INTRODUCTION:

Woman, the most respectable word in the world. She spends a remarkable period in her life for her family. She performs different roles and functions in the family like daughter, sister, wife, mother, grandmother etc. By the age of 30 to 35 years’ women are very busy with their career, mostly married and having kids. They mostly ignore their health during the middle age and going through a lot of physiological and hormonal changes as well¹.

As per the report in Indian express in 2018, sixty-eight percentage of women suffer from lifestyle diseases. Among them metabolic syndrome is an emerging health issue in the developing countries. It is more prevalent among women as compared to men as well as it starts in the middle age. Insulin resistance, visceral adiposity, atherogenic dyslipidemia, endothelial dysfunction, genetic susceptibility, elevated blood pressure, hypercoagulable state, and chronic stress are the several factors which constitute the syndrome. The interaction between components of the clinical phenotype of the syndrome with its biological phenotype (insulin resistance, dyslipidemia, etc.) contributes to the development of a pro inflammatory state and further a chronic, subclinical vascular inflammation which modulates and results in atherosclerotic processes². Studies found that the average metabolic syndrome knowledge was very low indicating the urgent needs of metabolic syndrome education in current practice. Predictors of better metabolic syndrome knowledge included higher educational level, history of dyslipidemia, and normal high-density lipoprotein cholesterol. Specific health education on metabolic syndrome should be provided to them especially for those with limited formal education or inadequate lipid management¹. Strategies to combat the forecast epidemic of type 2 diabetes and its vascular complications should focus on preventing and intervening early in metabolic syndrome³.

METHODS:

Study Design:

Research approach was Quantitative approach. In this study quasi experimental design with non-equivalent control group was used to evaluate effectiveness of selected lifestyle interventions on knowledge regarding metabolic syndrome among women.

Setting and Samples:

Women were recruited from a selected municipality in Ernakulam district. The participants were selected by multistage sampling. Sample size was 180. Inclusion criteria for the study were women who belong to the age group of 35 to 55 years and meet any three of the following five criteria of metabolic syndrome such as (a) waist circumference>88cm (b) high Blood pressure: SBP>130mmHg or DBP >85mmHg or on treatment for hypertension (c) high Fasting blood sugar >100mg/dl or on treatment for DM (d) HDL<50mg/dl (e) triglycerides >150mg/dl. Women who reported with any disease like cardiac disease, renal disease, cancer, ligament injury, surgery in the leg and neurovascular problems, pregnant women and women with psychiatric disorders and severe cognitive impairment were excluded. A mong 180 women, 34 women were withdrawn from the study during different stages (18 from experimental group and 16 from control group). The remaining 146 were taken for final analysis.

Figure 1. Consort diagram of the study

Instruments/ Measurements:

1. Socio demographic information sheet: Participants were asked to provide Socio demographic characteristics such as age, marital status, education, occupation, monthly income, type of Family, preferred food groups, lifestyle Habits and menstruation. Clinical parameters were collected such as history of gestational diabetes or pregnancy induced hypertension, history of diabetes mellitus, history of hypertension and dyslipidemia.

2. Structured knowledge questionnaire: The structured questionnaire was developed by the researcher to determine the knowledge of women regarding metabolic syndrome. It includes 20 questions related to various aspects of metabolic syndrome like definition, etiology and risk factors, components and its preventive measures. Each right answer carries a score of “1” and wrong answers “0”. The content validity of the questionnaire was determined for clarity, relevancy, simplicity and consistency of each question set from ten experts in the field. Twenty questions with item content validity index more than 0.80 were included in the questionnaire. Scale content validity index was 0.90. The reliability was measured by Cronbach’s alpha and reliability index was 0.71 which indicated that the tool is reliable.

Interventions:

Experimental Group: Selected lifestyle interventions are given to experimental group. It includes structured education on metabolic syndrome components, causes and its control measures including diet, exercises and regular follow up. It is emphasized about the importance of dietary modification, recommended daily dietary intake of calories, salt and fiber. A food exchange list was prepared as per the directions of the dietician and provided to the participants. It is also emphasized the benefits of moderate intensity exercises like walking and explained the steps to be followed while walking and warm up exercises. The women were instructed to walk 30 minutes per day (between 5 pm to 7 pm) for 5 days in a week. Information booklet related to metabolic syndrome was given after the education. Control Group: Control group did not receive any intervention.

