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1. Name of the candidate and address POOJA ASOKAN

(in block letters) I YEAR M. Sc. NURSING
MANGALORE - 575002

2. Name of the Institution INDIRA NURSING COLLEGE

MANGALORE - 575002

3. Course of Study and Subject M. Sc. NURSING


4. Date of Admission to the Course 30.06.2012

5. Title of the study





6. Brief resume of the intended work

6.1 Introduction

Adolescents young people between the age of 12 and 19 years are often thought
of as a healthy group. It is the transition stage between childhood and adolescence. Also
many serious diseases in adulthood have their roots in adolescence. For example, tobacco
use, sexually transmitted infections including HIV, and poor eating and exercise habits lead
to illness or premature death later in life1.

Hormone imbalances are becoming increasingly common due to changes in diet and
other environmental factors. In the past, hormone problems usually affect older women,
usually in their forties or fifties. Today, more teenage girls are showing signs of hormone
imbalance. For a teenage girl, problems associated with a hormone imbalance can be
particularly disturbing and embarrassing2.

There are a multitude of factors, both positive and negative, that influence health and
wellbeing of adolescents. Some factors can be biologically determined while others are
social in nature3.

Adolescents form a large section of population of India, about 22.5%. Adolescent

girls have to be focused more as it is a period of rapid physical growth, sexual,
physiological, and psychological changes. Habits and behaviour picked up during
adolescence have life long impact4.

The establishment of a regular menstrual cycle is an important process for an

adolescent girl. The challenge is to distinguish normal individual variation from real
endocrine or organic problems. Avoiding too early unnecessary intervention without missing
relevant abnormalities requires a firm grasp of process of physiological sexual development
as well as of the symptoms and aetiology of relevant abnormalities5.

The term polycystic means many cysts and Poly cystic ovarian syndrome (PCOS)
gets its name because of clusters of small, pearl size cysts in ovaries. These cysts are fluid-
filled bubbles (called follicles) that contain eggs that have not yet been released because of
hormonal imbalance6.

It is a well known fact that Poly cystic ovarian syndrome (PCOS) and infertility go
hand in hand. PCOS, a major cause of infertility in women, is related to the absence of
ovulation (anovulatory infertility). The fact is that most women don't find out they have
PCOS until they want to have a baby. After possibly trying for a year or more without
success, a woman will visit her doctor who confirms the problem. However, many of the
symptoms and characteristics of PCOS are present in a young girl even before she begins
menstruation and the impact of this condition far extends what we have thought to date.
This information alone has caused some researchers to question whether PCOS is a genetic
or hereditary issue7.

Adolescents challenge is that PCOS is a systemic, complex disorder that needs to be

actively managed by them for the rest of their life. They need to go to a deeper level and
develop certain health practices that will help their body to naturally minimise the symptoms
and long- term risks of polycystic ovary syndrome.8

If you don't get to work on improving your health practices today, you may pay a
heavy price later on.9

You don't need to let PCOS ruin your life. You can take action to build and protect
your health. You can still live the life of your dreams, but it will take some dedicated work.6

PCOS cannot only be on the radar of family and adult healthcare providers. There is
growing evidence that PCOS is also a paediatric syndrome. Because some females reach
menarche as early as 8-9 years old, PCOS needs to be a topic of concern for healthcare
providers early in a child or adolescents reproductive health.9

6.2 Need for the study

Education is given for sake of individuals with a view to save from destruction


According to an article in Women Health, Poly cystic ovarian syndrome (PCOS)

affects 7-10% of those in the childbearing age with symptoms often presenting during
adolescence and young adulthood. In women of Indian subcontinent, prevalence rates of as
high as 50% have been detected.6

Bronstein, Tawdekar, Liu, Pawelczak, David, and Shah (2011) found that Poly cystic
ovarian syndrome (PCOS) diagnosis is occurring at an earlier age in the paediatric
population, with PCOS preadolescents having had a significantly earlier onset of pubarche
and thelarche than adolescents with PCOS (P = 0.018). In addition to early puberty, PCOS
diagnosis occurred two years sooner after thelarche in preadolescents than in adolescents.9

The common features of normal puberty in adolescents mainly are menstrual

irregularities and insulin resistance, obscure PCOS diagnosis in addition to lack of defined
diagnostic criteria for PCOS in this age group. Bhattacharya (February 2008) concluded that
discovering one risk factor for PCOS in women should prompt the clinician to search for
other risk factors to trigger early diagnosis.9

