INTRODUCTION:

Before the onset of menstruation majority of women of reproductive ages experiencing physical or emotional symptoms.¹ amongst those, some women are so severely affected that it interferes with their psychological health, interpersonal relationships, and academics.

It has also been found that the prevalence of premenstrual syndrome (PMS) is higher in unmarried women, in women aged 35-44 years, and in women who belong to a low socioeconomic group living in socially deprived area.^2-3

Menstrual disorders affect 75% of adolescent females and are a common reason for them to seek medical care.⁴menstrual related complaints are also a major reason for school absenteeism among teens.^5-6 the most prevalent menstrual disorders among adolescents are excessive uterine bleeding, dysmenorrhea, and pre-menstrual syndrome. Scott et al. reported that twice as many African American adolescents felt unprepared and did not receive information about menarche when compared with Caucasian teens.⁷

The high prevalence of PMS is a major concern in many settings. In an Iranian study, it was revealed that 98.2% of undergraduate female students experienced PMS in most of their last 12 menstrual cycles and about 25% said that their educational performance had been disturbed.⁸ a study in Iran revealed that 99.5% of high school students suffered from PMS. None of the students had ever heard about PMS. They also did not know about any PMS coping strategies, including relaxation therapy.⁹

The study conducted by Pal et al. on Pakistani women states that physical symptoms predominate in the premenstrual experience of the Pakistani women and described abdominal bloating and cramps, irritability, and mood swings as the more common symptoms experienced by the women.¹⁰ Another study reported joint pain, muscle pain, back pain, and breast tenderness as the most prevalent symptoms¹¹. Several authors found anxiety, depression, fatigue, and anger as the most frequently reported symptoms¹². Studies also suggested skin disorders, swelling of extremities, gastrointestinal problems (like decreased appetite), and headaches as symptoms experienced by women before menstruation¹³.

Epidemiologic studies have estimated that as many as 80% of women of reproductive age experience some symptoms attributed to premenstrual phase of menstrual cycle.¹⁴ About 24-32% women report moderate to severe PMS and 3-8% have very severe form of PMS that is Premenstrual Dysphoric Disorder (PMDD).^15-16 It is defined as a distinct affective disorder characterized by the presence of at least five symptoms (one of which must be affective) that occur in the late luteal phase, are not a luteal exacerbation of an existing psychiatric condition and that significantly interfere with social activities or relationship with others.¹⁷ PMS is thus prevalent in women of all ages causing substantial morbidity with obvious detriment to interpersonal relationships, social interactions, lifestyle, work performance, emotional well-being and overall health-related quality of life.¹⁸

Premenstrual dysphoric disorder (PMDD) can be changed into depression¹⁹. PMDD is a disease occurring whenever the steroid hormone levels is changed in menstruation-ovulation cycle and is characterized by irritability, emotional instability, headache, anxiety, and physical symptoms. Dysfunction in hypothalamus- pituitary- adrenal axis observing in depressive patients is also reported in PMDD patients²⁰.

Premenstrual syndrome is no longer a taboo in western countries, where a lot of publicity, self-help books and specialized clinics highlights the importance of premenstrual syndrome to general public and help women to overcome this temporary problem. PMS has been studied and evaluated extensively in the West and only a handful amount of research studies have been conducted in Asia.²¹ Very few information is present on premenstrual syndrome. PMS symptoms bring negative impact on academic and social performances of the students.

The investigator decided that giving knowledge about PMS will help in coping with the negative impacts of PMS among the adolescent girls in the selected schools of Ratia. Students are the promising group to country’s development. Therefore the researcher felt a very strong desire to take up this study to assess the effectiveness of structured teaching programme on PMS knowledge and its coping strategies among adolescent girls in the selected schools.

OBJECTIVES OF THE STUDY:

1. To assess the knowledge regarding premenstrual syndrome and its coping strategies among adolescent girls

2. To evaluate the effectiveness of structured teaching programme regarding premenstrual syndrome and its coping strategies among adolescent girls

3. To find out the association between knowledge regarding premenstrual syndrome and its demographic variables

HYPOTHESES:

H₁: There will be a significant difference between mean pre-test and post-test knowledge scores of adolescence girls regarding premenstrual syndrome and its coping strategies.

H₂: There will be a significant association between pre-test knowledge level of adolescence girls regarding premenstrual syndrome & its coping strategies and their selected demographical variables.

OPERATIONAL DEFINITIONS:

ASSESS:

It refers to the process used to identify the level of knowledge of adolescent girls regarding premenstrual syndrome and its coping strategies

EFFECTIVENESS:

It refers to the extent to which the structured teaching programme will be helpful in gaining knowledge regarding pre-menstrual syndrome and its coping strategies among adolescent girls.