Data Collection Procedure:

Data collection was done from March 2019 to February 2020. Women who met the inclusion criteria were randomly assigned into two groups; experimental group and control group. Pretest was done. After assessment lifestyle interventions were given to experimental group and control group did not receive any intervention. Post-test was done after 12 weeks of intervention among two groups.

Data analysis:

The data obtained from the study was computed using a frequency distribution to describe the demographic characteristics and χ² test was carried out to find the homogeneity. Both parametric and nonparametric tests were done to evaluate the effectiveness of structured educational interventions on knowledge of metabolic syndrome. Kruskal Wallis test with Dunn’s multiple comparison test for comparison of knowledge and Wilcoxon signed rank test was used for comparison of pre and post test scores of knowledge. The analysis and plotting of the graph were carried out using Sigma Plot 13.0 (Systat Software Inc., USA).

Ethical Consideration:

The approval for conducting the study was obtained from the Saveetha Medical College Hospital Human Ethics committee (Approval no: 003/02/2019/ IEC/SMCH). Permission was obtained from the State Kudumbashree Mission and Community Development Society. The informed consent form was translated into regional language. The confidentiality of the information and right to withdraw from the study were explained at their level of understanding in the regional language. The written consent was obtained.

RESULTS:

Demographic variable of participants consists of age, marital status, education, occupation, monthly income, type of Family, preferred food groups, menstruation, Table 1 depicts the frequency and percentage distribution of women according to their demographic variables in control and experimental groups. Among 146 participants, 45% were between 51 to 55 years (66). Whereas only 16% (24) were below 40 years. Most of the participants (124) were married (85%). Only 12 (8%) were graduated. 50(34%) had primary education, 43 (29%) had secondary and 41(28%) had higher secondary education. Regarding the occupational status, most (97) of the participants are unemployed (66%). 16(11%) were skilled workers and 29(20%) were unskilled workers and only 4(3%) professionals. While assessing the monthly income, it was found that 58 (48%) participants had a monthly income between Rs:6000/-to 10000/-and 43 (29%) had income between Rs:10000/- to 20000/month. Most (101) of them were from nuclear family (69%) and majority (115) followed mixed food habits (79%). It was also observed that 24(16%) participants had irregular menstrual cycles and 63(43%) attained menopauses. Homogeneity was observed among the experimental group and control group.

Table 1. General characteristics of the participants (N=146)

Characteristics	Classification	CO(n=74)	Exp (n=72)
Characteristics	Classification	n (%)	n (%)
Age (yrs)	35-40	13(17.6)	11(15.3)
	41-45	11(14.9)	12(16.7)
	46-50	17(23.0)	16(22.2)
	51-55	33(44.6)	33(44.8)
Marital status	Married	63(85.1)	61(84.7)
	Widow	10(13.5)	10(13.9)
	Divorced	1(1.5)	1(1.4)
Education	Graduation and above	6(8.1)	6(8.3)
	Higher secondary	21(28.4)	20(27.8)
	Secondary	21(28.4)	22(30.6)
	Primary	26(35.1)	24(33.3)
Occupation	Professional	2(2.7)	2(2.8)
	Skilled worker	8(10.8)	8(11.1)
	Unskilled worker	15(20.3)	14(19.4)
	Unemployed	49(66.3)	48(66.7)
Monthly income (Rs/Month)	<6000/-	17(23.0)	18(25.0)
	6000-10000	29(39.2)	29(40.3)
	10000-20000	23(31.1)	20(27.8)
	20000-50000	5(6.8)	5(6.9)
Type of family	Joint family	23(31.1)	22(30.6)
Type of family	Nuclear family	51(68.9)	50(69.4)
Food habits	Vegetarian	16(29.6)	15(20.8)
	Mixed food	58(78.4)	57(79.2)
	None	58(78.4)	57(79.2)
Menstruation	Regular	31(41.9)	28(38.9)
	Irregular	12(16.2)	12(16.7)
	Menopause	31(41.9)	32(44.4)

