RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE

ANNEXURE –II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1 Name of the candidate and address

(in block letters)

BINU PAULOSE

FIRST YEAR M. SC. NURSING

SAHYADRI COLLEGE OF NURSING

FALNIR ROAD, KANKANADY, MANGALORE

2 Name of the institution SAHYADRI COLLEGE OF NURSING

FALNIR ROAD. KANKANADY

MANGALORE -02

3 Course of study and subject M.Sc. NURSING,

COMMUNITY HEALTH NURSING

4 Date of admission to course 5.6.2009

5 Title of the study:

A COMPARATIVE STUDY TO ASSESS THE QUALITY OF LIFE OF

POST-MENOPAUSAL WOMEN RESIDING IN SELECTED RURAL AND

URBAN COMMUNITIES WITH A VIEW TO CONDUCT AN

AWARENESS PROGRAMME ON POST MENOPAUSAL HEALTH.

1

6. BRIEF RESUME OF INTENDED WORK

Introduction

Menopause is a complex time in a woman’s life leading to both physical and

emotional challenges. Menopause currently affects the lives of millions of women

globally and will be an issue of increasing concern as the population ages over the

next few decades. The word menopause literally means the permanent physiological

or natural cessation of menstrual cycle. In other words, menopause means the natural

and permanent stopping of monthly reproductive cycles, which is usually manifest as

a permanent absence of monthly periods or menstruation. Post menopause refer to

the period of life after menopause has occurred. It is generally believed that the

postmenopausal phase begins when 12 full months have passed since the last

menstrual period. From then on, a woman will be postmenopausal for the rest of her

life1.

According to IMS (Indian Menopause society) research, there are about 65

million Indian women in the age group of 45 years. Average age of menopause is

around 48 years but it strikes Indian women as the age as 30-35 years. So

menopausal health demands even higher priority in Indian Scenario.2

6.1. Need for study

Menopause is an important time in women’s life. Declining levels of the

hormones i.e., oestrogen and progesterone produced by the ovaries bring about many

changes in the female .The historical and social construction of the menopause

experience has significant implications for menopausal women. Persistent

stereotypes imply that menopause is a time associated with a loss of youth and

sexuality. Further influencing the way in which menopause is perceived and

understood is the fact that the medical discipline has largely defined menopause as a

negative experience filled with a variety of undesirable physical and emotional

symptoms (Winterich & Umberson, 1999). Menopause is an inevitable milestone in

the reproductive life of every woman. Technically, it refers to a woman’s last

periods; a woman can be said to have reached menopause when she had one year

2

without menstruating. Menopause as a change in hormonal levels can conceal the

social context in which it occurs as a change of life marked by many life stages.3

Women play an important role in replenishing the earth but her reproductive

capacity is not permanent; it ceases one day which is coined as menopause.

Menopause, especially in a rural woman brings in lot of changes which she has to

tackle to get rid of chronic illnesses especially psychosomatic problems. The efficient

and effective means of preventing and controlling these problems is through

improving social support, self-esteem, and empowerment.

A research study measured on 56 middle-aged rural Indian women of selected

villages of Chennai, Tamilnadu reported correlations were statistically significant

with P < 0.01 in a two tailed test. Self-esteem was positively associated with social

support (r=0.044), empowerment (r=0.354), and self-efficacy (r=0.566). The highest

absolute correlation was found between loneliness and stress (r=716), depression and

stress (r^0.701) and social support with loneliness (r=0.646). The study concluded

that social support, self-esteem, empowerment, and psychosocial indicators have a

correlation.4

Menopause is accompanied by biological and psychological changes that

affect a women’s health and sense of well being. Menopause is the time in a

woman’s life, usually occurs naturally, often after 45 years. Menopause happens

because the woman’s ovaries stop producing the hormones oestrogen and

progesterone. Changes and symptoms can start several years earlier. They include

changes in periods – shorter or longer, lighter or heavier with more or less time in

between hot flushes and/or night sweats, trouble sleeping, vaginal dryness, mood

swings, trouble focussing and less hair on the head, more on the face, women as to

men, experience an age-related decline of physical and mental capacity. They

observe symptoms such as periodic sweating or hot flushes, depression, insomnia,

impaired memory, lack of concentration, nervousness, and bone and joint complaints.