PCOS is sometimes inheritable as it is influenced by genes. It is more likely to

develop if there is a family history of diabetes (especially type 2) or if there is early baldness
in the men in the family. It is also seen if mother or close relatives are subjects of PCOS.10

Classic PCOS has the symptoms of weight gain, failure to ovulate, infrequent
periods, infertility, facial hair, acne, hair loss and a predisposition to diabetes. The real
underlying issue is insulin resistance, which is caused due to various factors like too many
carbohydrates in the diet (about 30% of the population cannot cope with a "normal" amount
of bread and sugar), damaged vegetable oils called trans fat, smoking, environmental toxins
such as BPA , birth control pill.8

A cross-sectional study was conducted to evaluate the prevalence of PCOS among

1430 adolescent girls selected from 15-18 years old girls from a number of high schools.
After interview and clinical examination, those individuals with menstrual irregularities,
hirsutism or obesity were referred for further laboratory evaluation and abdominal
sonography in order to diagnose PCOS and estimate its prevalence. The overall prevalence
of syndrome was 3.4%. Out of 1430 girls, 49 were diagnosed with PCOS.11

A study was conducted by Medical University of Silesia regarding causes of

infertility. The most common causes were anovulatory cycles and endometriosis. The most
frequently anovulatory cycles were related to PCOS commonly associated with obesity and
hormonal disturbances in course of obesity. Recently published studies have revealed that

infertility affects about one in six couples during their lifetime and is more frequent in

A study was conducted to evaluate the effectiveness of a structured weight loss

programme in preventing complication like anovulation. The structured weight loss
programme included calorie restriction and exercise of 6 months duration in anovulatory
infertile women. The average weight loss was 15 lb. The spontaneous ovulation rate was
92% and there was a 33% to 45% spontaneous pregnancy rate. Weight loss was considered
first line therapy in adolescents with PCOS.13

According to IAP, prevalence of obesity in Indian adolescents ranges from 6 to 8%

and occasionally higher, but clubbed to mean overweight and obesity collectively. In urban
India, 31% of adolescent females were found to be overweight and 7.5% obese.14

A study was conducted in USA to determine the sleep and cardiometabolic function
in obese adolescent girls with PCOS. The study revealed that the prevalence of obstructive
sleep apnoea (OSA) was higher in girls with PCOS compared to control females (57% v/s
14.3%). Also girls with PCOS had significantly higher prevalence of insulin resistance
compared to control females (41% v/s 34.8%). Also women with PCOS were three times
more likely to develop endometrial cancer.15

According to an article in NY Times, there is a rapid escalating epidemic of Type 2

DM and CHD. Prevalence of Type 2 DM increased in urban India from <3% in 1975 to
>12% in year 2000. By the year 2025 it is predicted that India will have a rise of 59% of
diabetics in the population which is the highest number of diabetic patients in the world. Ten
percent of the newly diagnosed DM patients are in age group of 10-18 years in which most
were asymptomatic and commonly associated with PCOS. Physicians, paediatricians and
nurses have an important role in the prevention and control of the epidemic of lifestyle
disorders as they begin in childhood.14

A meta-analysis study was conducted to screen for anxiety, mood disorders in all
women with PCOS. The study shows that girls with PCOS were at higher risk for anxiety
and depression. From among 613 relevant articles, four studies had data on the prevalence of
generalised anxiety symptoms in women with clearly defined PCOS and well-selected

control women. The prevalence of anxiety was 20% in women with PCOS (42 of 206) v/s
4% in controls (8 of 204). Early detection and treatment of PCOD is necessary for
preventing complication.16

According to PCOS Foundation, established in the US to spread awareness regarding

PCOS among public, a vast majority of US population has no knowledge of PCOS,
including many women and adolescent girls affected by PCOS. Females must be aware of
symptoms, health precautions, and risks for diseases associated with PCOS to help prevent
future complications.17

The onset of PCOS occurs mainly during the adolescence. They suffer from both
physical and psychological morbidity. Signs and symptoms of PCOS cause psychological
morbidity and can negatively affect quality of life of adolescents. Also, if untreated, PCOS
can lead to complications. So early recognition, prevention, and treatment are important to
prevent long-term sequelae.

From the various studies above, the investigator found that adolescent girls lacked
knowledge regarding PCOS and were neglecting taking care of the disease. Hence the
investigator felt that it was important to educate adolescent girls regarding PCOS.