CO= Control group; Exp=Experimental Group

Clinical information obtained from the participants include history of diabetes and hypertension during pregnancy, history of diabetes mellitus, history of hypertension and dyslipidemia. 62(90.5%) and 61(90.3%) in the control and experimental group respectively were not had a history of gestational diabetes. Most of the women 65(94.6%) and 65(94.9%) in the control and experimental group respectively did not have history of hypertension during pregnancy. Most of the women did not report the history of diabetes mellitus; 51(74.3% in CO) and 61(88.9% in experiment). 52(36%) in the control and 50(34%) in the experimental group did not have the history of hypertension. Most of the women did not report the history of elevated blood cholesterol 66(45%) in control and 65(44%) in experimental group).

Table. 2 explains the effect of selected lifestyle interventions on knowledge regarding metabolic syndrome among women. The median knowledge in pre test of control and experimental group are 8.0 and 8.0 respectively. It is not found to be statistically significant (p=0.987). The median knowledge in post test of control and experimental group are 8 and 16 respectively. It is found to be statistically significant (p<0.001)^*. The pre test and post test of respective control and experimental group were tested by Wilcoxon signed rank test. In the case of control, it was not significant (p=0.147). Whereas, in case of experimental group it was statistically significant (p<0.001).

The association between the knowledge and selected demographic variables were determined by chi square test (Table.3) and it was found that there is an association of knowledge with education, occupation and monthly income (p<0.001). It was not associated age of the participants.

Table 3. Association between pretest knowledge score and selected socio demographic variables (N=146)

Variable	Category	Knowledge Score		Chi Square (p)
Variable	Category	<Median	≥ Median	Chi Square (p)
Age (Yrs)	35-40	14	10	5.031 (0.170)
	41-45	11	12
	46-50	17	16
	51-55	46	20
Education	Graduation and above	0	12	61.597 (<0.05)
	Higher secondary	15	26
	Secondary	23	20
	Primary	50	0
Occupation	Professional	0	4
	Skilled worker	8	8	10.426 (<0.05)
	Unskilled worker	15	14
	Unemployed	65	32
Monthly Income (Rs/month)	<6000/-	21	14	15.010 (<0.05)
	6000-10000	44	14
	10000-20000	21	22
	20000-50000	2	8

DISCUSSION:

The prevalence of metabolic syndrome increases with age its importance is increasing in recent decades. A study on age and sex difference in clustering metabolic syndrome factors and associated mortality rate found that metabolic syndrome is present among 26% of people were younger than 65yrs and 55% were older than 65yrs. In younger adults having all five metabolic syndrome factors were most strongly associated with mortality ^[4]. Another cross-sectional study revealed that the prevalence was increased from11.0% in the 20 to 29 years age group to 47.2% in the 80 to 89 years age group in man and 9.2% to 64.4% for women in the corresponding age groups⁵. The prevalence of impaired fasting glucose and diabetes mellitus were two-fold in elderly as compared with young age groups. Waist circumferences were lower among elderly than among younger age groups⁶.

A cross sectional survey among Iranian adults found a prevalence rate of more than 42.3% among women. An inverse association was found between education and metabolic syndrome. The vigorous activity was inversely associated with metabolic syndrome compared with low level physical activity⁷. Another study among Filipinos shows that the metabolic syndrome was associated with increasing age, urban residence, and employed status. It was higher in females⁸. A study from Indonesia and Netherland found that in both populations, hypertension is the primary contributor to the prevalence of metabolic syndrome and abdominal adiposity was more strongly associated with metabolic syndrome than overall adiposity⁹.

A study to verify persistence of metabolic syndrome and components in overweight children and adolescents, as well as its relation to socioeconomic and demographic characteristics and to the pathobiological determinants of atherosclerosis in youth observed persistent metabolic syndrome in 38.3% of the sample, associated cardiovascular risk in 79.7%, reduction in arterial pressure and do HDL-c¹⁰. A study from South Korea reveals that metabolic syndrome prevalence increased with age from 4.6% at age 19−29 years to 25.0% at age 50−65 years. The women with high-income and high-education group were 52% less likely to have metabolic syndrome compared with the middle-income and middle-education group. The most common combination of metabolic syndrome components were central obesity + low HDL cholesterol + hypertriglyceridemia, which occurred in 15.5% of all metabolic syndrome patients and in 3.4% of all adults¹¹.

