INTRODUCTION:

“Yesterday’s girl is today’s adolescent and tomorrow’s mother.”

-Kurt Vonnegut. Jr

Beginning from the day of conception even after birth and till death people go through many changes in life throughout various stages. Child first grow rapidly and they enjoy every drop of their life as they grow.

But everything doesn’t feel to be normal as puberty begins. Although it was expected it feels so different and life will change¹

Adolescent girls are future mothers. Going through the puberty can be challenging time for any girl. Although it may occur at different ages for all girls, adolescent girlhood is always a critical time of identity formation and a period of transition from childhood to womanhood. Due to lack of providence of knowledge regarding puberty the adolescent girls go through the physiological and emotional stress and malpractices¹.

The word Puberty is derived from the latin word “Pubertas” which means age of manhood. It refers to the physical rather than behavioral changes which occur when the individual becomes sexually mature and is capable of producing off springs. According to WHO adolescence is the period of life extend from 10-19 years².

According to UNICEF, Puberty is defined as the sequence of events by which the individual is transformed into a young adult by a series of biological changes. As growing numbers of girls reach puberty even before they are ten. Adolescence begins with the onset of puberty³.

It is a period of rapid physical, psychological, emotional and behavioral changes when individual achieves nearly the adult body stature. The girls begin their pre-adolescent spurts at about 10years of age⁴. In about 50% of girls the first sign of puberty is the enlargement of breast buds, followed by development of pubic hairs, despite variable onset of other features, what is reasonably constant is that mensturation⁵.

In physical changes common pubertal changes include accelerated growth in weight and height gain, breast changes like pigmentation of areola, enlargement of breast tissue and nipple, appearance of pubic hair, changes in vaginal secretions, activation of axillary sweat glands, appearance of axillary hair and onset of menstruation. Emotional changes includes depression, anger, irritability, fear and anxiety. Puberty is a period of rapid skeletal and sexual maturation that occurs mainly in early adolescence. The Stein Berg defined ‘puberty as the biological changes of adolescence and biological developments which can change girls from physical maturity to biological maturity⁶.

Due to lack of adequate information adolescents may have ambivalent feelings about menstruation. They may resent the fact that they cannot completely control all their bodily functions and may therefore consider menstruation as a burden⁴.

BACKGROUND OF THE STUDY:

Puberty is the phase of life during which secondary sexual characteristics develop, menstruation begins and capability of sexual reproduction is attained. A study published by Donhey regarding puberty revealed that the age of puberty is declining for girls with more girls developing breast by age 7 than in years past. This undoubtedly a reflection of improved nutritional status and healthier living condition⁷.

Anusha M, Radhika M and Indira conducted a study on effect of structured teaching programme on knowledge regarding pubertal changes in pre-adolescent girls in Nellore showed that 71.6% had inadequate knowledge and 28.4% had moderately adequate knowledge. There is a significant increase in knowledge after teaching programme.⁸

Neelam M (2010) conducted a study on effectiveness of a structured teaching programme on knowledge regarding puberty among pre- adolescent girls in Karnataka showed that knowledge score during pretest was poor (33.52%) and increased to 80.71% after planned teaching programme³.

Pathak RN and Pawar conducted a study on problems and needs of adolescents in Madhya Pradesh (2001) revealed that students had poor knowledge on their body changes and more than 50% of students were not able to correctly define puberty and secondary growth changes. Students need to improve their knowledge on adolescents and reproductive health.⁹

A community based cross sectional study was conducted by Nair P, GroverVL, and Kannan AT (2007) on awareness of menstruation and pubertal changes amongst 102 unmarried female adolescents in East Delhi. The results showed that only 45.7% of girls had attained menarche and only 33.4% of the girls were aware of all the pubertal changes.¹⁰

The onset of menstruation is one of the most important changes occurring among girls during adolescent years. Menstruation is still regarded as something unclean or dirty in Indian society. Because of various myths and beliefs during menstruation girls often develop negative attitude towards this natural phenomenon. Majority of girls lack scientific knowledge about menstruation and puberty. They are often reluctant to discuss the topic with their parents and often hesitate to seek help regarding their menstrual problems.¹¹

Puberty is occurring earlier in most of the girls than actual age due to westernization and fast food pattern. The mothers or family sometimes not even canprepare their girls to face onset of menstruation. This leads to lack of knowledge at accurate time regarding her physiological maturation and onset of menarche further that makes misunderstanding of the need of the teenage girls¹².