These symptoms more seen in rural communities. Quality of life different from rural

and urban communities.5

3

The investigator during her community health field experience observed as

well as listened to menopausal women complaining about various minor problems

that interfere in their day to day life. These complaints can be overcome to improve

the quality of life. Due to illiteracy Indian women are ignorant about the changes

taking place in their reproductive system. Religion and culture of our society also

inhibits to express these changes. So awareness programme need to be conducted to

overcome these issues. But there is a lack of awareness of cause, effect and

management pertaining to it. A wide gap in the knowledge has been documented on

the women from developed and developing countries. And this gap is even wider in

women from rural and urban communities. So the investigator felt that there is a

need to improve the quality of life of post menopausal women through an awareness

programme.

6.2 Review of Literature

A study was conducted to evaluate the factors influencing the quality of life

(QOL) of Moroccan postmenopausal women with osteoporosis. Forty-three post

menopausal women aged 48-60 yrs participated in this study. Questionnaire was used

to assess the quality of life of post menopausal women. The independent factors were

associated with poor quality of life, low educational level (p=0.01), vertebral

fractures (p=0.03) and a history of peripheral fracture (p=0.006). Worse QOL was

observed in the group with fractures in all domains except “pain,” namely, physical

functioning (p=0.002), fear of illness (p=0.00), and psychosocial functioning

(p=0.007). The number of fractures was a determinant of a low QOL, as indicated by

an increased score in physical functioning (p=0.001), fear of illness (p=0.007), and

total score (p=0.01) after adjusting on age and educational level. Patient with higher

score had low quality of life in these two domains too (p=0.002, p=0.001

respectively) and in the total score (p=0.01) after adjusting on age and educational

level.6

A study was conducted among women in age after 45 years from Poland,

Belarus, and Greece. The menopause rating scale (MRS) was used. It consists of and

letter of 11 symptoms which had been answered. The respondents have and choice

among 5 categories – no symptoms, mild, moderate, marked, and severe. Mild and no

complaints in similar degree were reported by all women from these three countries.

4

The investigator also found that almost 14.4% of women from Greece had marked

complaints in menopause rating scale compared to complaints of 9% respondents

from Belarus and 9.5% from Poland. These differences were significant (P < 0.001).

Moderate complaints were reported more frequently by women from Poland

(32.56%) and Belarus (34%) compared to women from Greece 28.5%). Severe

complaints were noted more rarely in 1.6% Greek women compared to 2.6%

Belarusian and 3% Polish respondents. These findings were not significant.

Furthermore, a half of the respondents from Poland, Belarus, and Greece reported hot

flushes (in moderate degree). In contrast 70% of Greek women declared hot flushes

from, 54.4% from Poland, and 60% from Belarus. Insomnia was reported more

frequently by women from Poland (34.6%) and Belarus (36%) than by respondents

from Greece (17.6%). No significant differences between no complaints, mild,

moderate, marked and severe were found between women from Belarus, Poland and

Greece.7

A study was conducted on health related Quality of Life of post menopausal

women. The age group 45-60 yrs was selected. A randomized lifestyle intervention

trial of diet, physical activity was included in the study. Analysis focused on the

women who lost ≥5lb during the initial phase of the study, baseline to 6 months

(n=248). This cohort was divided into 3 groups based on sub sight weight change

between 6 & 18 months : weight loss (WL; ≥lb loss), wt stable (WS; <±5lb change)

& weight regain (WR; ≥5lb gain) of the 248 women studied, 5, (21%) continued to

loss weight after initial weight loss, while 127 (51%) maintained & stable weight &

70 (28%) regained weight. Between baseline & 6 months, women in weight regain

group had deceased mental health & social functioning scores, while the weight loss

and weight stable groups improved in those subscales. Between baseline & 18

months, energy improved most significantly in those with continued weight loss

(P=0.0003).8

A study was conducted in Chandigarh, India. Systematic random sampling was

used. The study population comprised of women above 40 years and resident of

study area. Out of total 528 women interviewed, 302 (56%) were residing in urban

area and rest were the resident of slums. 78.8% urban 60.2% from slums had attained

menopause. Majority (70.3%) of urban residents had heard about menopause as

compared to 30.9% in slums. The most common menopausal symptoms were vaginal

5

irritation /discharge (47.7%) less than half of females (38.7%) took treatment for

menopausal symptoms. Calcium supplements were taken by majority 63%.