6.3 Review of literature

Studies related to PCOS

A prospective study was conducted to find out the prevalence of Poly cystic ovarian
syndrome (PCOS) in Indian adolescents. Data was collected from 460 girls aged 15 to 18
years. Out of 460 girls, 1 (0.22%) had oligomenorrhoea with clinical androgenism, 29(6.3%)
had oligomenorrhoea with polycystic ovaries, 1 (0.22%) had polycystic ovaries with clinical
androgenism and 11 (2.39%) had oligomenorrhoea with polycystic ovaries in the presence of
clinical androgenism. Thus 42 (9.13%) had PCOS. So early diagnosis and treatment of
PCOS in adolescent girls is necessary.18

A cross-sectional study was conducted on the prevalence of PCOS in Iran. The

prevalence of the syndrome was 4.8%. Multistage random sampling was done. Subjects were
selected from 15-18 years old girls from a number of schools. After clinical

examination, lab evaluation and abdominal sonography, out of 1430 girls, 59 (4.8%) were
diagnosed with PCOS.11

A study was conducted to determine whether obesity increases risk of PCOS and
whether degree of obesity of PCOS patients has increased. Data were analysed from two
consecutive population studies. Participants included 675 women who participated in
prevalence studies and 746 PCOS patients. The prevalence rate of PCOS in underweight,
normal weight, over weight and obese women were 8.2, 9.8, 9.9, and 9%. Prevalence rate
reached 12.4 and 11.5% in women with BMI 35-40 kg/m 2 and greater than 40 kg/m2 The
mean BMI of PCOS patients diagnosed between 1987 and 2002 rose. The obesity rate rose
to 10-14% in 1987, 15-19% in 1997, 25% or more in 2002. Thus obesity contribute to PCOS
and PCOS patients are at risk of becoming obese.19

A comparative study was conducted in New Delhi regarding the prevalence of

clinical manifestations in obese and lean PCOS women and their health hazards. Group A
included overweight and obese, Group B included normal weight and lean, and were further
divided into two groups according to their body mass index. The result is found that the
prevalence of menstrual irregularities, clinical hyperandrogenism, endometrial hyperplasia
and type 2 DM was significantly higher in obese group, whereas android central obesity was
similar in both groups. The study highlighted that DM and EH appears to be more prevalent
in obese, putting a greater risk of morbid problems at a much younger age than the lean

A cohort study was conducted to determine the prevalence of depressive disorders in

young women with PCOS. The results revealed that women with PCOS were at increased
risk for depressive disorders (new cases) compared with controls (21% v/s 3%; odds ratio
5.1) [95% confidence interval (CI) 1.26-20.69] P<3. The overall risk of depressive disorders
in women with PCOS was 4.23 (95% CI 1.49-11.98; P<0.01) independent of obesity. Also
compared with non depressed PCOS subjects, the depressed PCOS subjects has higher body
mass index. Thus there was a significant increase in incidence of depressive disorders in
young women with PCOS.21

Studies related to knowledge on PCOS

A descriptive study was conducted to describe patient perception and awareness of
PCOS. About 657 women of age group of 26-34 years were included in the study. A
questionnaire was used and study revealed that patients emotions associated with diagnosis
of PCOS include frustration (67%), anxiety (16%), sadness (10%), and indifference (2%).
Therefore awareness regarding PCOS can be achieved through wide public service
announcements or other structured media exposure, as they would be helpful.18

Studies related to effectiveness of learning package as a teaching module

A study was conducted to assess the knowledge on PCOS, evaluate the effectiveness
of structured teaching programme, and to associate the knowledge of adolescent girls with
that of demographic variables. Data were collected from 80 randomly selected samples by
using the structured interview schedule 40 sample were allocated for experimental group and
40 samples for the control group. The overall knowledge mean value in experimental design
was 48.69 with the standard deviation of 17.41. Whereas in the control group the mean value
was only 5.36 with the standard deviation of 11.94. After structured teaching programme the
paired t value was 17.69 with the p<0.001 which was highly significant. The study
concluded that there was improvement in the knowledge on PCOS among adolescents

An experimental study was conducted in selected schools of Nepal to find the

effectiveness of structured teaching programme in improving knowledge and attitude of
school going adolescents on reproductive health using pre-test post-test control group
design. The mean pre-test score of the experimental group on knowledge of reproductive
health was 39.8316.89 and of the control group was 39.47 0.08. The same of experimental
group after administration of the structured teaching programme was 84.6010.60 and of the
control group with conventional teaching method was 43.9310.08, which was statistically
significant (p<0.001).23

A study was conducted to find the effectiveness of teaching on home care

management of DM among 50 samples selected using purposive sampling technique. The
structured questionnaire was used and found that 60% of participants had inadequate

knowledge, 40% of them had moderate knowledge, and none of them had adequate
knowledge in the pre-test. In the post-test it was found that 70% of participants gained

adequate knowledge, 30% had gained moderate knowledge, and none of them had
inadequate knowledge. The overall mean and standard deviation increased in post-test
(M=30.06, SD=3.45) when compared with pre-test (M=19.30, SD=4.67).24

6.4 Statement of the problem

A study to assess the effectiveness of planned teaching programme regarding poly

cystic ovarian syndrome (PCOS) among adolescent girls (16-18 years) of selected schools at

6.5 Objectives of the study

Objectives of the study are:

1. to find the pre-test and post-test knowledge of adolescents regarding PCOS as

measured by a structured knowledge questionnaire.

