Thesis97
Upcoming SlideShare
Loading in...5
×
 

Thesis97

on

  • 1,033 views

 

Statistics

Views

Total Views
1,033
Views on SlideShare
1,033
Embed Views
0

Actions

Likes
0
Downloads
24
Comments
0

0 Embeds 0

No embeds

Accessibility

Categories

Upload Details

Uploaded via as Microsoft Word

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

Thesis97 Thesis97 Document Transcript

  • DECLARATION BY THE CANDIDATE I hereby declare that this dissertation titled “A Study To Assess The Effectiveness Of Video Assisted Teaching On Knowledge Regarding Infertility Among Infertile Couple In Selected Hospitals At Haryana” Is a bonafide and genuine research work carried out by me, for the partial fulfillment of the requirement for the degree of M.Sc (OBG) under the guidance of Prof. Mrs. Vishnupriya.K Principal Sophia college of nursing Gwalior and Co Guided by Mrs.S. Rani Lecturer department of OBG Sophia College of nursing Gwalior Madhya Pradesh. Signature of the Candidate
  • II
  • Certificate by Guide and Co guide This is to certify that this dissertation title “A Study To Assess The Effectiveness Of Video Assisted Teaching On Knowledge Regarding Infertility Among Infertile Couple In Selected Hospitals At Haryana” Is a bonafide and genuine research work carried out by Ms Hem kumari for the partial fulfillment of the requirement for the degree of M.S c in Nursing (OBG Specialty) under my guidance. Guide Co Guide III
  • Certificate This is to certify that this dissertation “ A study to assess the effective ness of video assisted teaching on knowledge regarding infertility among infertile couple in selected hospitals at Haryana” Is a bonafide and genuine research work carried out by Ms Hem kumari for the partial fulfillment of the requirement for the degree of M.S c in Nursing (OBG Specialty) Internal Examiner External Examiner PLACE IV
  • ENDORSEMENT BY THE HEAD OF THE DEPARTMENT AND HEAD OF THE INSTITUATION This is to certify that this dissertation titled “A Study To Assess The Effectiveness Of Video Assisted Teaching On Knowledge Regarding Infertility Among Infertile Couple In Selected Hospitals At Haryana” Is a bonafide and genuine research work carried out by Ms Hem kumari for the partial fulfillment of the requirement for the degree of M.S c in Nursing (OBG Specialty). Sign of HOD Seal & Sign of Principal V
  • COPY RIGHT DECLARATION BY THE CANDIDATE I hereby declare that the JIWAJI UNIVERSITY GWALIOR MADHYA PRADESH shall have the rights to preserve, use and disseminate this dissertation/thesis in print or electronic format for academic/research purpose. Sign of candidate VI
  • ABSTRACTS STATEMENT OF THE PROBLEM: A Study To Assess The Effectiveness Of Video Assisted Teaching On Knowledge Regarding Infertility Among Infertile Couple In Selected Hospitals At Haryana. BACKGROUND OF THE STUDY: Reproduction is a phenomenon that has evolved for the survival of the living of different species by producing continuous stream of new generation of that species. Production of a new human being begins with fertilization .Failure to this process results in Infertility. Though infertility does not claim an individual life, it inflicts devastating emotional trauma on the individual for being unable to fulfill the biological role of parenthood for no fault of his/her own. WHO estimates that approximately 8-10% of couples experience some form of infertility .On a worldwide scale, this mean that 50-80%million people suffer from infertility with men and women in almost identical proportion. Infertility is exclusively a female problem in 30-40% of cases and male in 10-30% of cases. Most infertility cases (85-90%) are treated with medication or surgery. Improvement in infertility treatment have made it possible for many women Whose male partner is infertile to become pregnant .These new and advanced Technologies include , X
  • In vitro fertilization (IVF),Intra cystoplasmic sperm Injection (ICSI) and other similar procedures OBJECTIVES OF THE STUDY: • To assess the pre-test knowledge of infertile couples regarding infertility before video assisted teaching. • To assess the post-test knowledge of infertile couples regarding infertility after video assisted teaching. • . assess the post-test knowledge of infertile couples regarding infertility after video assisted teaching. • To compare the pre-test and post knowledge of infertile couples. • To assess the effectiveness of Video Assisted Teaching on knowledge regarding infertility among infertile couples. • To determine the association between the pre-test knowledge with selected demographic variables HYPOTHESES: H1: There will be a significant difference between the pre-test mean and post-test mean knowledge score of infertile couples. H2: There will be a significance association at 0.05 level of significance between knowledge scores with selected demographic variables of infertile couples.
  • XI METHODS: The conceptual framework of the study was developed based on ‘’General System Theory ‘’by Bertanlanffy. A pre experimental one group pre-test and post-test design was used for the study .Non- probability convenient sampling technique was used to select the sample A structured knowledge questionnaire and a video assisted teaching on infertility was implemented as a tool for data collection. A scoring was developed to score the items of analysis of data. The content validity of the tool was established on the basis of correction given by experts from the field of nursing and medical field. Reliability (r-0.93) of the tool was tested by test-retest method and reliability co-efficient was calculated by using raw score formula. A Pilot study was conducted with 10 subjects to find out the feasibility of conducting the study. The main study was conducted with samples at hospitals. The video teaching on infertility was administering following pre-test. The post-test was after 7 days to assess the effectiveness of video teaching. RESULT: The collected data was analyzed by using descriptive and inferential statistics.
  • XII THE SIGNIFICANCE FINDINGS OF THE DATA WERE: The mean pre-test knowledge score of infertile couple was 18.06 ( 45.15%) and the mean post-test knowledge after administration of video assisted teaching was 32.24 (80.60%) which revealed that significance 35.45% of improvement in couple’s knowledge regarding infertility after administration of video teaching. The calculated paired (t) test value 27.41 for knowledge is greater than table value and found to be high statistical significant at the level of p<0.05. Hence research hypotheses stated that there will be significant difference between pre-test and post-test knowledge among infertile couples about infertility was accepted .Findings revealed that there was statistically significant association between the pre-test knowledge scores with selected Demographic variables was calculated by using chi-square test at p<0.05 level of the subject .Hence the research hypotheses stated that there will be significant association between pre-test K score with selected demographic variables was accepted. CONCLUSION: The overall findings of the study revealed that the administration of video teaching programme facilitated the infertile couples to learn more about infertility which is evident in the significantly improved pre-test K scores. The video teaching method was found highly effective in improving knowledge of the couples regarding infertility.
  • XIII TABLE OF CONTENT CHAPTER CONTENT CHAPTER-1 Introduction PAGE NO 1 Background Of the Study 3 Significance and Need for study 4 Problem Statement 7 Objectives 7 Operational Definitions 8 Assumptions 8 Research Hypothesis 9 Delimitations 9 Projected Outcome 9 Conceptual Framework 10 CHAPTER-2 Review of Literature 14 CHAPTER-3 Research Methodology 28 Research Approach 29 Research Design 29 Variables 30 Settings 31 Population 31 Sample Technique 32 Sampling Criteria 32
  • Development of the Tool 34 Scoring Key 36 Content Validity 37 Reliability 37 Pilot Study 38 Method For Data Collection 39 Plan for Data Analysis 39 Protection Of Human Subjects 40 CHAPTER-4 Data Analysis &Interpretation 42 CHAPTER-5 Discussion 56 Conclusion 60 Implication 60 Recommendation 65 Limitation 65 Summary 66 Bibliography 69 Annexure 75 XV ACKNOWLEDGEMENT
  • “Give me a spirit of thankfulness, Lord; For numberless blessing given, Blessings that daily come to me, Like dewdrops falling from heaven.” “Man’s effort is always crowned by God’s grace and blessing”. Express my deep sense of gratitude to the Lord Almighty for the blessings and mercy which enabled me to reach up this step and complete my study. The successful of this study comes through the valuable help, guidance contribution of some of the teachers, seniors, friends and other well-wishers. Investigators recall their kindness with a great full heart and are trying to express these gracious sentiments in a few words flowing from within. I express my gratitude and appreciation to Dr.Manjeet Kaur Bhalla Chairperson Sophia College of Nursing Gwalior for providing me the opportunity to undertake the P.G course in this esteemed institution and to conduct this study. This study has been undertake and completed under the expert guidance of Prof. Mrs. Vishnupriya.K Principal Sophia College of Nursing, Gwalior. I am grateful of her constant help and guidance in shaping this project in to the present from her support, encouragement and providing the required facilities for the successful completion of this study. VII
  • My sincere thanks to co-guide Mrs. S. Rani Lecturer Deptt of Obstetric and Gynecological Nursing Sophia College of Nursing Gwalior for her constant encouragement, valuable guidance, supervision and timely help during the entire course of this study. It gives me a great pleasure to express my sincere thanks to all the head of department, Lecturers and Asst. Lecturers for their constant encouragement, guidance, valuable suggestions and their loving attitude which helped me in completion of this study. My sincere thanks go to all the participants who formed the core and basis of this study for their whole hearted cooperation. I express my deep gratitude to librarian of Sophia Nursing College for helping me through the invaluable treasures. I cherish the friendship I had and take this opportunity to thank each one of them. My friends have been an encouragement every time and their motivation my confidence that had helped me reach here and I also thank for their constant support and whole hearted solidarity. I use this opportunity to thank Mr. Prasanth.K and MS. Megha for helping throughout the process of my study and also for this concern and enthusiastic support. VIII
  • I am speechless! I can barely find words to express all the wisdom, love and support given me for that I am eternally grateful to my beloved Husband Mr. Sukhpal Singh for his endurance and encouragement and enthusiastic support throughout the course. I would like to express motherly warm love towards my children Baby Hitashi and Baby Vivaan, for their unconditional love and their support even they were left alone during the period of my study. Once again, I am grateful to all of them who have directly and indirectly helped me in completion of this study, including those whom I may have in divergently failed to mention. Signature of the candidate Ms. Hemkumari IX