7.7% female complained of post menopausal bleeding out of which 13(14.8%) had it

after intercourse. Only 2(28.6%) women had their pap smear done after being

suggested by doctor and they were from urban area only. The study highlights that

there is lack of awareness regarding menopause and related aspects especially post

menopausal bleeding in both urban and slum population.9

A study was conducted on Quality of Life impairment among postmenopausal

women living in urban areas. In this study women aged 40-50 years participated in a

cross-sectional study filling out the Menopause Rating Scale (MRS) and a general

questionnaire. A total 579 women were included. 153 Hispanic, 295 indigenous and

131 Afro-descendent. Hispanci Women had an average age of 55.3+/- 3.3 years.

Indigenous and balck women were less educated than the Hispanic ones (2.2+/- 1.8

and 4.6+/--4.4 vs. 6.4+/- 3.5 years, p<0.0001). Hispanic women displayed lower total

MRS score (better QoL) when compared to indigenous and black women. Urogenital

scoring was worse among indigenous women compared to Hispanic and black

women. Black women presented higher MRS psychological and somatic scorings

than Hispanic and indigenous women. After adjusting for confounding factors,

indigenous and black women continued to display a higher risk for impaired QoL,

total menopause rating scale score >16 which was significantly higher among

indigenous women due to urogenital symptoms and black women due to

psychological and somatic symptoms.10

A study was conducted on the effects of physical exercise on the quality of life

of post-menopausal women. Forty-eight menopausal women aged 55-72 years were

recruited at a primary care centre as voluntary participants in a quasi experimental

study. They were randomly assigned to one of the two groups – control (n = 24) and

experimental (n=24). The experimental group participated in a 12-month programme

of cardiorespiratory, stretching, muscle-strengthening, and relaxation exercise carried

out during two fully supervised exercise sessions per week (total 3 hours weekly).

Health-related quality of life was assessed by using the Quality of Life Profile for

Chronically Ill Patients, a generic questionnaire widely used in epidemiological and

clinical studies to measure the wellbeing and function, incorporating as an optional

module, the Kuppeman Index of Menopausal Symptomatology. There was a

6

statistically significant improvement in health-related quality of life of the

experimental group, whereas the health-related quality of life of the control group

significantly worsened. Menopausal symptoms also significantly improved in the

experimental group and significantly worsened in the control group over the 12-

month study period.11

6.3 Problem Statement

A comparative study to assess the quality of life of post-menopausal women

residing in selected rural and urban communities with a view to conduct an

awareness programme on post menopausal health.

6.4 Objectives of the Study

1. To assess the quality of life of postmenopausal women residing in selected

rural and urban communities.

2. To compare the quality of life of post menopausal women residing in selected

urban and rural communities.

3. To find out an association between quality of life of postmenopausal women

and selected demographic variables such as age, income, occupation.

6.5 Operational definitions

1. Quality of life: According to the World Health Organization, Quality of Life

can be defined as “Individual’s perception of their position in life in the

context of the culture and value systems in which they live, and in relation to

their goals, expectations, standards and concerns.

In this study, quality of life refers to the way a woman overcomes significant

physical, physiological, emotional, and psychological changes taken place

due to menopause which may affect interms of health.

a. Physical changes such as weight gain, ageing process, skin changes,

dryness of vagina and painful intercourse. These changes can be

managed by physical exercises like jogging, walking and cross

legging.

b. Physiological changes such as low back pain, joint ache, hot flushes,

night sweats, and dryness of vagina, and sexual changes. These

changes can be handled by meditation, pranayama, yoga, and

nutritious diet containing Calcium, Vitamin E, C and A.

7

c. Psychological changes refer to mood swings, irritability, anxiety,

depression and sexual problems. These changes can be managed by

recreational therapies like reading books, music, picnics, and spiritual

gathering.

d. Emotional changes are irritation, nervousness, headache, and feelings

of fear, sadness, and loneliness. These changes can be managed by

family support and social support.

2. Postmenopausal women: According to Webster New World medical

dictionary “It is the time after which a women has experienced 12 consecutive

months of amenorrhoea.

In this study, postmenopausal women refer to married, unmarried, employed

or unemployed women in the age group of 45-60 years, who have

experienced 12 consecutive months of amenorrhoea and who are not on

hormone replacement therapy (HRT)

3. Rural: Rural are large and is isolated areas of a country, often with low

population density (Wikipedia).

In this study, it refers to the selected villages which comes under selected

primary health centre.

4. Urban: Urban area is characterized by higher population density and vast

human features in comparison to areas surrounding it (Wikipedia).

In this study, it refers to the selected areas which comes under selected urban

family welfare centre.

5. Awareness Programme on post menopausal health: In this study it refers

to the individual health education and selected demonstration such as breast

self examination, yogas and calcium preparation which will be provided to

postmenopausal women of selected areas with the use of charts to improve

the quality of life.

8

6.6 Assumptions

The study assumes that:

Post-menopause is a period in which women will have some health problems

which contribute to having changes in the quality of life.