2. to evaluate the effectiveness of planned teaching programme regarding PCOS in

terms of gain in post test knowledge score.

3. to find out association between mean pre test knowledge score with selected
demographic variables.

6.6 Operational definitions

Assess: Evaluate the level of knowledge among adolescents of selected higher secondary
school regarding PCOS before and after planned teaching programme using structured
knowledge questionnaire.

Knowledge: Knowledge refers to the facts and information about PCOS expressed by
adolescent girls participating in the study as measured by the scores obtained according to
their responses to items on structured knowledge questionnaire.

Effectiveness: It refers to the extent of desired knowledge gained by the adolescents after
administering the planned teaching programme regarding PCOS.

Planned teaching programme: It refers to the systematically planned teaching strategy

designed to provide information to adolescent girls regarding PCOS.

PCOS: It refers to complex condition affecting many organ sites in reproductive age women
including hypothalamus, pituitary, ovary, pancreas, peripheral glucose sensitive tissues, and
skin in different individuals.

Adolescent girls: It refers to the +1 and +2 students aged 16-18 years in selected higher
secondary schools at Mangalore.

6.7 Assumptions

The assumptions of the study are:

Adolescent girls will gain knowledge regarding PCOS.

Planned teaching programme will be effective in improving the knowledge level of

adolescent girls regarding PCOS.

6.8 Hypotheses

The hypothesis will be tested at 0.05 level of significance.

H1: The mean post test knowledge scores of adolescents who have undergone planned
teaching programme regarding PCOS will be significantly higher than their mean
pre-test knowledge score.

H2: There will be significant association between mean pre-test knowledge score of
adolescents regarding PCOS and their selected demographic variables.

6.9 Delimitations

The study is delimited to adolescent girls aged 16-18 years of selected higher
secondary schools at Mangalore.

7. Material and methods

7.1 Source of data

Data will be collected from adolescent girls aged 16-18 years of selected higher

secondary schools at Mangalore.

7.1.1 Research design

Pre-experimental design: One group pre-test post-test design was adopted for
conducting the present study.

Subjects Pre-test Treatment Post-test

Adolescents of selected higher secondary school O1 X O2

O1 X O2

O1: Pre-test knowledge of adolescent girls regarding PCOS

X: Treatment (planned teaching programme regarding PCOS)

O2: Post-test knowledge of adolescent girls regarding PCOS


Dependent variable: Knowledge of adolescent girls regarding PCOS.

Independent variable: Planned teaching programme regarding PCOS.

7.1.2 Setting

The study will be conducted at selected higher secondary schools at Mangalore.

7.1.3 Population

Adolescent girls aged 16-18 years studying in the selected higher secondary schools
at Mangalore.

7.2 Method of data collection

7.2.1 Sampling procedure

Convenience sampling technique will be used to select the sample.

7.2.2 Sample size

In the present study, the sample would comprise 100 adolescent girls studying in the
selected higher secondary schools at Mangalore.

7.2.3 Inclusion criteria for sampling

Adolescent girls who are willing to participate in the study.

Those who are available during data collection.

Adolescent girls who can read and write English.

7.2.4 Exclusion criteria for sampling

Adolescent girls who are not willing to participate in the study.

Adolescent girls who cannot read and write English.

7.2.5 Instruments intended to be used

Section 1: Demographic data.

Section 2: Structured knowledge questionnaire to collect data related to PCOS among

adolescent girls studying in selected higher secondary schools at Mangalore.

7.2.6 Data collection method

Prior to the study permission will be obtained from authorities of school. The purpose
and need for the study will be explained to adolescent girls. Confidentiality of the collected
data will be assured and written consent will be obtained. The investigator would assess the
pre-test knowledge by administering a knowledge questionnaire. After assessing

the pre-test knowledge, the investigator will administer a planned teaching programme for
30 minutes with the help of audiovisual aids regarding PCOS. After seven days the post-test
knowledge will be assessed using the same structured knowledge questionnaire.