  • CHAPTER-I INTRODUCTION “Pain during labour is tolerable but emotional pain due to infertility is intolerable” “The greatest work of art created first by god and then by man, is the creation of life. This art takes two artists, man and woman, each bringing their own parts of a pallet to create a work of art that not only has a piece of both artists but has a living, breathing, ever-changing, piece of art with an identity of its own.” Bethany Jane Andrews Marriage is an event by which a male and female shares their life with each other. Entry of a child changes a marriage, completely and permanently. It changes individuals as a couple and also make changes in the way they think and act and relate to each other. It adds beauty to life as if sweet scent to a beautiful flower.1 To become a mother and father is one of life’s greatest blessings. It changes their heart, thoughts, and actions. It is a lifelong event that forever changes the couples.1 In our society, individuals are committed in relationships like marriage with the goal of procreation. Both men and women are supposed to pass on their genetic and generational traits .Failure by both men and women to fulfill their need for a child is usually devastating, humiliating, and emotionally destructive .Thus it becomes a 1
  • Major life stressor, which can affect the well-adjusted couples. Even though tremendous strides have been made in treating this relatively common condition, infertility is typically not openly discussed.1 Infertility is defined as failure to conceive within one or more years of regular unprotected coitus. Primary infertility denotes those patients who have never conceived .Secondary infertility indicates previous pregnancy but failure to conceive subsequently. Infertility is a heartbreaking condition that affects nine million couples in the world each year. It causes tremendous stress, can trigger debilitating sadness and depression, and can tear a marriage to shreds. It is shown that 1 in 6 couples are said to have infertility in India .If the couples are more than 35 years, it increases as 1 in 3 couples. The males are responsible for 40 % while females are responsible for another 40 % and 10 % because of the problems within the both, 10 % is due to idiopathic reasons.2,3 A study conducted in rural areas of India on prevalence of female infertility among 232 couples, reported that 14.4% had the prevalence of infertility.4 The first step in obtaining infertility therapy is fertility testing. There are many reasons why couples have trouble in conceiving, including low sperm count, low hormone levels, and abnormalities in reproductive organs. Only comprehensive fertility testing can isolate the problem and allow doctor to suggest appropriate courses of treatment.5 2
  • BACKGROUND OF THE STUDY Reproduction is a phenomenon that has evolved for the survival of the living of different species by producing continuous stream of new generation of that species. Production of a new human being begins with fertilization. Failure to this process results in Infertility. Infertility is a tragic condition. Though infertility does not claim an individual life, it inflicts devastating emotional trauma on the individual for being unable to fulfill the biological role of parenthood for no fault of his/her own.6 WHO estimates that approximately 8-10% of couples experience some form of infertilit. On a worldwide scale, this means that 50-80% million people suffer from infertility with men and women in almost identical proportion. Infertility is exclusively a female problem in 30-40% of cases and male in 10-30% of cases.7 Most infertility cases (85-90%) are treated with medication or surgery. Improvement in infertility treatment have made it possible for many women Whose male partner is infertile to become pregnant .These new and advanced Technologies include , In vitro fertilization (IVF),Intra cystoplasmic sperm Injection (ICSI) and other similar procedures 3 3
  • NEED FOR THE STUDY Everyone has the goal of becoming a parent, but for those who are unable to conceive a child, it is an exquisitely painful reality. Many of the people spend a portion of the life attempting to avoid unplanned pregnancies, and assume that once they are ready to conceive, it will happen with little difficulty. They tend to think that shifting gears from preventing pregnancy to planning conception and childbirth will proceed in a relatively smooth and orderly fashion.1 Infertility has come to be recognized as a significant social problem. There are numerous infertility cases among many couples who try to conceive a child .A multicounty study carried out by the world health organization and including India place the incidence of infertility between 10% to 15%.It affects almost 13% to 15% of couples of world wide .In the united kingdom it is estimated that one in six couples would be companied of infertility. The prevalence varies widely, being less in developed countries and more in developing countries.8 In India, due to influence of western culture and increasing urbanization, the view of individuals towards marriage system has changed. Higher education, better career opportunity and economical independence are the factors that cause young people to delay marriage without realizing that their action could affect country’s 4
  • demography and health care system. Reproductive function declines as a women age, particularly after the age of 35 years .Thus it places all women who are opting for a late marriage at higher risk of infertility.9 Women with polycystic ovarian syndrome (PCOS) often are infertile because they don’t ovulate. 40%-80% of women with PCOS have a problem with infertility. The reason for this wide variation is that PCOS is a complex metabolic syndrome, with multiple factors that can interfere with fertility10 The American society for reproductive medicine estimates that 5 million American heterosexual couples report difficulties in achieving a viable pregnancy of which 1.3 million seek advice for the problem .The researcher also suggested that condition will be worst in the coming world.11 A study conducted on knowledge and attitude of infertile couples about assisted reproductive technology among 400 infertile couples reported that 41.7% have good knowledge and 55.7% had poor knowledge. Even though 73% got information from ART centers, only a small percentage have exhibited adequate knowledge .About 94.5% of patients mentioned that Assisted Reproductive Technology expenses are not affordable to them .12 A Study conducted in South Africa on knowledge and treatment – seeking behaviors for childlessness among 120 women reported that, 58 % of the samples 5
  • had little knowledge regarding recent advancements in infertility management and only 45% have a positive attitude towards it ,45.8% did not have any concern regarding the topic .13 From many reviews the student researcher found that incidence of infertility is increasing day by day, mean while most of the infertile couples are not having adequate knowledge regarding recent advancements in infertility management which is leading to the reduced acceptance of these treatments among them. The prevalence of infertility will be more devastating in the future with the upcoming concept of late marriages .So the student researcher perceived the need for assessing updated knowledge regarding the recent advancements among the infertile couples in order to make future informational programmes and there by promoting them for the proper utilization of the services. A significant number of couples complain that they are not told about the treatment path and a lot of their questions remain unanswered. This information gap might lead to anxiety. The goal of this study is to evaluate the impact of provision of training regarding infertility on infertile couples. 6
  • STATEMENT OF THE PROBLEM:A study To Assess The Effectiveness Of Video Assisted Teaching Programme On The Knowledge Regarding Infertility Among Infertile Couples In Selected Hospitals at Haryana. OBJECTIVES:• To assess the pre-test knowledge of infertile couples regarding infertility before video assisted teaching • To assess the post-test knowledge of infertile couples regarding infertility after video assisted teaching • • To compare the pre-test and post knowledge score of infertile couples. To assess the effectiveness of Video Assisted Teaching on knowledge regarding infertility among infertile couples. • To determine the association between the pre-test knowledge with selected demographic variables. 7
  • OPERATIONAL DEFINITIONS: A. ASSESS: It refers to the evaluation or estimation of knowledge level of infertile couples regarding infertility. B. EFFECTIVENESS: In this study it refers to the extent to which the video teaching programme has achieved the desired effect as measured by gain in knowledge level of infertile couples by a structured questionnaire C.VIDEO ASSISTED TEACHING PROGRAMME: It is a planned teaching material of lecture combined with video with duration of 45minutes. D. KNOWLEDGE: The ability of infertile couples to respond towards the questionnaire on the selected aspects of infertility. E. INFERTILITY: The inability of a couple to achieve a pregnancy after repeated intercourse without contraception for one year. F. INFERTILE COUPLE: Any given couple who is infertile may be related to the female partner, the male partner or the combination of both. ASSUMPTIONS: • Most of the infertile couples are not having enough knowledge regarding infertility. • Participatory care will improve self esteem towards the promotion of health.
  • 8 RESEARCH HYPOTHESES H1: There will be a significant difference between the mean pre-test and mean post-test knowledge score of infertile couples. H2: There will be a significance association at 0.05 level of significance between the pretest knowledge scores with demographic variables of infertile couples. VARIABLES: A. Independent Variables: Video teaching programme regarding infertility. B .Dependent Variables: Knowledge level regarding infertility. C .Demographic Variables: Age, Gender, Education, Occupation, Duration of treatment, Previous Knowledge. DELIMITATION: • • Infertile couples who are illiterate. • • Infertile couples who are available at the time of the study. Sample size limited to 50 infertile couples. Prescribed data collection is 4-6 weeks. PROJECTED OUTCOMES This study is proposed to determine the effectiveness of knowledge gain regarding infertility among infertile couples through video assisted teaching.
  • 9 CONCEPTUAL FRAMEWORK: Conceptual framework refers as a background or foundation for a study .Concepts are related in a logical manner by the researcher (ROSE MARIE NIESWIADOMY,2008). Conceptual framework assists individual in organizing their thinking in order to select a focus of study and interpreting the findings (MORSE JM , 1992). Conceptual framework serves as a spring board for theory development. As this is made up of concepts, which are mental images of a phenomenon, it provides for thinking and interpreting what is seen. A model is used to denote symbolic representation of concepts (Jacqueline Fawcett, 1987 ). The modified conceptual framework for the present study has been developed from '' General System Theory” by Ludwig Von Bertanlanffy (1968). He states that, an open system is a system which continuously interacts with the environment. The interaction can take the form of information, energy or material transfers in to or out of the system boundary, depending on the discipline which defines the concept. In this theory, focus is on the discrete parts and their interrelationship which makes up and describes the whole. It defines system in a complex interaction which means that system consists of two or more converted elements which form an organized and which interact with other. All system must receive varying type of information from the