There will be difference in the quality of life of urban and rural communities.

6.7 Delimitations

The study is delimited to:

Postmenopausal women in the age group of 45-60 years.

Postmenopausal women who are not on hormone replacement therapy

Selected areas of Mangalore.

6.8 Hypotheses

H1: There will be significant difference between the mean quality of life score of

postmenopausal women in rural and urban areas.

H2: There will be significant association between the quality of life of

postmenopausal women and selected demographic variables such as age,

income and occupation.

7. MATERIALS AND METHODS

7.1 Source of data

Post menopausal women in the age group of 45-60 years in selected urban

and rural areas in Mangalore.

7.1.1 Research design

Comparative survey.

Phase 1 Phase 2 Phase 3

Quality of life of postmenopausal women of rural area

Quality of life postmenopausal women of urban area

Prepare and validate awareness programme on post menopausal health.

Conduct awareness programme on postmenopausal health.

7.1.2 Setting

9

The study will be conducted in selected rural and urban communities of

Mangalore.

7.1.3 Population

Post menopausal women who have experienced 12 consecutive months of

amenorrhoea living in rural and urban communities.

7.2 Method of data collection

7.2.1 Sampling procedure

The purposive sampling technique will be used to select the sample.

7.2.2 Sample size

Sample size consists of post menopausal women 40 from rural and 40 from

urban communities.

7.2.3 Inclusion criteria for sampling

Those who have experience one year of amenorrhoea in the age group of 45-

60 years.

Those who are willing to participate in the programme.

7.2.4 Exclusion criteria for sampling

Those who have been diagnosed with critical medical, surgical and

gynaecological problems.

Those who are on Hormone replacement therapy.

7.2.5 Instrument intended to be used

Demographic proforma.

Modified Menopause Rating Scale to assess the quality of life

10

7.2.6 Data collection method

Permission will be obtained from concerned authorities.

The purpose of the study will be explained to postmenopausal women and

informed consent will be obtained from them.

Pilot study will be conducted prior to the study.

Quality of life of post menopausal women will be assessed using modified

menopause rating scale.

Awareness programme to improve quality of life will be given to the post

menopausal women residing in selected rural and urban communities.

7.2.7 Data analysis plan

Data will be analysed using descriptive and inferential statistics.

7.3 Does the study require any investigation or intervention to be conducted

on patients or humans or animals? If so please descriptive briefly?

No.

7.4 Has ethical clearance been obtained from institution in case of 7.3?

Yes, ethical clearance will be obtained from concerned authority.

11

8. LIST OF REFERENCES

1. Tamilmani. Menopause and hormone replacement therapy. Nightingale

Nursing Times. 2006; 2(1): 24-27.

2. Puri S, Bhatia V, Mangat C. Perceptions of menopause and post menopausal

bleeding in women of Chandigarh. The Internet Journal of Family Practice.

2008; 6(2): 601-608.

3. Sharon D, Wonshik C. Menopausal symptom experience : an online forum

study. Journal of Advanced Nursing 2008; 60(7): 541-548.

4. Sharadha R. Social support system in menopause. Nightingale Nursing

Times. 2009; 5 (6): 12-15.

5. Dutta DC. Text book of gynaecology. 3rd edition, New central book agency

(P) Ltd. 2004; 46.

6. Sabbah. Quality of life in rural and urban population in Lebanon using Sf-36

health survey. Health quality of life outcomes. 2003; 1(10): 477-498.

7. Isaac S. The benefits of regular exercise for post menopausal women.

Alternative medicine for menopause. 2004; 5 (10): 90-97.

8. Robert P. Exercise boosts quality of life in post menopausal women. Jama

archives journals. 2007; 28 (12): 34-39.

9. Alvaro M, Juan B, Peter C. Quality of life impairment among post

menopausal women. Gynaecological Endocrinology. 2008 ; 25 (8): 491-497.

10. Sanat B. Effect of physical exercise on the quality of life of menopausal

women. Journal of Advanced Nursing 2009; 54 (1): 54-58.

11. D’souza S, Melba. Health promoting quality of life of post menopausal

women. Journal of Advanced Nursing Sciences 2009; (66)2:142-146.

12

13

8. Signature of the candidate

9. Remarks of the guide

10. Name and designation of (in block letters)

10.1 Guide

10.2 Signature

10.3 Co-guide (if any)

10.4 Signature

11 11.1 Head of the department

11.2 Signature

12. 12.1 Remarks of the Chairman and Principal

12.2 Signature

14

15