7.2.7 Plan for data analysis

Data will be analysed using descriptive (mean ,median, mean percentage and
standard deviation) and inferential statistics (chi- square and paired t test).

7.3 Does the study require any investigations or interventions to be conducted on

patients, or other animals? If so please describe briefly.

Yes, in the present study investigator uses a structured knowledge questionnaire to

evaluate the effectiveness of planned teaching programme regarding PCOS.

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

Yes, ethical clearance will be obtained from the institutional ethical committee and prior
permission will be obtained from the school authority and consent will be taken from
the adolescent girls.

8. References

1. World Health Organisation. Adolescent health. [online]. Available from:

URL:www.who.int/topics/adolescent health/en/
2. Anderson M. Signs and symptoms of teenage girls with hormonal imbalance.
[online]. Available from: URL:www.ehow.com/about 5506284-signs-teenage girl-
3. Minnesota Department of Health. Being, belonging, becoming. Minnesotas
Adolescent Health Action Plan. [online]. Available from:

4. Dubey A. Health and nutrition for adolescent girls. 1-2. [online]. Available from:
5. Segal M. On the teen scene a balanced look at the menstrual cycle. FDA Consumer
1998 Aug 3;14-6.
6. Priya G. Polycystic ovarian syndrome-the hidden epidemic. Women Health 2009 Aug
7. Infertility. [online]. 2012. Available from: URL:www.fertility-factor.com
8. The PCOS factor. What does having polycystic ovarian syndrome really mean? 2012.
9. Matzke A. Underdiagnosis of polycystic ovarian syndrome in normal weight
adolescent females. 2011. 16-17.
10. Cahell D. Net doctor polycystic ovarian syndrome. Womens Health 2010;28-32.
11. Salehpour A, Esmaeitnia H, Enlezari A. Evaluation of prevalence of PCOS among
adolescent girls in Tehran. Tehran during 2005-2006. International Journal of Fertility
and Sterility 2010 Oct-Dec;4(3):122-7.
12. Koulak P, Chudek J, Kotlarz B. Psychological disturbances and quality of life in
obese and infertile women. International Journal of Endocrinology 2012 May

13. Norman JR, Deiwally D, Legro SR, Hickey ET. Polycystic ovary syndrome. The
Lancet 2007 Aug;370(9588):685-97.

14. Bhave A. Obesity in adolescents-Indian scenario. Indian Academy of Paediatrics,

India. 2012. [online]. Available from: URL:www.googlesearch.india.com

15. Nandalike K, Agarwal C, Sin S. Sleep and cardiometabolic function in obese

Adolescent Girls with PCOS. USA. [online]. 2012 Aug 23. Available from:

16. Dokras A. Screen for anxiety, mood disorder in women with PCOS. [online]. 2011
Dec 9. Available from: URL:www.ncbi.nlm.nih.gov/pubmed/22178257

17. Allon LB. PCOS Foundation. [online]. Available from:


18. Nidhi R, Nagaratna R, Amrithanshu R. Prevalence of polycystic ovarian syndrome in

Indian adolescents. 2011 Aug;220-4.

19. Yildiz BO, Azziz R. Impact of obesity on risk for PCOS. The Journal of Clinical
Endocrinology and Metabolism 2008 Jan;93(1):162-8.

20. Majundar A, Singh TA. Comparison of clinical features and health manifestation in
lean v/s obese Indian women with PCOS. Journal of Human Reproductive Sciences
2009 Jan;2(1):12-7.

21. Hollinrake E, Dokras A, Voorhis B. Increased risk of depressive disorder in women

with PCOS. Fertility and Sterility 2007 Jan;87(6):1369-76.

22. Shanmugasundaram S. Effectiveness of structured teaching programme on

PCOS awareness among adolescent girls in a selected rural area. Chennai. India.
Abster Academy Health Meet. [online]. Available from:

23. Dhital AD, Badhu B. Effectiveness of structured teaching programme in

improving knowledge and attitude of school going adolescents on reproductive
health. Kathmandu University Medical Journal 2005;3(12):380-3.

24. Shauni GS, Venkatesan L, Ben A. Effectiveness of structured teaching programme on

home care management of diabetes mellitus. Nursing Journal of India 2007 Sep;197-
9. Signature of the candidate

10. Remarks of the guide

11. Name and designation of (in block letters)

11.2 Guide

11.2 Signature

11.3 Co-guide (if any)

11.4 Signature

12 12.1 Head of the department

12.2 Signature

13. 13.1 Remarks of the Chairman and Principal

13.2 Signature