  • Environment. The system uses the input to maintain its homeostasis 10 The main concepts of the open system model are input, throughput, output and feedback. INPUT: '' Input” refers to any form of matter, energy, and information that enter in the system through its boundary. In the present study,'' Input” refers to assessment of existing knowledge of infertile couples regarding infertility in terms of pre-test knowledge and administration of video assisted teaching on infertility. THROUGHPUT: ''Throughput '' refers to process of the input .In the present study throughput refers to a process of change in knowledge and understanding about the various aspects of infertility. OUTPUT: “Output” refers transfers matter, energy and information to the environment is an altered state. In the present study, ' output ' refers to evaluation of change in knowledge of infertile couples regarding infertility in terms of post -test knowledge after administration of video assisted teaching on infertility. FEEDBACK: ‘Feedback ' refers to information of environment responses to the system, output is used by the system in adjustment, correction and accommodation to the interaction with the environment. In the present study, 'Feedback' refers to effectiveness of video assisted teaching on infertility by comparing pre-test and post -test knowledge and find out the association between the pre-test knowledge with selected demographic variables of infertile couples.
  • 11 The model states that feedback loops are necessary to produce a mutually determined plan of care and if the planned intervention is not effective, the determination is made that further assessment is necessary. In the present study the investigator evaluates the effectiveness of video assisted teaching on knowledge regarding infertility by comparing pre and post- test knowledge score. The gain in knowledge depicts a positive outcome of the programme while if no gain in knowledge is seen further assessment of the area of the subject interest is necessary. SUMMARY: This chapter dealt with the Introduction, background of the study, significance and need for the study, statement of the problem, objectives, operational definitions, assumption, research hypotheses, variables, delimitation, projected outcomes and conceptual framework of the study.
  • 13 CHAPTER – II REVIEW OF LITERATURE:It is the term of literature refers to the activities involved in identifying and searching for information on a topic and developing a comprehensive picture of the state of knowledge on the topic. Review of literature helps the investigator to develop insight in the problem and gain information about the problem and what has been done before. It provides basis for future investigation, justifies the need for replication, throws light on the feasibility of the study, constraints of data collection, and relates the findings from one study to another with a hope to establish a comprehensive body of scientific knowledge and a professional discipline from which valid and pertinent theories may be developed. Based on the objectives of the study the literature from various sources had been reviewed and arranged under following categories: SECTION- A. Studies related to incidence and prevalence of infertility. SECTION-B. Studies related to infertility knowledge assessment in infertile couples. SECTION- C. Studies related to treatment modalities.
  • SECTION- D. Studies related to video assisted teaching program. 14 SECTION- A. Studies related to incidence and prevalence of infertility. The prevalence of infertile couples differs according to the definition of couple’s infertility. If we accept the most commonly used definition, i.e. the lack of pregnancy after 1 year of unprotected regular intercourse, infertile couples represent about 10 to 15 %of all couples. According to the definition of the European society for Human Reproduction and Embryology, i.e. the lack of pregnancy within 2 years by regular coital exposure, the prevalence of infertile couples in Europe and North America is approximately 5 to 6%.14 In a follow-up study of 1297 couples registered at a NOVA SCOTIA infertility clinic with a complaint of infertility of at least 12 months duration, the cumulative pregnancy rate at 36 months, with 95 % confidence limit was found to be 49.4%.The predictors of pregnancy by univariate analysis were a favorable primary clinical, diagnosis (p<0.001) ,a duration of infertility of less than 3 years (p<0.001) , a single diagnosis for the infertility (p<0.001), a previous pregnancy in the partnership (p=0.001),and a length of marriage of less than 4 years (p=0.002). Proportional hazard analysis confirmed these variables as predictors of pregnancy. The highest cumulative pregnancy rates after 12 and 36 months of follow- up were observed in case of ovulation
  • deficiency, and the lowest were seen in cases of tubal defects. However, before the process of diagnosing infertility begins, useful prognostic information can be 15 determined from the length of marriage, the duration of infertility and the partnership’s history of previous pregnancy.15 A study was conducted among 175 consecutive infertile couples were interviewed together and individually in accordance with a 25 point questionnaires. Amongst the males, premature ejaculations 66% was most common problem followed by erectile dysfunction 15%, decreased libido 11% and orgasmic failure 8%. Amongst females dyspareunia 58%, decreased libido 28%, and orgasmic failure 14% were most common problems. Various types of misconceptions were also observed in the infertile couples. Lack of sexual awareness and education formed an important part of observations. Psychosexual dysfunction and infertility was found to occur, in a large number of couples, together in association. Most common cause for this problems seems to be ignorance and lack of sex education.16 A population survey was conducted to assess the prevalence of infertility and the proportion of couples seeking help in more and less develop countries from 25 population surveys sampled 172 to 413 women. The 12 month prevalence rate ranged from 3.5% to 16.7% in more developed nations and from 6.9% to 9.3% in less developed nations, with an estimated overall median prevalence of 9%. In 17 studies, sampling 6410 women, the
  • proportion of couples seeking medical medical care was an average 56.1% range 4276.3% in more developed countries and 51.2% range 27-74.1% in less developed 16 Countries range 27-74.1% in less developed countries. The proportion of people actually receiving care was substantially less, 22.4%. Based on these estimates and the current world population, 72.4% million women are currently infertile, of these 405 million are currently seeking infertility medical care.17 A survey was done about distribution of infertility those who were attending primary infertility clinics in Israel. Infertility is one of the most prevalent health disorders in young adults. About 2515 couples 37% and tubal damage 18%. Infertility factors were identified in the women alone in 30.6% participated in the study. Out of these male factor 45%, Oligo ovulate cases and the men among in 29.2%. To combine infertility factors were found in 18%, the rate of unexplained infertility was 20.7%. The study was concluded by saying that male factor accounts for almost half of all cases of infertility in couples.18 B. Studies related to infertility knowledge assessment in infertile couples:A descriptive study conducted found that, there is scarce Knowledge regarding the impact of infertility on couples. The main objective of the study was to review the findings on quality of life and health related quality of life among infertile couples. .Among infertile subjects, women had lower scores in several QOL or HRQOL domains
  • in sample size comparison to men. So from this study, it is evidenced that there is a scarcity of knowledge in infertile couples19. 17 A study conducted about knowledge and attitudes towards infertility held by members of 2 countries councils in Sweden. For this study 182 samples were taken and 153 answered the questionnaire. The result of the study shows that different age groups did not show different levels of knowledge; the committee members who were very positive towards infertility treatment did not have any better knowledge of such treatment than those who were less positive. At the time of survey displayed the same level of knowledge as the other council members. The members showed very little familiarity with the priority groups suggested in the report from the health care priority committee.20 A phenomenological study was conducted about couple’s experiences of. In his study he focused on the improvement of knowledge of infertility among infertile couples by the nurse. If nurses are to work effectively with families in contemporary societies, their practice and activities must be appropriately informed. The purpose of this study was to examine in-depth the experience of couples undergoing treatment for infertility. He explains that all couples undergoing infertility treatment experienced life changes which included life style changes, various physical and emotional changes, and changes in the relationship of couples. Most of the couples reported feelings of social isolation
  • associated with being infertile. Findings from this study will add more knowledge based on infertility among the infertile couples.21 A study conducted about the women’s and men’s perceptions of infertility 18 Their associations with psychological adjustment. The main objective of the study was to extend the knowledge of the couples by examining the perception of infertility among couples undergoing treatment. The study was cross-sectional and included two samples. Sample 1 included 72 couples at their first visit to an infertility clinic and sample 2 included 49 couples at various stages of treatment. The result of the study shows that the partners differed in their perceptions of infertility and their distresses.22 The descriptive cross-section study was conducted to evaluate the knowledge of infertile couples about infertility at patient infertility clinics of University Hospital in Tehran Iran. Data was collected from 400 infertile couples by a self administer structured questionnaire. The study findings showed that 120 couples (30 %) had good knowledge but 280 (70 %) had poor knowledge about infertility.23 A study report shows that there is a lack of infertility knowledge in the general population. The aim of the current study was to asses people’s knowledge about infertility, focusing on identifying the type of information needed to educate people about the potential risks for infertility.24
  • A study report found that knowledge about infertility issues is a core motivator behind engaging in the medical process for infertility problem. The results demonstrated that the participants were knowledgeable about the risk factors for infertility but were not as knowledgeable at recognizing factors that had no effect on fertility, and believed that 19 thesefactors actually increased a woman’s fertility.Fertility awareness campaigns need to address false beliefs as they may give individuals a false sense of security about their fertility.25 SECTION C:Studies related to treatment modalities: A study was conducted about the epidemiological aspects of primary infertility in Kashmir region of India. The main objective of this study is to assess the magnitude of primary infertility and to study its etiological aspects in India. About 10,063 married couples were interviewed to ascertain the prevalence of primary infertility. The result of the study shows that 15%of the couples interviewed had primary infertility among which 4.66%had unresolved infertility at the time of survey. The etiology of infertility in250 consecutive couples revealed a female factor in 57.6%, a male factor 22.4%, combined factor in5.2%and an undetermined cause in 14.8%.26 A study report shows that smokers have lower sperm counts and stopping smoking increase sperm count. Smokers sperm count is on average 13 – 17 % lower than One half