NEED AND SIGNIFICANCE OF THE STUDY:

Puberty is the time of change for every adolescent girl. Due to lack of knowledge regarding puberty, the adolescent girls go through the physiological and emotional stresses and malpractices. In Indian society most of the girls do not get adequate knowledge about their own bodies, physiological changes and about menstruation. If we are providing accurate knowledge to the pre-adolescent girls it will be helpful for them at the time of puberty.

During pre-adolescent period, dramatic changes take place in girls like growth spurts, reproductive system development and appearance of secondary sexual characteristics¹³. Statistics indicate that girls in the United States are maturing at an earlier age than they did 30 years ago and the number of girls with diagnosed precocious puberty is on rise¹⁴.

A study was conducted by Jacob JM in Udupi to assess the knowledge and anxiety of pre-adolescents related to pubertal growth among 170 pre-adolescent girls, 55.8% do not receive adequate parental preparation on pubertal growth and 61% had only average knowledge¹⁵.

A cross sectional study was conducted in Malaysia to determine perception towards menstruation and premenstrual syndrome to provide insight to menstrual related education information in order to help adolescent girls manage the physical and psychological changes associated with menstruation. Eighty percentage of girls is having deficient knowledge regarding menstruation and 20% is having minimal knowledge¹⁶.

A study conducted by Gumangai SK and Aryee RK among 460girls whose ages ranged from 14- 19 years revealed that their ages at menarche ranged from 9-16 years and their menstrual cycle lengths ranged from 21-35days¹⁷.

Puberty and adolescents can be a wild ride for girls, especially when their first period arrives. In many cultures the onset of puberty is a hugely significant life transition and a focus for all sorts of celebrations and rituals. Majority of girls usually have lack of scientific knowledge regarding puberty, menstruation and its hygienic practices. They are reluctant to discuss this embracing topic with their care-providers and often hesitate to seek help regarding the menstrual problem from external sources. So girls should be educated in pre-adolescent period itself¹⁸.

MATERIAL AND METHOD:

a) Research Approach:

Quantitative, Quasi experimental approach.

b) Research Design:

One group pre testpost test design.

c) Setting:

Selected school at Varkala Taluk.

d) Population, Sample and Sampling technique

Population:

Pre-adolescent girls belonging to the age group 9-10 years, studying in 5^th standard in selected

schools at Varkala Taluk.

Sample:

It consists of 80 pre-adolescent girls, studying 5th standard in a selected school at Varkala Taluk.

Sampling Technique:

Cluster sampling

e) Tools and Technique:

Section A: Socio demographic proforma.

Section B: Questionnaire to assess knowledge of pre-adolescent girls regarding puberty.

f) Pilot Study:

Pilot study was conducted after obtaining formal permission from Institutional Ethics Committee of Sivagiri SreeNarayana Medical Mission College of Nursing, Varkala, District Educational officer and Principal of concernedschool. Informed consent were taken from each subject in the study. Eight pre-adolescent girls were included in the pilot study. Data were collected from 19/12/2016 to 01/01/17. Pre test knowledge was assessed using a questionnaire. Structured teaching programme was given to samplesregarding puberty. Post test knowledge was assessed after two weeks. The data collected were tabulated andanalyzed. Analysis was done using descriptive and inferential statistics. The study was found researchable andfeasible.

