*	0.225
Inference	Positive correlation	Positive correlation

t (29)0.355 *significant(p<0.05)

Above table shows that the correlation (r) values were computed between the variables of knowledge and attitude on impact of early marriage and pregnancy. It is observed that positive correlation exist between test and post test scores. The value r = 0.386is significant at 0.05 level, other remaining r values, were found to be low positive though not significant. Hence the third research hypothesis is accepted.

Hence the second research hypothesis is accepted.

Section VI: Association between the level of knowledge and attitude with selected demographic variables on impact of early marriage, pregnancy among adolescent girls.

To test the statistical significance, the following hypothesis was stated

H3: There will be a significant association between knowledge and attitude on impact of early marriage, pregnancy with selected demographic variables of adolescent girls.

Association between the knowledge and attitude with selected demographic variables on impact of early marriage, pregnancy among adolescent girls.

In the present study researcher found that there was significant association between the post test scores of knowledge with selected variables such as type of family, age of adolescent and even there is an association with post test scores on attitude with educational status of adolescent girls. Where as in the control group there was association only in age of adolescent girls and religion in post test scores knowledge and attitude.

Outcome of the study were adolescent girls aged between 14 to 15 years were having moderately adequate knowledge after the post test scores ,majority of adolescent girls (53.33) belongs to nuclear family.

This finding coincides with the findings of Raj.A.et al(2006)concluded that 22.6% were married before age 16 years, and 2.6% were married before age 13 years. Early marriage was significantly associated with no contraceptive use before first child birth [95%]55.

This finding coincides with the findings of Anita Raj et al.(2010) concluded that majority of births (73%) were mothers married as minors and have got ill effect on their health as the impact of early marriage46.

IMPLICATIONS:

The finding of the study can be implicated in nursing education, nursing practice and nursing research:

NURSING SERVICES:

· The contents of lesson plan and power point presentation will help the nursing professionals to improve their knowledge on problems of early marriage ,pregnancy and to change their attitude towards early marriage ,pregnancy

· The findings of the study will help the nursing personnel to plan the nursing care based on the problem of adolescent girls

· Camps can be conducted to identify the presence of problems of early marriage ,pregnancy among adolescent s and provide preventive measures

· The findings of the study will help the nursing professional working in the community to gain the knowledge and change in attitude regarding problem of early marriage, pregnancy.

NURSING EDUCATION:

· The nurse educators can use power point presentation to teach the nursing students about problems of early marriage , pregnancy.

· Nursing student can utilize the findings to educate family members on the area which have inadequate knowledge and problems of teenage pregnancy.

· The findings will help the nursing faculty to give more importance for planning and organizing the planned teaching programme to improve the knowledge regarding problems of early marriage, pregnancy.

NURSING ADMINISTRATION:

· Professional interaction between the nurses and the public will help to improve professional standards and creates better image in the community.

· Specialized teaching package in specific topic create interest among public and serves as reference material.

NURSING RESEARCH:

· The study helps the investigator to develop insight regarding impact of early marriage, pregnancy develop the nursing care for the newborn.

· This study will serve as a valuable reference material for future investigators

· In-depth research studies can be conducted by including all the three domains i.e. knowledge, attitude and practice.

· Large scale studies can be conducted.

RECOMMENDATIONS:

· A similar study can be under taken on large scale.

· A descriptive study may be conducted to assess the knowledge, attitude and practice.

· An explorative study may be conducted to identify the awareness, knowledge, practice and attitude of impact

· A similar study can be under taken by taking variables such as knowledge and practice.

LIMITATIONS:

1. The study findings limited to adolescent girls studying at 8th, 9th, and 10th standard.

2. The findings limited to adolescent girls of Belgaum dist.

Received on 31.07.2013 Modified on 08.10.2013

Asian J. Nur. Edu. & Research 4(1): Jan.-March 2014; Page 61-69