  • of 1%of men was functionally sterile in 1938.Today it has reached between 8-12 %.Functionally sterile” is define as sperm counts below 20 million per ml of semen. 27 A high number abnormal sperm heads is associated with decreased fertilization. Some drugs such as sulphasalazine, used to treat inflammatory bowel disease can drastically reduce semen quality.28 20 A study of 3 smokers who were followed for 5 – 15 months after stopping smoking reported that their sperm count rouse 50 – 80 %, suggesting that chemicals in the smoke are responsible and any reduction in sperm count is reversible.29 A study found that alcohol reduces fertilization success. A large 50% reduction in experiments of test animals given intoxicating doses of alcohol 24 hours prior to mating.30 Ovulatory dysfunction can be suggested by late menarche, presence of premenstrual syndrome, abnormal cycle length, amount of menstrual loss, premenstrual spotting, hot flushes and excessive physical exercises and/or weight changes greater than 10%in the past year. Systematic diseases such as diabetes mellitus and thyroid dysfunction that are not adequately treated may also have adverse effects on fertility .Medical treatments may cause temporary(sex steroids)or permanent (cytotoxic agents) damage to the Ovulatory function.31 8.4%o of women 15-44years had impaired ability to have children and about half of these couples eventually conceive. These are statistics will vary greatly depending on the age of the woman. Couple infertility rates are nearly double percentage since it then take
  • into account male infertility.32 38% of female non-smokers conceived in their 1 st cycle of attempting pregnancy compared to 28% of smokers. Smokers were also 3-4 times more likely than non smokers to have taken greater than a year to conceive.33 21 A study of 1,909 women in Connecticut found the risk of not conceiving for 12 months (the usual definition of infertility), was 55% higher for women drinking 1 cup of coffee per day -100% higher for women drinking more than 3 cups of coffee per day.34 Risk of infertility increased in females who reported exposures to textile dyes, dry cleaning chemicals, noise, lead, mercury and cadmium. There was a significant risk of increased time to conception among women exposed to anti-rust agents, welding, plastic manufacturing, lead, mercury, cadmium, or anesthetic agents.35 Expensive fertility treatments resulted in only a 6percentage point improvement in achieving pregnancy over “infertile” couples who just “kept trying. In a study of 1145 couples who had been diagnosed as infertile, only half of them were treated to help attain pregnancy. After a two to seven-years follow up, pregnancies occurred in 41%of the treated couples and 35% of untreated couples.36 Infertility by itself does not threaten physical health but has a strong impact on the psychological and social well-being of couples. In the last 2 decades, progress in caring
  • for the infertile couple, in particular progress in the field of assisted reproduction and micromanipulation, has provided significant hope for many couples for whom hope could not have been offered in the past. This is especially true for bilateral tubal diseases and for male factor infertility, as near all couples with male factor in fertility can now undergo either one(or more)IVE or ICSI attempt (s).For couples with other causes of 22 Infertility, however, the differences in pregnancy rate often do not reach statistical significance.37 A study was conducted in 32 couples in the age group of 21- 43 years, who had primary infertility ranging from 1-12 years. The female partner was given eve care syrup at a dose of 2 teaspoonfuls for 6 months. The male partner was given Spemann tablet at a dose of 2 tablets, twice daily for the same periods. The female were advices during test to detect human chorionic gonadotrophin if they had a missed period for duration of more than 15 days after 3 months of treatments, 6 female tested positive, for tested positive after 4 months and for tested positive after 6 months of treatment. The pregnancies were later confirmed with pelvic ultrasonography, which showed live fetus without any abnormalities. Among the males, there was a marked improvement in the sperm count especially in those males hoe has abnormal or low sperm counts. A complete analysis was done at the end of 6 months and the final report showed that the fertility rate after eve care
  • and Spemann therapy was 43.75%.This was combine therapy could bring out a good out come in infertile couples if the used Eve care and Spemann for at least 6 months.38 MSG (Monosodium glutamate), a common flavor enhancer added in foods, was found to cause infertility problems in test animals. Male rats fed MSG before mating less than a 50% success rate , where as male rats not fed MSG had over a 92%success 23 rate.Also the offspring of the MSG treated males showed shorter body length, reduced testes weight and evidence of overweight at 25 days. MSG is found in ascend, flavored potato chips, Doritos, meat seasoning and many packaged soups.39 The sexual history of the couple is very important. The frequency and timing of intercourse and the use of lubricants should be assessed. It happens frequently that an infertile couple abstains from intercourse and has only timed exposures in the middle of the cycle, but there is no evidence that prolonged abstinence increases the change of pregnancy; abstinence (7 to 8 days) should be reasonably recommended only if oligozoospermia is present. Use of lubricants should be discouraged because of their detrimental effects on semen quality.40 In a study conducted, clinical infertility is a prevalent problem with significant financial and costs. Modifiable life style factors exists that may affect a Person’s time to conception and there chance of having a healthy, live birth.A person’s time pregnancy and
  • their chance of having a healthy, live birth may be affected by factors such as weight , vitamin and iodine intake, alcohol and caffeine consumption, smoking, substance abuse, stress, environmental pollutants vaccination and oxidative stress.41 A case control study was conducted to assess the differences in attitude towards aspects of assisted reproductive technology between infertile and porous women a university-based tertiary clinic of Kuopio. A sample of 392 women with fertility 24 problem and 200 porous women as control was selected on the basis of convenience sampling technique. A questionnaire consisting of 46 questions on different aspects of ART was administered to the sample. The study revealed that response rate in group of infertile women was 48 %( 189/392). Porous women responded with a similar rate of 42%(82/200).The mean age (ISD) of parous women responded with a similar rate of 42 %(84/200).The mean age (ISD)of parous women was 35.0(+_5.0)years and it was 34.0 (+_6.1) years in women with fertility problem over 80% women and parous women would set on upper age limit to the infertility treatment for women,66% of infertile women and 73% of parous women would set an upper age limit for men also. Two-third of infertile women and 58% of parous women agreed to the question that is the duty of parents to tell a child about the use of assisted reproductive technology .Infertility regarded an illness by infertile women, but only 34% of the parous women .Thus the study conducted that split attitude was influenced by the wish of infertile women to help childless couples and to the
  • recruit suitable /oocyte donors. Parous women were motivated by their concern for children’s right.4 SECTION- D.Studies related to video assisted teaching programme. A Study was conducted by Kumari Sathya K in 2005 to determine the effectiveness of video assisted teaching vs. lecture method on knowledge of newborn assessment among final year general nursing and midwifery students of selected Institutes, Bangalore 25 The sample consisted of 60, experimental Group 1-30 and Group-2-30.A structured knowledge questionnaire on newborn assessment was developed by the investigator. The major findings of the study were: mean difference between the lecture and video were 22.9 and 25.4 respectively. Video is slighter high than lecture. Findings of the study score shows that Video assisted teaching was also an effective teaching strategy. Different teaching strategies should be used in teaching to make students better understand, theory as well as practical.43 A study was conducted to assess the effectiveness of video assisted nursing intervention on lumbo-sacral pain and activities of daily living among antenatal primi mothers at SRH. The study was conducted on 60 primi mothers and the post-test knowledge of the mother regarding pain and daily living activities were higher than the Pre-test scores after video assisted teaching. The findings indicates that 65.5% had good knowledge ,while 15.45% had average knowledge and 19.09% had poor knowledge
  • before video assisted teaching program me. The study concluded that video assisted teaching programme will improve the knowledge of the primi mothers and it will help in regaining their activity level than those who did not participate in the study.44 A study was conducted to compare the efficacy of a video- assisted module versus conventional module (lecture), regarding post exposure prophylaxis (PEP) among 58 dental students, in Shahid Behest University of Medical Sciences, Tehran, Iran. They 26 were asked to take a test about the principles of prior to being taught via lecture or the video films. The test was repeated following conventional teaching module and the video – assisted teaching module. The pre- teaching test results indicating low knowledge among the students regarding PEP with a mean value of 8.98+ 2.99 which was significantly different compared to post-teaching test results following the lecture-only phase ( 11.30 ± 3.90) and the video- assisted teaching phase ( 17.32 ± 2.94).45 A study was performed to investigate the effects of video-based self assessment on the ability of nursing students to accurately measures vital signs, their communication skills, and their satisfaction. A quasi – experimental control- group, pretest- posttest of 40 second year student nurses were enrolled fundamental of nursing course in a college of nursing. Results of the research indicate that there was a statistically significant difference in exam scores for assessing long- term memory, in video rewiring group demonstrating higher score (t=4.75,df=213,p,0.001).Students satisfaction was also
  • significantly higher in the video-review group than in the control group. These results suggested that video-based self assessment is a beneficial and an effective instructional method of training undergraduate nursing students to develop awareness of their strength and weakness, to improve their clinical and communication skills.46 27 CHAPTER-3 RESEARCH METHODOLOGY INTRODUCTION: Research methodology is a way to solve the problem systematically. It is a Procedure in which the research starts from initial identification of the problem to final conclusion. It organize all the components of the study in a way that is most likely to lead to valid answer to the problem that have been posed.(NANCY BURNS and SUSAN K GROVE). Research methodology provides a brief description of the method adopted by the investigator in the study. It indicates the general pattern of organizing the procedure of gathering valid is reliable data for an investigation .It includes research approaches, research design, the setting, the population, sample, sample size, sampling technique, and criteria for sample selection ,description of tools, validity and reliability of the tool,