Cronbach’s Alpha is used to establish reliability of tool. Number of items are 26 and the reliability ‘r’ value was0.7. So the tool was reliable.

g) Data collection:

The researcher obtained formal permission from the Institutional Ethics Committee of Sivagiri Sree Narayana Medical Mission College of Nursing, Varkala, and Principal of Sivagiri Sree Narayana Higher SecondarySchool, Varkala. The data was collected from 14/01/2017 to 13/02/2017. Investigator introduced herself to thesamples and explained about the study. Confidentiality of the data was ensured and informed consent was obtained from the selected samples.

All the subjects who met the inclusion criteria and available during the time of data collection were selected as samples. Pretest knowledge of eighty pre-adolescent girls were assessed using self-administered knowledge questionnaire.76.2% had poor knowledge and 23.8% had average knowledge.

Structured teaching programme was imparted to the samples for 30 minutes. Doubts were cleared during thesession. Post test knowledge was assessed after 2 weeks.

h) Data analysis:

Data was analyzed using descriptive and inferential statistics. Frequency, percentage, mean and standard deviation were used to describe socio demographic proforma and knowledge regarding puberty. Paired t test was used to determine the effect of structured teaching programme on knowledge regarding puberty among pre-adolescent girls. Chi-square was used to find out the association between pre-adolescents knowledge and selected socio demographic variables.

RESULTS:

Section I-Socio demographic proforma

Table 1 Distribution of pre-adolescent girls based on age (n=80)

Age (in years)

31.2

53.8

15.0

Table 2: Distribution of pre-adolescent girls based on religion, (n=80)

Religion

Hindu

Muslim

Christian

53.8

32.5

13.8

Table 3 Distribution of pre-adolescent girls based on educational status of father, (n=80)

Educational status

Illiterate

Primary school

High school

Higher secondary school

Graduation and above

6.2

23.8

35.0

30.0

5.0

Table 4: Distribution of pre-adolescent girls based on educational status of mother, (n=80)

Educational status

Illiterate

Primary school

High school

Higher secondary school

Graduation and above

3.8

22.5

50.0

18.8

5.0

Table 5: Distribution of pre-adolescent girls based on occupation of father, (n=80)

Educational status

Private employee

Self employed

Daily wages

33.8

38.8

27.5

Table 6: Distribution of pre-adolescent girls based on occupation of mother, (n=80)

Educational status

House wife

Government employee

Private employee

Self employed

Daily wages

42.5

13.8

22.5

7.5

Table 7: Distribution of pre-adolescent girls based on type of family, (n=80)

Religion

Nuclear family

Joint family

73.8

26.2

Table 8: Distribution of pre-adolescent girls based on place of residence, (n=80)

Place of residence

Rural

Urban

78.8

21.2

Section II:

Level of knowledge of pre-adolescent girls regarding puberty

Table 9: Distribution of mothers based on pre test knowledge level, (n=80)

Knowledge score

Poor

Average

76.2

23.8

Table 10: Distribution of pre-adolescent girls based on post test knowledge level, (n=80)

Knowledge score

Average

Good

71.2

28.8

Section III:

Effect of structured teaching programme on knowledge regarding puberty among pre-adolescent girls.

Table 11: Mean standard deviation and t value on knowledge regarding puberty among pre-adolescent girls.

Knowledge score

Mean

Pre test

Post test

7.30

16.32

2.74

2.81

29.43 ***

0.001

*** Significant at 0.001 level

Section IV:

Association between level of knowledge and selected socio demographic variables:

There is no association between the level of knowledge regarding puberty among pre-adolescent girls and their socio demographic variables like age, religion, education of father, education of mother, occupation of father, occupation of mother, type of family and location of residence.

DISCUSSION:

The present study focused on the assessment of pre-adolescent girls knowledge regarding puberty with a view to develop a structured teaching programme.

The major findings of the study are discussed in relation to the findings of the other research studies.