STRUCTURED TEACHING PROGRAMME:

It is a systematically developed programme with teaching aids, design to impart knowledge regarding pre-menstrual syndrome and its coping strategies among adolescent girls.

PRE-MENSTRUAL SYNDROME:

It refers to the symptoms like anger, irritability, abdominal pain which is occurring before every menstrual period in adolescent girls of selected schools.

KNOWLEDGE:

it refers to the facts, information, and skills acquired through structured teaching programme regarding pre-menstrual syndrome and its coping strategies among adolescent girls

ADOLESCENT GIRLS:

In this study adolescent girls would be aged between 15-17 years and who are doing their studies in selected schools.

COPING STRATEGIES:

In this study coping strategies refers to the process through which the person manages the demands and emotions generated by the premenstrual syndrome

ASSUMPTIONS:

1. Adolescent girls in selected schools will have some knowledge on premenstrual syndrome and its management.

2. Teaching adolescent girls regarding premenstrual syndromes will help to improve their knowledge about premenstrual syndrome and its coping strategies

RESEARCH METHODOLOGY:

Research design:

One group pre - test and post- test, pre-experimental design was adopted for the study.

Settings of the study:

The present study was conducted at Government Girls Sr. Sec. School. Ratia. Haryana

Population:

For this study the population is all the adolescence girls who are studying in Government Girls Sr. Sec. School.

Sample Size:

100 adolescence girls

Sampling Technique:

Convenient sampling technique

Sampling criteria:

The following criteria were set to select samples.

Inclusion criteria:

1. Adolescence girls who were studying in Government Girls sr. Sec. School. Ratia.

2. Adolescence girls who were willing to participate in this study.

3. Adolescence girls who were present at the time of study.

4. Adolescence girls who were able to understand Hindi and English.

Exclusion criteria:

1. Adolescence girls who were not willing to participate in study

2. Adolescence girls who were above 17 years.

Tool for data collection:

A structured knowledge questionnaire was used to assess knowledge regarding premenstrual syndrome and its coping strategies among adolescence girls.

Tool consists of three sections

Section – A: It consist of demographical variables such as Age, Education, Menstruation, Locality of house, Religion, Type of family, Type of diet and Source of information,

Section – B: It consists of self-structured knowledge questionnaire to assess the level of knowledge regarding premenstrual syndrome and its coping strategies among adolescence girls.

Section – C: Scoring and Interpretations

S. No	Scores	Level of Knowledge
1.	0 – 10	Inadequate
2.	11 – 20	Moderate
3.	21 - 30	Adequate

Description of blue print:

A blue print was prepared prior to the construction of self-structured knowledge questionnaire. Based on the information obtained the term were distributed according to content in five areas.

· Introduction and meaning of premenstrual syndrome

· Definition and type of premenstrual syndrome

· Path physiology of premenstrual syndrome

· Clinical features and symptoms of premenstrual syndrome

· Coping strategies of premenstrual syndrome

Table: I: Blue print for structured knowledge questionnaire on knowledge regarding premenstrual syndrome and its coping strategies among adolescence girls

Sr. No.	Content Area	Question No.	Total No. of items	%
1	Introduction and meaning of premenstrual syndrome	1, 2, 3	3	10.00%
2	Definition and type of premenstrual syndrome	4, 5, 6, 7	4	13.33%
3	Path physiology of premenstrual syndrome	8, 9, 11	3	10.00%
4	Clinical features and symptoms	12, 13, 14, 15,16, 17, 18, 19	8	26.66%
5	Coping strategies of premenstrual syndrome	20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30	11	36.67%
6	Total	30	30	100%

Content validity of the tool:

Content validity of the tool was obtained from the 7 experts. Three experts from obstetrics & gynaecological nursing, three experts in psychiatric nursing and one statistician.

Reliability of the tool:

Through test retest method the tool’s reliability was checked and the tool was found to be reliable with the Karl Pearson co-efficient correlation score (r) = 0.78.

Pilot Study:

After obtaining formal administrative approval the pilot study was conducted at government sr. Sec. School, Rattakhera (Ratia) from 23^rd -30^thJanuary 2017. 10 subjects were selected with convenient sampling technique. Through pilot study the feasibility of the study was ascertained.

Procedure for Data Collection:

Data was collected from 4^thFebruary-10^thFeb. 2017 from the adolescence girls. All the adolescence girl students who met the criteria are selected for the study. Pre test was done on 4^th February; on the same day after structured teaching programme was administration. On the 7^th day the post-test was done.

Plan for Data Analysis:

Data analysis was done with descriptive and inferential statistics.