  • intervention, pilot study and data gathering process, plan for data analysis and the protection of human subjects The present study is aimed to assess the effectiveness of video assisted teaching programme on knowledge regarding infertility among infertile couples in selected hospitals at Haryana. 28 RESEARCH APPROACH: Research approach is an umbrella that covers the basic procedure conducting research (Kothari CR 2004) According to (Denise F. Polit et al, 2001), experimental approach is to explore the dimension of a phenomenon or to develop hypotheses about relationship between the phenomena. A pre experimental research approach was considered to be the most appropriate and adopted to assess the effectiveness of video assisted teaching programme on knowledge regarding infertility among infertile couples in selected hospital. RESEARCH DESIGN: The research design refers to the researcher’s overall plan for the obtaining answer to the research questions and all spells out strategies that the researcher adopted to develop
  • information that is accurate ,objective and interpretation (Denise F. Polit et al,2001), experimental. A pre experimental one group, pre-test, post-test research design has been used to attain the objectives of the present study. According to (Denise F. Polit et al, 2001) the schematic representation of preexperimental research design: 29 Pre-test(01 ) Pre Intervention assessment Post-test (02) of Video assisted teaching Post knowledge programme assessment regarding knowledge regarding Regarding infertility Knowledge on infertility infertility among infertile couples among infertile couples. infertile by among structured structured knowledge questionnaire couples questionnaire after of by knowledge after intervention. intervention. TABLE 1:- SCHEMATIC REPRESENTATION OF RESEARCH DESIGN VARIABLES: Variables are the measurable characteristics of a concept and consist of special group attribute (Janice M .MORSE. and Peggy Anne Field, 2005) Independent Variables:
  • An Independent variables is that which is believed to cause or influence the dependent dependent variable, in experimental research by the manipulated (treatment) variables (DENISE F POLLIT et al 2001) In this study the independent variable refers to video assisted teaching on infertility 30 Dependent variables: The variable is hypothesized to depend on or be caused by another variable, (the independent variable) the outcome variable of interest (Kerlinger, and Freed In, 1983) In the present study dependent variable refers to knowledge level of infertile couples regarding infertility. SETTING: Setting refers to the area where the study is conducted. It is the physical location and condition in which data collection takes place in a study (Denise F. Polit et al, 2001). Based on the geographical proximity, feasibility and familiarity with the setting, the investigator selected infertility clinics, at Haryana, to carry out the present study POPULATION:
  • The population referred to as the target population, which represents the entire group or all the elements like individuals or objects that meets certain criteria for the inclusion in the study (Nancy Burns, and Susan K Grove, 2007). The target population of the present study comprises of infertile couples who were attending hospitals at Haryana. 31 SAMPLE: Sample refers to the subset of a population that is selected by the investigator to participate in a research project (Dorothy Y. Brockopp, and Marie T H). Sample size of the present study consists of 60 infertile couples getting treatment from the hospitals at Haryana. SAMPLING TECHNIQUE: Sampling defines the process of selecting a group of people or other elements with which to conduct a study (Basavanthappa BT, 2007). Non-probability sampling technique was adopted to select the samples for the present study based on inclusion criteria. SAMPLING CRITERIA: The samples were selected with the following predetermined set of criteria.
  • INCLUSION CRITERIA: All the infertile couples who: • Attend the infertility clinics. • Are willing to participate in the study. • Can understand Hindi/ English. EXCLUSION CRITERIA: All the infertile couples who: • Are associated with other obstetric complication. • Have other chronic illness. • Cannot understand Hindi. 32 DEVELOPMENT OF THE TOOL: After the extensive review of literature discussion with the guide and the various experts in the field of obstetric and gynecological nursing and medical field based on their suggestion and recommendations, the tool was constructed in three parts consists of demographic variables, self administered structured knowledge questionnaire and video teaching regarding knowledge on infertility. PREPARATION OF THE BLUE PRINT: A blue print on the knowledge questionnaire consisting of five areas was prepared. It depicted the distribution of items according to the content areas based on three domains namely Knowledge, Comprehension, Analysis.
  • Table-2: DISTRIBUTION OF ITEMS ACCORDING TO THE THREE DOMAINS IN THE BLUE PRINT: DOMAINS NO OF ITEMS PERCENTAGE KNOWLEDGE 14 35.00% COMPREHENSION 5 12.50% ANALYSIS 21 52.50% TOTAL 40 100.00% 34 Table-3: DISTRIBUTION NUMBER OF ITEMS AND PERCENTAGE OF MARKS ACCORDING TO THE AREAS. ASPECTS NUMBER OF PERCENTAGE QUESTIONS MARKS Anatomy and Physiology 13 32.5% Definition and Types 7 17.5% Incidence of Infertility 3 7.5% Causes of Infertility 6 15% Investigations of Infertility 4 10% Treatment of infertility 7 17.5% TOTAL 40 100% OF
  • DESCRIPTION OF THE TOOL: The tool was the standardized knowledge questionnaire regarding infertility. Tool consists of two section-1consisted of baseline variables and section-2 had the knowledge questionnaire on infertility. Total of 40 items were prepared and each carried one mark. 35 Part I: It consist of the following demographic variables. DEMOGRAPHIC DATA: • Age • Gender • Education • Occupation • Duration of Treatment • Previous Knowledge Part II: It consists of self administered structured knowledge questionnaire consisting 40 knowledge items related to infertility which dealing about: • Anatomy and physiology of reproductive organs • Definition and types of infertility • Incidence of infertility. • Causes of infertility. • Investigations of infertility. • Treatment of infertility.
  • Part III: It consists of video assisted teaching programme on infertility. Scoring key: Scoring Procedure: Scoring key is prepared for Part I: By coding the demographic variables Part II: By awarding score for the correct response Score ‘1’ – correct response Score ‘0’—wrong response Maximum score – 40 36 Score interpretation: To interpret the level of knowledge the scores subjected as Inadequate 10% -- 40% Moderate 41% --70% Adequate >70 Content validity: Validity is a measure of truth or accuracy of a claim and is an important concern throughout the research process. It refers to whether an instrument accurately measures Measures what it is supposed to measure. Content validity of tool was ascertained in consultation with ten experts, seven experts were from the field of obstetric and gynecological nursing, and other three experts were doctors. The experts were requested to judge the items for accuracy, relevance and appropriateness. The tool was modified accordingly and content validity index was found to be 0.8.
  • Reliability: Reliability refers to stability and repeatability of the data collected instrument (Jacqueline Rose Hott, and Wendy C. Budin, 2006). In order to establish reliability of the tool the technique called test and retest method was used and reliability co-efficient was calculated by using the raw formula the calculated value of ‘r’ was 0.09.The developed tool was found to be highly reliable. 37 INTERVENTION:The intervention in this study was a video assisted teaching regarding knowledge on infertility. The topic was introduction, anatomy and physiology of reproductive organ, definition, incidence, types, causes, investigation and treatment. At the end of the teaching 40 question were included for infertile couples self assessment. The questions were validated by the experts. The duration of the video assisted teaching was 45 minutes. PILOT STUDY: Pilot study is a small scale version or trial run done in preparation for a major study. (Denise f. polit et al 2001). The refined tools were used for pilot study to test feasibility and practicability. After obtaining formal permission from the director, of Sarvodaya hospital at Haryana. Pilot study was conducted. Among 10 infertile couples selected by convenient sampling technique. The investigator given self non- probability introduction, explain the
  • purpose of the study and subject’s willingness to participate in the study we ascertained. The subjects are assured anonymity and confidentiality of the information provided by them and written informed consent was obtained. The pretest was conducted by administering the structured knowledge questionnaire followed by video assisted teaching on infertility .On the 8th day post test was conducted by using the same. 38 Method of data collection: The data were collected from the subjected after obtaining formal permission from the doctors and NS of Sarvodaya hospital at Haryana. The main study was conducted among 60 subjects. The subjects are selected by non-probability convenient sampling technique. The investigator given self introduction explained the purpose of the study and subject’s willingness to participate in the study was ascertained. The subjects are assured anonymity and confidentiality of the information provided by then and written informed consent was obtained. The pre test was conducted by administering the structured knowledge questionnaire followed by video assisted teaching on infertility. On the 8 th day post test was conducted by using the same tool. Each subject took 45 minutes to complete the structured knowledge questionnaire. PLAN FOR DATA ANALYSIS:
  • The data analysis plan included descriptive and inferential statistics. DESCRIPTIVE STATISTICS: • Percentage and frequency to analyze demographic variables. 39 INFERENTIAL STATISTICS:• Paired‘t’ test was used to compare the pre test and post test. • Mean and standard deviation to analyze t and post test level of knowledge scores regarding infertility. • Chi square test was used to associate the pre test level of knowledge of score regarding infertility with selected demographic variables of infertile couples. he pre and post test level to knowledge regarding infertility. PROTECTION OF HUMAN SUBJECTS:This research study was conducted was with full consideration for the rights of human subjects .Only infertile couples were included. The proposed study was conducted after the approval of hospital authority. The research procedure was explained to the subjects and written consent was obtained before intervention. Assurance was given to the study participants regarding the confidentiality of the data collected from them.