The first objective of the study was to assess the knowledge regarding puberty among pre-adolescent girls. The results showed that in pre test 76.2% had poor knowledge and 23.8% had average knowledge regarding puberty.

The findings of the study was supported with a study conducted by Rani M, Sheoran P, Kumar Y to assess the knowledge and attitude regarding pubertal changes among 204 pre- adolescent girls. The findings revealed that 74% of girls is had below average knowledge on puberty¹⁹.

A study was conducted by Singh SP, Singh M, Arora M, to assess knowledge regarding puberty in 504 girls with age group of 10-19 years in Varanasi. The findings showed that only 45.6% obtained average knowledge score and others had poor knowledge.²⁰

The second objective was to determine the effect of structured teaching programme on knowledge regarding puberty among pre-adolescent girls. From the present study it was found that the mean knowledge score was increased from 7.3 to 16.3 and was statistically significant at 0.001 level.

The study findings was supported by a study conducted by Prabhu P on effectiveness of teaching programme on pubertal changes and menarche in 40 preadolescent girls. Study result revealed that in pretest 65% of students had averageknowledge and no one had good knowledge where as in post test 65% had good knowledge and 32.2% had average knowledge²¹.

A study was conducted by Anusha L, Radhika M, Indira on effect of structured teaching programme regarding pubertal changes among pre-adolescent girls in Nellore. The findings showed that 71.6% had inadequate knowledge and 28.4% had moderately adequate knowledge⁸.

A study was conducted by Neelam M on effectiveness of structured teaching programme regarding puberty among pre-adolescent girls in Karnataka. The findings of the study revealed that knowledge score during pretest was poor (33.5%) and in posttest knowledge increased to 80.7%³.

The third objective is to find the association between level of knowledge regarding puberty among pre- adolescent girls and selected socio demographic variables. From the present study it was found that there was no association between knowledge and socio demographic variables.

ACKNOWLEDGEMENT:

The investigator is immensely thankful to the Management of Sivagiri Sree Narayana Medical Mission College of Nursing, Varkalafor giving an opportunityto undertake the Post Graduate course in this esteemed institution.

The investigator express her heartfelt thanks to Prof. D. Santhakumari, Principal, SSNMM College of Nursing, Varkala, for her scholarly guidance, advice, valuable suggestions and supervision throughout the study.

The investigator owes a great deal of thanks to Dr. S. J. Douglas Linsby, Former director, SSNMM Hospital and Chairman of Institutional Ethics Committee, SSNMM College of Nursing, Varkala for his valuable guidance and support.

The investigator express her deep sense of gratitude to her guide Mrs. Saramma N. B, Associate Professor, SSNMM College of Nursing, Varkala for her warm encouragement, thoughtful guidance, insightful decision, critical commentsand constant motivation for the successful completion of the study.

The investigator express her heartfelt thanks to Prof. Wincely Sahayaraj. RVice principal, SSNMM College of Nursing, Varkala for his scholarly guidance, advice and valuable suggestions throughout study.

The investigator express her sincere thanks to Prof. Kiruba J Cand all teaching faculty of SSNMM College of Nursing for their priceless support, valuable suggestions and timely help to carry out this study.

The investigator is thankful to Dr. K. Syamalan, Professor of Medical Statistics and Head of Sree Gokulam Research Foundation and Mrs. Manju. L, Associate professor, Department of stastistics, Sree Gokulam Medical College and Research Foundation, Venjaramoodu for their help and guidance in statistical analysis.

The investigator acknowledges her deep and heartfelt gratitude to the headmistress Mrs. B. Lissyof Sivagiri Sree Narayana Higher Secondary School, Varkala for his permission to collect data from the school.

The investigator is extremely grateful to all participants for their whole-hearted cooperation and forbearance without which this study would have never been in reality.

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Received on 08.04.2018 Modified on 22.05.2018

Asian J. Nursing Education and Research. 2018; 8(4):519-524.

DOI: 10.5958/2349-2996.2018.00106.4