DATA ANALYSIS AND INTERPRETATIONS:

Table – II: frequency and percentage distribution of subjects according to selected socio – demographic variables (N = 100)

S. No

Socio Demographic Variables

Frequency

Percentage

Age: (Years)

a. 12 – 13

b. 14 – 15

c. 16 - 17

31.00

50.00

19.00

Education:

a. 9^th

b. 10^th

c. 11^th

d. 12th

20.00

30.00

20.00

Regularity of Menstruation:

a. Regular

b. Irregular

90.00

10.00

Religion

a. Hindu

b. Sikh

62.00

38.00

Type of diet

a. Vegetarian

b. Non – vegetarian

60.00

40.00

Type of family:

a. Joint

b. Nuclear

60.00

40.00

Area of living:

a. Rural

b. Urban

66.00

34.00

Source of Information:

a. Health personnel

b. TV and Radio

c. Newspaper and Magazine

d. Family Members

39.00

5.00

6.00

50.00

From table – II: it was interpreted that with regard to age one – half of the total subjects 50 (50.00%) were in age between 14 – 15 years. Education of the subjects shows equal distribution of subjects 30 (30.00%) each was in 10^th and 11^th standard. An overwhelming majority of the subject 90 (90.00%) were having regular menstruation. Subject’s distribution with religion shows majority 68 (68.00%) were Hindus. Distribution of subjects based on the type of family reveals majority 60 (60.00%) belongs to joint family, similarly with regard to the type of diet majority of them 60 (60.00%) were vegetarian. Area of living of the subjects depicts majority 66 (66.00%) were from rural areas. With regard to source of information regarding premenstrual syndrome majority of the subjects 50 (50.00%) obtained information from their family members.

Table – III: level of knowledge score regarding premenstrual syndrome and its coping strategies (N = 100)

S. No	Level of Knowledge	Pre-test		Post-test
S. No	Level of Knowledge	f	%	f	%
1.	Inadequate	90	90.00	0	0
2.	Moderate	10	10.00	12	12.00
3.	Adequate	0	0.00	88	88.00

In pre-test overwhelming majority of the subjects 90 (90.00 %) were having inadequate knowledge, 10 (10.00 %) of the subjects were having moderate knowledge and none of them had adequate knowledge regarding premenstrual syndrome and its coping strategies.

During post-test an overwhelming majority of the subjects 88 (88.00%) were with adequate knowledge and 12 (12.00 %) of the subjects were with moderate level of knowledge. None of the subjects had inadequate level of knowledge.

Table – IV: Area wise knowledge score of premenstrual syndrome and its coping strategies (N = 100)

S. No.	Knowledge Aspects	Max Score (30)	Pre-test			Post-test
S. No.	Knowledge Aspects	Max Score (30)	Mean	SD	Mean %	Mean	SD	Mean %
1.	Introduction to premenstrual syndrome	3	1.41	7.55	47	2.28	5.2	76
2.	Definition	4	1.25	3.69	31.3	2.76	2.7	69
3.	Clinical features	6	2	1.71	33.5	4.1	3.9	68.3
4.	Signs and symptoms	2	0.99	4.36	33	1.92	5.3	64
5.	Treatment	5	1.59	1.71	31.8	2.83	6.9	70.8
6.	Precautions	5	1.64	4.15	32.8	3.52	3.1	70.4
7.	Coping strategies	5	1.19	2.89	29.8	3.43	4.9	68.6
8.	Total	30	10.07	26.06	239.2	20.84	32	487.1

Table – IV: shows area wise analysis of pre-test and post-test knowledge of adolescence girls regarding premenstrual syndrome and its coping strategies.

The overall pre-test mean score was 10.07 the overall SD value was 26.06 and the pre-test mean % score was 239.2. Similarly the post-test overall mean score was 20.84, with SD value 32 and the overall Post-test mean % score as 487.1.

Table – V: Effectiveness of structured teaching programme on knowledge regarding premenstrual syndromes and its coping strategies (N = 100)

Test

Mean

Mean Difference

Paired ‘t’ test value

‘P’ Value

Level of Significance

Pre-test

10.07

10.77

26.06

22.22

(df = 199)

0.001

Significant

Post-test

20.84

Level of Significance > than 0.05

The mean pre-test knowledge score was 10.07 (SD< 26.06). The post-test knowledge score was 20.84 (SD < 32) the mean difference score was 10.77. The paired‘t’ test score was 22.22 for the degree of freedom 199. The estimated ‘P’ value was 0.001 which shows the effectiveness.