  • SUMMARY:This chapter deal with the description of research approach, research design, setting, variables, population, sample, sampling technique, development and description of the tool. Validity and reliability of the tool, pilot study, procedure for data collection and the plan for data analysis. 40 CHAPTER-IV DATA ANALYSIS AND INTERPRETATION INTRODUCTION:This chapter deals with analysis and interpretation of the data collected to assess the effectiveness of video assisted teaching in improving knowledge regarding infertility among infertile couples and its interpretation. The analysis and interpretation of information are based on data collected through administration of video teaching to the study group. The result were computed using descriptive and inferential statistics based on the objectives of the study. PRESENTATION OF DATA:The data obtained were entered in a master data sheet for tabulation and statistical processing. The analysis of data is organized and presented under the following sections: SECTION-A: Analysis of sample characteristics-baseline variables.
  • SECTION-B: Knowledge of infertile couples regarding infertility in pre-test and posttest. SECTION-C: Effectiveness of video assisted teaching on knowledge regarding infertility by comparing pre-test and post-test knowledge score among infertile couples. SECTION-D: Association between the level of pre-test knowledge score with their selected demographic variables. 41 SECTION-A ANALYSIS OF SAPLE CHARACTERISTICS-BASELINE VARIABLES TABLE-4: Description of baseline characteristics. Frequency and Percentage distribution of Demographic Variables of Infertility Demographic Variables Frequency Percentage 24 20 11 5 40.0% 33.3% 18.3% 8.4% 30 30 50% 50% 15 19 20 6 25% 31.7% 33.3% 10% Age 20 – 24 25 - 29 30 - 34 35and above Gender Male Female Education Primary Secondary Senior Secondary Graduate Occupation 75%
  • Employed Un-Employed Duration of treatment Yes No 25% 30 21 9 50% 34.8% 14.2% 6 54 Below one year One year Above one year Previous knowledge 45 15 10% 90% 42 Fig-1: Distribution of subjects according to age in years (No =60) Age in years
  • Fig-1: Depicts that out of 60 subjects 40% were in the age group of 20-24 years, 33.30% in between 25-29 years, 18.30% in 30-35 years and 8.40% were in the age group of 35 and above. 43 Fig-2: Distribution of subjects according to gender (No =60)
  • Fig-2: Depicts that there 50% were male participants and 50% were female participants. 44 Fig-3: Distribution of study participants according to education (No =60)
  • Fig-3: Depicts that out of 60 subjects none were illiterate, 25% were primary , 31.70% were secondary, 33.30% were senior secondary, and 105 were graduate and above. 45 Fig-4: Distribution of study participants according to occupation
  • (No =60) Fig4: Depicts that out of 60 subjects 25% were unemployed and 75% were employed.
  • 46 Fig-5: Distribution of subjects according to duration of treatment (No =60 Fig-5: Depicts that out of 60 subjects 50% were taking treatment below one year, 34.80% s, 18.30% were taking treatment from one year, and 14.2 % were taking treatment above one year.
  • 47 Fig-6: Distribution of subjects according to previous knowledge (No =60) Fig-6: Depicts that out of 60 subjects 10% 0f infertile couples had knowledge on infertility and 90% infertile couples had no knowledge on infertility.
  • 48 SECTION-B: KNOWLEDGE OF INFERTILE COUPLES REGARDING INFERTILITY IN PRE-TEST AND POST-TEST TABLE-5: DISTRIBUTION OF KNOWLEDGE LEVEL REGARDING INFERTILITY AMONG INFERTILE COUPLES IN THE PRE-TEST Knowledge on Inadequate 10-40% Moderate 41-70% Adequate >70% infertility Pre test 31 51.7 29 48.3 0 0 Table-5: depict that among the 60 subjects, 31(51.7%) subjects had inadequate knowledge and 29 (48.3%) subjects had moderate knowledge regarding infertility. TABLE-6: DISTRIBUTION OF KNOWLEDGE LEVEL REGARDING INFERTILITY AMONG INFERTILE COUPLES IN THE POST-TEST Knowledge on Inadequate 10-40% Moderate 41-70% Adequate >70% infertility Post test 0 0% 6 10% 54 90% Table-6: depict that among the 60 subjects, 6( 10%) subjects had moderate knowledge and 54 (90%) subjects had adequate knowledge regarding infertility 49
  • Fig-7: DISTRIBUTION OF KNOWLEDGE LEVEL REGARDING INFERTILITY AMONG INFERTILE COUPLES IN PRE-TEST AND POST-TEST Fig-7: Depicts the knowledge level regarding infertility among infertile couples in pre-test and post-test. 50
  • SECTION-C: EFFECTIVENESS OF VIDEO ASSISTED TEACHING ON KNOWLEDGE REGARDING INFERTILITY BY COMPARING PRE-TEST AND POST KNOWLEDGE SCORES AMONG INFERTILE COUPLES TABLE-7: COMPARISON OF MEAN AND STANDARD DEVIATION OF KNOWLEDGE SCORES REGARDING INFERTILITY IN PRE-TEST AND POST-TEST Fig-8: Depicts that out of 60 subjects 10% 0f infertile couples had knowledge on infertility and 90% infertile couples had no knowledge on infertility. 51
  • TABLE-8: PAIRED t TEST VALUE OF KNOWLEDGE SCORES REGARDING INFERTILITY KNOWLEDGE MEAN S.D D.F ON Paired t TABLE VALUE VALUE 27.41 2.010 INFERENCE INFERTILITY PRE-TEST 14.18 3.65 49 SIGNIFICANT POST-TEST (p < o.o5) The table 8- indicates that, the calculated paired t test value 27.41 of pre and post test knowledge score of infertile couples regarding infertility. Life supporties greater than table value and found to be high statistical significant at the level of p<0.05 .Hence research hypotheses stated that there will be significant difference between pre and post test knowledge among infertile couples about infertility. Was accepted. 52
  • SECTION D:ASSOCIATION BETWEEN PRE-TEST KNOWLEDGE SCORES WITH SELECTED DEMOGRAPHIC VARIABLES OF INFERTILE COUPLES. TABLE 9: ASSOCIATION BETWEEN THE PRE-TEST KNOWLEDGE SCORES WITH SELECTED DEMOGRAPHIC VARIABLES OF INFERTILE COUPLES. Demographic Variable Below Above Mean Mean Degree of Chi Freedom Square Value Table Value Inference AGE 23 37 2 0.096 5.99 SIGNIFICANT GENDER 27 33 1 3.91 3.84 SIGNIFICANT EDUCATION 37 33 1 6.9 3.84 SIGNIFICANT OCCUPATION 29 31 4 12.48 9.49 SIGNIFICANT DURATION OF TREATMENT 32 28 3 7.82 7.82 SIGNIFICANT PREVIOUS 21 KNOWLEDGE 39 3 9.74 7.82 SIGNIFICANT From the above table 9 findings revealed that there was statistically significant association between the pre-test knowledge scores with selected demographic variables of the infertile couples. Like age gender education, occupation, duration of treatment, previous knowledge at the level of p<0.05 by using chi square test. Hence the research hypotheses stated that there will be significant association between the pre-test knowledge score with selected demographic variables was accepted. 53
  • SUMMARY: This chapter dealt with analysis and interpretation of data using descriptive and inferential statistics. The data gathered were summarized in the master sheet and both descriptive and inferential statistics were used for analysis. Findings revealed that the mean pretest knowledge score of infertile couples was 18.06 and the mean posttest knowledge score was 32.24. Paired ‘t’ test was used to analyze the effectiveness of video assisted teaching. Findings show a gain in knowledge which was significant at 0.01level of significance in infertile couples, who had received the video teaching on knowledge regarding infertility. 54
  • CHAPTER-V DISCUSSION, CONCLUSION, IMPLICATION AND RECOMMENDATION AND SUMMARY This chapter deals with the discussion of the result obtained from statistical analysis based on the collected data, objectives, hypotheses and review of literature selected for the study, summary, conclusion, limitation,implication,and recommendation of the study for future nursing education, nursing practice, nursing administration and nursing research. The purpose of the study was To Assess the Effectiveness of Video Assisted Teaching on Knowledge Regarding Infertility among Infertile Couple in Selected Hospitals at Haryana. DISCUSSION: The findings of the study were discussed in this chapter with reference to objectives of the study under the following headings. SECTION-A: Analysis of sample characteristics-baseline variables. SECTION-B: Asses the existing Knowledge of infertile couples regarding infertility in terms of pre-test knowledge score. SECTION-C: Knowledge of infertile couples regarding infertility after administering of the video assisted teaching in terms of post-test knowledge score. 55
  • SECTION-D: Determination of Effectiveness of video assisted teaching on knowledge regarding infertility by comparing pre-test and post-test knowledge score. SECTION-E: Association between the level of pre-test knowledge score with their selected demographic variables. SECTION-A: Analysis of sample characteristics-baseline variables: Distribution of infertile couples according to age( Fig-1) majority of subjects were in the age group of 20-24 years, and only few subjects were in the age group of 35 and above. Distribution of infertile couples to gender( Fig-2) female and male were in equal number in both groups. Distribution of infertile couples according to education ( Fig-3) shows that out of 60 subjects only 15 were educated at graduation level and above . Distribution of infertile couples according to occupation ( Fig-4) shows that out of 60 subjects majority (75%) were employed. According to duration of treatment distribution of infertile couples ( Fig-5) out of 60 subjects half of them were taking treatment below one year, and 14.2 % were taking treatment above one year. Distribution of infertile couples according to previous knowledge ( Fig-6) 90% of infertile couples had no previous knowledge on infertility. 56
  • SECTION-B: Assess the existing Knowledge of infertile couples regarding infertility in terms of pre-test knowledge score. From the analysis it was found that among the 60 infertile couples 31(51.7% ) subjects had inadequate knowledge , 29( 48.3%) had moderate knowledge and the overall mean knowledge score obtained by the subjects was 18.06 with standard deviation 3.83 regarding knowledge of infertility in pre-test. SECTION-C: Knowledge of infertile couples regarding infertility after administering of the video assisted teaching in terms of post-test knowledge score. In post-test analysis revealed that majority of the subjects 54 (90%) had adequate knowledge and only 6 (10%) had inadequate knowledge and overall mean knowledge score obtained by the subjects was 32.24 with standard deviation 2.83 regarding knowledge of infertility in post-test. SECTION-D: Determination of Effectiveness of video assisted teaching on knowledge regarding infertility by comparing pre-test and post-test knowledge score. The comparison of pre-test and post-test knowledge regarding infertility revealed that the calculated‘t’ value of 27.41 which showed high statistical significance at p< 0.5 level. Hence the research hypotheses state that there will be significant difference in pre and post-test level of knowledge among infertile couples was retained. 57
  • SECTION-E: Association between the level of pre-test knowledge score with their selected demographic variables. OBJECTIVE-5:- To determine the association between the pre-test knowledge with selected demographic variables. H2- There will be a significance association at 0.05 level of significance between the pretest knowledge scores with demographic variables at 0.05 level of significance. Chi-square was used to assess the association between pre-test knowledge and selected variables such as age, gender, education, occupation, duration of treatment, previous knowledge and values found was 0.096, 3.91,6.9,12.48,7.82 and 9.74 respectively and table value found was 5.99,3.84,3.84,9.49,7.82,7.82 respectively hence it is concluded that there is no association between the baseline variables and knowledge level and hypothesesH2 is rejected. There was no association shown between the baseline variables and knowledge scores of the participants in the study, hence it is concluded that there is no association between the Knowledge level of the infertile couples with their age, gender, education, occupation, duration of treatment and previous knowledge. Irrespective of all the baseline characteristics infertile couples can be trained adequately to gain knowledge regarding infertility. 58