The knowledge about metabolic syndrome and its consequences in society is in infancy stage. Increasing the awareness of metabolic syndrome itself may account for huge decline as early interventions help to abort the associated complications. Simple lifestyle changes and routine health checkups can help keep metabolic syndrome at bay. The prevalence of metabolic syndrome is high as well as unrecognized among the general population¹². In the present study structured education was given and evaluated the improvement in the knowledge. After the education the experimental group showed significant improvement in the knowledge compared to control group. A similar study to assess the knowledge of college student’s awareness and knowledge about conditions relevant to metabolic syndrome found that more than 80% of students correctly identified symptoms and complications of diabetes, hypertension, arteriosclerosis, myocardial infarction and stroke, and 92% identified adiposity as a risk factor for heart disease¹³. A study on dissemination of evidence-based knowledge on metabolic syndrome from research to practice found that the knowledge attitude and practice level is significantly improved after promotional activities¹⁴. The diseases associated with metabolic syndrome can be chronic, debilitating, and lethal. Understanding the origins of obesity and its pathways to metabolic syndrome are essential to prevent and treat affected patients¹⁵.

A study was to assess the knowledge of metabolic syndrome (MS) among Chinese adults and provide directions for designing healthcare promotion schemes for improving metabolic syndrome awareness in the community. The mean knowledge score was 44.9 out of 100; most participants (61%) scored below 50, indicating a poor level of metabolic syndrome knowledge. Participants who were older, had a lower level of education or were unemployed scored the lowest¹⁶. A cross-sectional study to examine the current health literacy levels, risk perceptions about metabolic syndrome, and associated management challenges in diverse Indian settings showed that difficulty in understanding healthcare information was commonly reported, especially in rural and slum settings. Only 10% of the individuals perceived lifestyle behaviors as a risk factor of acquiring metabolic syndrome. Significant disparities were seen among urban, rural, and slum individuals about using diet and exercise as means to manage their metabolic syndrome. An urgent need exists to develop interactive health education programs that can enhance self-management approaches to meet the growing burden of metabolic syndrome by providing access to right information applicable to individuals living in diverse Indian settings¹⁷. A study on educational inequalities in the metabolic syndrome and coronary heart disease among middle-aged men and women found that metabolic syndrome defined by NCEP criteria was less prevalent in subjects with university education (21% in men and 14% in women) compared with basic level education (41% and 27%, respectively)¹⁸.

IMPLICATIONS FOR PRACTICE:

Middle age years are now much active, because of increasing in life span and greater survival. Nurse’s work at all levels of health care and all levels of prevention. There is considerable lack of awareness about metabolic syndrome and control measures of among women, both urban and rural women in India. The nurse educators and the administrators should be prepared for the assessment of metabolic syndrome in women and design early intervention to promote their quality of life and preventing complications.

CONCLUSION:

The study results explain selected lifestyle interventions significantly improved the knowledge of metabolic syndrome among women. The study concludes that there is a significant change in knowledge regarding metabolic syndrome among women after the intervention. Selected lifestyle interventions are found to be an effective and economically feasible strategy to control the metabolic syndrome parameters. This may reduce the need for pharmacological intervention and also prevent complications such as CVD and T2DM.

CONFLICT OF INTEREST:

Author declares no conflict of interest.

ACKNOWLEDGEMENTS:

The author wishes to express their appreciation to all women participants in this study.

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Received on 08.07.2025 Revised on 07.08.2025

Accepted on 25.08.2025 Published on 25.10.2025

Available online from November 04, 2025

Asian J. Nursing Education and Research. 2025;15(4):241-246.

DOI: 10.52711/2349-2996.2025.00049

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.

Variable	Time	Control Group (n=74)		Experimental Group (n=72)		H	p	Effect size
		Median and Percentile	Z (p)	Median and Percentile	Z (p)
Knowledge	Pre test	8(7.0-9.0)	1.604 (0.147)	8(7.0-9.0)	7.441 (<0.001)	0.027	0.987	3.62
	Post test	8(7.0-9.0)		16(15.0-18.0)		148.263	<0.001