Table VI: Association between selected demographical variables and post-test knowledge score (N = 100)

Sr. No.	Demographical variables	Chi-square value	df	p-value	Significance
1	Age	6.229	3	0.101	NS
2	Education	24.83	4	0.0001	S
3	Menstruation	1.956	2	0.376	NS
4	Area of living	34.44	4	0.0001	S
5	Religion	19.24	2	0.0001	S
6	Type of family	3.483	1	0.062	NS
7	Type of diet	78.8	1	0.0001	S
8	Source of information	1.704	4	0.790	NS

Level of significance < 0.05, S = Significant. NS = Non Significant

Table – VI depicts the Association between selected demographical variables and post-test knowledge score. From the table we found the following socio– demographic variables such as education, area of living, religion, and type of diet are statistically associated with the post-test knowledge scores of the subjects.

DISCUSSION:

Study findings were discussed according the study objectives.

The first objectives of the study were to assess the knowledge regarding premenstrual syndrome and its coping strategies among adolescent girls:

In the present study, table – III shows the level of knowledge score regarding premenstrual syndrome and its coping strategies. In pre-test overwhelming majority of the subjects 90 (90.00%) were having inadequate knowledge, 10 (10.00%) of the subjects were having moderate knowledge. During post-test an overwhelming majority of the subjects 88 (88.00%) were with adequate knowledge and 12 (12.00%) of the subjects were with moderate level of knowledge.

The above findings were supported by the following studies.

Study done to evaluate the effectiveness of structured teaching programme on premenstrual syndrome among adolescent girls in selected schools of Taran Taran Navdeep Kaur (2017), shows with regard to pre-test assessment on knowledge regarding premenstrual syndrome and its management, 1(1.66%) had adequate knowledge and 24(40%) had moderate knowledge, 35(58.3%) had inadequate knowledge. Post – test Assessment knowledge regarding premenstrual syndrome and its management among adolescent girls shows subjects with adequate 16(26.6%) and 36(60%) had moderate knowledge, 8(13.3%) had inadequate knowledge.22

Pathak K, and Udapi G (2017) A descriptive survey approach was used in the study since the study aimed to assess the knowledge regarding psychological problems of premenstrual syndrome and its management among adolescent girls. In this study the knowledge distribution of adolescent girls regarding psychological problems during premenstrual syndrome shows majority 66 (84%) were having average knowledge, subjects with good knowledge were 10 (13%) and those who were with poor knowledge were 2 (3%).²³

The second objective of the current study is to evaluate the effectiveness of structured teaching programme regarding premenstrual syndrome and its coping strategies among adolescent girls:

Table – V shows the effectiveness of structured teaching programme on knowledge regarding premenstrual syndromes and its coping strategies. The mean pre-test knowledge score was 10.07 (SD< 26.06). The post-test knowledge score was 20.84 (SD < 32) the mean difference score was 10.77. The paired‘t’ test score was 22.22 for the degree of freedom 199. The estimated ‘P’ value was 0.001 which shows the effectiveness. These findings were supported by the following studies done in the past.

Study conducted by Ather A (2014) shows After the intervention, the experimental group showed a significant increase in PMS knowledge (Z=6.32, p=.000) and self-health behavior (t=3.00, p=.004) compared to the control group. After the intervention the experimental group showed a significant increase in PMS knowledge (Z=-4.64, p=.000) and self-health behavior (t=-3.04, p=.005) than before the intervention.²⁴

Padmavathi P, Rajasankar and Kokilavani N (2013): aimed to assess the effectiveness of SIM on premenstrual syndrome among adolescents. In pre-test, the mean score of the sample was 6.73 and the post test mean score was 23.54 with Paired‘t’ value of 21.82. This showed that the SIM was effective in enhancing the knowledge of the adolescent girls regarding premenstrual syndrome.²⁵

The third objective of the present study was to find out the association between knowledge regarding premenstrual syndrome and its demographic variables:

In the present study table – IV shows the Association between selected demographical variables and post-test knowledge score. From the table we found the following socio – demographic variables such as education, area of living, religion, and type of diet are statistically associated with the post-test knowledge scores of the subjects. This finding was not supported by any previous studies.

CONCLUSION:

Prior to the implementation of the structured teaching programme the adolescent girls had inadequate knowledge in maximum numbers. The number of subjects was increased to adequate knowledge to maximum after implementing structured teaching programme. The researcher concluded that in every schools in India special educational programmes to be organized among early adolescents in order to enhance their knowledge regarding premenstrual syndrome and its coping strategies.

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Received on 07.10.2020 Modified on 06.11.2020

Asian J. Nursing Education and Research. 2021; 11(1):107-112.

DOI: 10.5958/2349-2996.2021.00028.8