  • CONCLUSION: Analysis of the level of knowledge of infertile couples on infertility shown that in pre-test that among the 60 subjects, 31(51.7%) subjects had inadequate knowledge and 29 (48.3%) subjects had moderate knowledge regarding infertility. In post-test among the 60 subjects, 6( 10%) subjects had moderate knowledge and 54 (90%) subjects had adequate knowledge regarding infertility. These shows there was a significant increase in the knowledge level in the post-test when compared to pre-test. Effectiveness of video assisted teaching assessed by doing paired t test. In the pre-test the mean knowledge score was 18.06 and post-test mean knowledge score was 32.24 respectively. The paired t value calculated was 27.41with a SD of 3.65,the table value was significant at level of 2.010 level of significance. Hence the hypotheses H1 was accepted. Therefore it is concluded that there was a significant gain in knowledge regarding infertility through video assisted teaching among infertile couples. NURSING IMPLICATION S OF THE STUDY: The investigator had drawn the following implications from the study which is of vital concern to the field of nursing service, nursing education, nursing administration and nursing research and nursing practice. 59
  • NURSING PRACTICE • The knowledge of infertility is very complex in nature and required to be explored in all the aspects of phenomena as well as the factors influencing it. The present study was helpful in identifying the causative factors and treatment modalities of infertility which will help to design strategies to help the infertile couple face the crisis with confidence and courage. • The study findings have opened several implications for nursing practice in the reproductive health area. • Health education is an important function of the health personnel. Nurses as resource persons working in community settings and hospitals should disseminate the proper information especially on prevention aspects of infertility. • The infertile couples should be explained about the phases of menstrual cycle, sign of ovulation and how to plan their sexual intercourse during the period of ovulation. • As most of the couples undergo various investigation and treatment procedures, proper explanations, pre requisites, preparations required, cost involved and the outcomes has to be adequately informed to infertile couples by the nurses and chances must be given to clarify their doubts. 60
  • NURSING EDUCATION • The nursing curriculum can include video assisted teaching on infertility for better understanding. The current curriculum in nursing education places much emphasis on obstetrical care of patients. • The curriculum contains need to be revised their importance is also given care of infertile couple and the advanced reproductive technologies, recognizing the increased in the incidence of infertility. As the infertile couples have lack of knowledge regarding infertility and they are very sensitive. The students must clarify their doubt and knowledge should be provided. • Change in the people's unhealthy practices. The major goal of the nursing practices is to import the knowledge and encourage the healthy practices. • The present study assessed the knowledge of infertile couples regarding infertility .On the basis of findings of the study the following conclusion. The results reveal that majority (55%) of the subjects had moderately adequate knowledge with regards to infertility. • The study disclosed that there was a significant association found between the level of knowledge of infertile couples with their variables. • Education enlightens the darkness of the life through the public awareness, increased and brings demographic variables such as age, educational status, occupation, duration of 61
  • Married life, duration of treatment, previous knowledge NURSING THEORIES: The conceptual and theoretical models exclusively for the use of reproductive health nursing practice are yet to be developed by the nursing theorists. The path analysis used to provide knowledge to infertile couples is presented in the present study in the form of a conceptual model which can be used to educate and guide the nurses in caring for infertile couples. NURSING ADMINISTRATION: Nurse as an administrator plays an important role in educating the professionals such as mass health education measures in the community as well as hospitals. • The nurse administrator should formulate policies, protocols, guidelines and systems of care in collaborations with the multi-disciplinary team • Nurse administrator should take the initiate in organizing in-service and continuing educational programs and short term courses to prepare the staff nurses get specialized in caring for infertile couples. • Nurse administrator ensures professional practice which is research based and which is clinically effective. • Nurse administrator should take into consideration about facilities and supplies of all resources made available in the library related to infertility. 62
  • • This will help the staff and student to reinforce and enhance their knowledge on infertility. NURSING RESEARCH The essence of research is to build a body of knowledge in nursing. The finding of the present study serves as the basis for the professional and students to conduct further studies. Nursing research is the means by which nursing profession is growing. • Nursing research with regard to support of infertile couple is not well developed .Further research in the area of knowledge regarding infertility among infertile couples are required to identify specific interventions that would be useful in helping the infertile couples to achieve their ultimate goal of becoming a parent. • The interventions which will increase marital adjustment, family support and decrease stress of infertile couples are to be developed, tested through research and recommended for practice. • Research on nurse's knowledge regarding infertility should be carried out continuously to assess their knowledge and upgrade their knowledge and practices. 4.The video assisted teaching prgramme can be implemented to the infertile woman and their families and its effectiveness in reducing the lack of knowledge in infertile woman can be researched. 63
  • • Discrimination of findings through conference, professional journals and internet will make application of research findings to be effective. RECOMMENDATIONS: • The study can be replicated in different settings. • The same study can be done on a larger population for a more valid generalization. • The knowledge, attitude and practice of reproductive health nurses in psychological intervention for infertile couples can be studied. • A comparative study can be conducted to evaluate the effectiveness of video assisted teaching to assess the knowledge of infertile couples. • A similar study can be undertaken by adopting a true experimental design using structured teaching program to improve the knowledge of infertile couple. LIMITATIONS: The study is limited to infertile couples of a hospital and is limited to 60 infertile couples.
  • 64 SUMMARY The primary aim of the study was to assess the effectiveness of video assisted teaching regarding knowledge of infertility among infertile couples in selected hospital at Haryana. THE OBJECTIVES OF THE STUDY WERE • To assess the pre-test knowledge of infertile couples regarding infertility in select • To assess the post-test knowledge of infertile couples regarding infertility in selected hospitals. • To compare the pre-test and post knowledge of infertile couples. • To assess the effectiveness of Video Assisted Teaching on knowledge regarding infertility among infertile couples. • To determine the association between the pre-test knowledge with selected demographic variables. The study based on the assumption that: • Most of the infertile couples are not having enough knowledge regarding infertility. • Participatory care will improve self esteem towards the promotion of health.
  • The research hypotheses formulated were: • H1: There will be a significant difference between the mean pre-test and mean post-test knowledge score of infertile couples. 65 • H2: There will be a significance association at 0.05 level of significance between the pre-test knowledge scores with demographic variables of infertile couples. The review of literature is discussed under 2 sections, infertility and studies related to video teaching. Conceptual framework adopted for the study was based on Bertalanffy’s General System Theory. The research approach adopted for this study was an evaluative approach. The quasi experimental design was adopted for the present study and non-probability convenient sampling technique was used to select the samples. The data was collected from 60 infertile couples by using a structured knowledgeable questionnaire followed by a video. The content validity of the tool was done by 8 experts. The reliability of the tool was 0.08. the obtained data was analyzed in terms of objectives and hypotheses using descriptive and inferential statistics. Among the 60 infertile couples 31(51.7%) subjects had inadequate knowledge, 29(48.3%) had moderate knowledge and the overall mean knowledge score obtained by the subjects was 18.06 with standard deviation 3.83 regarding knowledge of infertility in pre-
  • test. In post-test analysis revealed that majority of the subjects 54 (90%) had adequate knowledge and only 6 (10%) had inadequate knowledge and overall mean knowledge score obtained by the subjects was 32.24 with standard deviation 2.83 regarding 66 Knowledge of infertility in post -test. The comparison of pre-test and post-test knowledge regarding infertility revealed that the calculated’ value of 27.41 which showed high statistical significance at p< 0.5 level. Hence the research hypotheses state that there will be significant difference in pre and post-test level of knowledge among infertile couples was retained. Therefore it is concluded that there was a significant gain in knowledge regarding infertility through video assisted teaching among infertile couples.
  • 67 BIBLIOGRAPHY 1) Jessica Evert. Introduction to Infertility. Mental help net [serial online] 2007 Jan 2; Available from: URL: http://mentalhelp.net 2) D C Dutta. Textbook of gynecology. 4th edition. Kolkata: new central agency; 2007. 212-213 3) US Census Bureau. Statistics by Country for Female infertility. Population Estimates 2004 4) D .Kumar. Prevalence of infertility. Journal of rural and remote health research [serial online] 2007 May 8; 7. Available from: URL: http://www.rrh.org.au Siti Nurani Mohr Nor. New Reproductive Biotechnology Values and Society. Eubios Journal of Asian and International Bioethics. [serial online] 1999; 9: 166-9. Available from: URL: http://eubios.info/index.html 5) Kangar. Late marriages impacting demography. Journal of health care system 2009 Nov; 284-290. 6) M.B Wingate. Recent advances in investigation. Can med assoc J. [serial online]1998Nov1; 43. Available from: URL:http//www.ncbi.nlm.nih.gov/pmc
  • 7) Alice D. Domar. Conquering Infertility Mind/Body Guide to Enhancing Fertility and Coping With Infertility .Human reproduction [serial online] 2002 Oct; 17(5): 1534-46. Available From: URL: http://www.helium.com/ 68 8) Kangar. Late marriages impacting demography. Journal of health care system 9 .Boivin J, Andersson L, Psychological reaction during in vitro fertilization: similar response pattern in husbands and wives . J Human Repord. 1998, 13: 3262-3267. 10. Seif D, Albrzi S. The effect of emotional and demographic factors on life- satisfaction of infertile women. InSfertility and Reproductive J. 2001,66: 71-74. 11. Infertility: Frequently asked question. National’ Women’s Health Information center. http://www.womenshealth.gov/FAQ.cfm. Accessed April 30, 2009. 12.Brassard M., et al., Basic infertility including polycystic ovary syndrome. Medical clinics of North America. 2008,,92:1163 13. Shushan A., Eisenberg V.H., Schenker JG. Subfertility in the era of assisted reproduction: change and consequences, Fertil Steril, 1995, 64:459—469. 14. Crosignani P.G ,Rubin B., Guidelines to the prevelance , diagnosis, treatment and management of infertility , Hum repord. I996,11: 1775-1807.
  • 15 .John A.C., Ying S., Wilson E.H., Can Med Assoc. J ., vol . 130, February 1, 1984: 269. 69 16. K Jain, G. Radhakrishnan ,P.garwal, Infertility and psychosexual disorders:Relationship in infertile couples, Indian journal of medical sciences 200054(1)1-7. 17.Jacky Bovin,Laura Buntin, John A. Collins and Karl G.Nygren. Intrnational estimate of infertility prevalence and treatment seeking : Potential need and demand for infertility medical care. Human Reproduction 2007 22 (6) 1506-1512. 18. Farhi J,Ben-Haroush A. Distribution of causes of infertility in patients attending primary fertility clinics in Israel. Isr Med Assoc J , 2011 JAN ;13(1): 51-4. 19. Chachamovich JR, Chachamovich E,Ezer H, Fleck MP, Knauth D,PassosEP. Investigating quality of life and health related quality of life in infertility. 2010 Jan; 31(2):101-10 20.Kjellberg S, Sydsjo G, Glebe K. Sundelid M. Knowledge of and attitude towards infertility held by members of two country councils in Sweden. Acta Obstet Gynecol Scand 2000 Nov; 79 (11) : 1015-20
  • 21.Imeson M, McMurry A. Phenomenological study of couples experiences 1of infertility . J Adv Nurs 1996 Nov ; 24 (5): 1014-22. 70 22. Benyamini Y, Gozlan M, Kokia E, Women’s and men’s perception of infertility and their association with psychological adjustment. Br J health psycho 2009 Feb; 14 (pt1):,1-16. 23.Suhrabrand F, Jafasabadi M. Knowledge and attitude of infertile couples assisted reproductive technology . Iranian Journal of reproductive Medicine 2005;3(2) 90-4. 24.Parazzini F, Treatment for infertility and risk of invasive epitelialcancer Hum Repord 1997:12:2159-2167. 25.World Health Organization;towards more objectivity in diagnosis and management of fertility .J.Andeol1997;7(suppl):1-53. 26. Zargar AH , Wani AI, Masoodi SR , Laway BA. Epidemiological aspects of primary infertility in Kashmir. 1997 Oct. 27. Jacobson C., Reproductive genetics center Vienna, Virginia. 28. Skakkebaek N. E., Lancet, June 11, 1994: 1474.
  • 29.Sachita Sahachoudhary, Fertilizing ability of human sperm. The nursing journal of india 2006 Nov. 30.National Summary and Fertility clinic report, Atlanta:2008. 71 31 World Health Organization, Manual for the standardized investigation and diagnosis of the infertile couple, Cambridge University Press.U.K, 1993. 32. Howard Jones, New England Journal of Medicine December 2,1993:1710. 33. Baird D., Journal of the, American Medical Association, 1985, 253:2979-8324. 34. Rivard C.I., Journal of the American Medical Association, December 22, 1993. 35. Bogus law, Environmental Health Perspectives 1993, 101(suppl 2):85. 36. Collins J.A., New England Journal of Medicine November 17, 1983. 37. Shushan A., Eisenberg V.H., Schenker JG. Sub fertility in the era of assisted reproduction: change and consequences, Fertile Steril, 1995, 64:459—469. 38. Nalini B., Shenoy S.K., The Role of Herbal Drugs in Infertile Couples, Obs, & Gynae., Today, 2003, 8 (5): ,281-287. 39. William J. P., et. Al., Neurobehavioral Toxicology, 1979, 2:1-4.
  • 40. Cooper T.G., Keck C, Oberdieck U, Nieschlag E. Effects of multiple ejaculations after extended periods of sexual abstinence on total, motile and normal sperm numbers, as well as accessory gland secretions, from healthy normal and oligozoospermic men. Hum Reprod, 1993, 89:1251-1258. 72 41. World Health Organisation ;Towards more objective in diagnosis and management of fertility. J.Andeol 1997:7(suppl):1-53. 42. Iteikkela K, Lansimees E,Hippelainen M, Heinonen S. A suevey of the attitude of infertile parous women towards the availability of assisted reproductive technology.International journal of obstetrics 2004 Nov; 111:1229-35 43. Kumarisathya k. A study to determine the effectiveness of video assisted teaching Vs lecture method on knowledge of newborn assessment,. India 2005. URL:http://digitoollibrary.megill.ca/R/?func=dbm-,jump-full&objectid=23446&local base GI:NO1 44. A study to assess the effectivenes of video assisted nursing intervention on lumbosacral pain and activities of daily living among antenatal primi mother at SRH. 45 Maleki Z.Mahdian M. Assessment of efficacy of a video-assisted teaching programme on the knowledge of undergraduate students .BMJ 2006 Oct ; 14(5): 682-689.
  • 46 Yoo MS, et.all Video-based self – assessment: Implementation and evaluation in an undergraduate nursing course. Nurse education today ,2009 Aug ; Volume 29 (6): 585590. 73
  • ANNEXURE-II INFORMED CONSENT I understand that I am being asked to participate in research study at Sarvodaya hospital. This research study will evaluate “The effectiveness of video assisted teaching programme on knowledge regarding infertility among infertile couple’’ If I agree to participate in the study, I will be attending a knowledge and a video assisted teaching programme last for 45 minutes followed by a post test. I realize that the knowledge gained from this study may help either me or other patients and there are no known risks associated with this study. I realize that my participation in this study is entirely voluntary, and I may withdraw from the study at any time I wish. I understand that all study data will be kept confidential. The study has been explained to me .I has read and understands this consent form, all of my questions have been answered, and I agree to participate. Signature of subject Date
  • Signature of investigator Date 75 ANNUXRE-III PART-1 (TOOL) DEMOGRAPHIC DATA Name 1. Age a.20 years --- 24 years b.25 years --- 29 years c.30 years --- 34 years d.35 years and above 2.Gender a. Male b. Female 3.Education a. Primary b.Secondary c.Senior secondary. d.Graduate / post graduate 4. Occupation a Employment b Unemployment 5.Duration of Treatment a.Below one year b.One year c.Above one year S.NO ----
  • 6 Previous Knowledge a.Yes b.No 76 SECTION –II INSTRUCTION: Encircle the most appropriate option out of given choices. 1. What do you mean by fertilization? a. Development of reproductive organ b.Family planning methods c.Any disease condition of reproductive organ. d.Fusion of sperm and ovum 2. Which of the following are main reproductive organs of a female? a.Kidney, Ureters ,Urethra b.Vagina ,Ovaries, Fallopian tubes, uterus c.Stomach, Uterus, Small intestine d.Ovum, Fallopian tube, Pancreas 3. Which of the following are main reproductive organs of a male? a.Liver, Gallbladder, Pancreas b.Kidney, Ureter, Nephron c.Scrotum, testes, prostate gland, penis d.ovaries, testes, penis 4. Which of the following causes fertility in males? a.Ovum b.Bacteria c.Sperms d.Atoms
  • 5. Which of the following causes fertility in female? a. virus b. Ovum 77 c. Molecules d. Atoms 6. Which of the following reproductive organ produce spermatozoon? a. Liver b.Scrotum c.Urethra d.Fallopian tubes 7. Which female reproductive organ produce ovum? a. Ovary b.Uterus c.Fallopian tubes d.Liver 8. Which of the following contains sperms? a.Urine b.Bile c. Seminal fluid d. Acid 9. What is the amount of seminal fluid ejaculated by man after intercourse normally? a.1ml – 3 ml b.2 m l– 5 ml c.10 ml – 12 ml d.40 ml-50 m 10. What is the normal count of sperms in an ejaculated seminal fluid? a.1 million/ ml
  • b.5 million/ ml c.20 million/ ml d.50 million/ ml 78 11.What is the age of menarche in a woman? a.12 – 13 years b.14 –15 years c.16 – 17 years d.18 – 19 years 12. How many times menstrual cycle occur in a month normally? a.Four times b.Three times c.One time d.Two times 13. What is the duration of menstrual cycle ? a.1 – 2 days c.4 – 5 days d.8 – 9 days d.10 – 12 days 14. What do you mean by Infertility? a. Occurrence of menstrual cycle b. Not birth of a male child after one year of marriage c.Not development of reproductive organ d. Failure to conceive within one or more years of regular unprotected sex 15. In which of the following infertility occurs? a.Only in females
  • b.Only in males c.males & females d.None of the above 79 16. What is the incidence of infertility in male? a.0 % b.20% c.40% d.60% 17. Which of the following is incidence of infertility in female? a.40% b.60%c c.80% d.100% 18. Which shows the incidence of infertility in males and females? a.10 – 20 % b.30 –40% c.50 - 60% d.70 – 80% 19. Which of the following are types of infertility? a. External, Internal. b.Primary, secondary, tertiary. c.Biological, physical. d.Primary,Secondary, Unexplained 20. What do you mean by primary infertility? a.No delivery of a male child.
  • b.Spontaneous miscarriages. c.Who have never conceived? d.Use of contraceptives. 80 21. Which of the following is true about secondary infertility? a.Have twins pregnancy. b.Have previous pregnancy but failure to conceive subsequently c.Have not conceived after two years of marriage d.Have two female child 22. What do you mean by unexplained infertility? a.Faults in both male and female detected in one year of married life. b.Couple who have Hormonal deficiency c.Couples who are infertile with no abnormality detected d.Couple who have sexually transmitted diseases 23. Which of the following are main cause of infertility in male? a. Oligospermia, Azoospermia, Impotency b.Oligospermia, Heamaturia , Impotency c.Haemrrhoids, Oligospermia, d.Impotency, Oligospermia, Azoospermia 24. What factor can cause infertility in males ? a.Working in hot atmosphere b.Working in cold atmosphere c.Working in dry atmosphere d.Working in humid atmosphere 25. Which of the following are main cause of infertility in females ? a. Anovulation, Blocked fallopian tubes
  • b.Leucorrhoea, Anovulation c. Blocked fallopian tubes, Menorrhagia d . Leucorrhoea, , Menorrhagia 81 26. What disease can cause infertility in females? a.Jaundice b.Typhoid Fever c.Chicken Pox d.Fibroid uterus 27. Which of the following diseases cause infertility in males ? a.Poliomyelitis b.Renal calculi c.Mumps occur in puberty d.Measles 28. In which conditions sperms are not form in males? a.Undescended testes b.Any trauma of testes c.tumor of testes d.All of the above 29. What is the main investigation for male infertility? a.Semen analysis b.Chest X - ray c.Stool examination d.Sputum examination 30. In which conditions testicular biopsy is done? a.Oligouria b.Azoospermia
  • c.High amount of semen d.Premature ejaculation 82 31. Which of the following female reproductive organs are investigated for infertility? a.Ovaries, fallopian tube, uterus b.Ovum, Fallopian tube, Uterus c.Stomach, rectum, vagina d.lungs, intestine, femur 32. What are the investigations done to identify blocked fallopian tubes? a.Inflation of fallopian tube b.Biopsy of fallopian tube c.MRI of fallopian tubes d.surgery of fallopian tube 33. Which of the following should be adopted by infertile couples? a.Avoid wearing of loose undergarments b.Avoid eating of fresh vegetables c.Avoid wearing of cotton undergarments d.Avoid wearing of tight undergarment 34. What is the treatment for blocked fallopian tubes? a.Through tubal ultrasound b.Through tubal medicine c.Through tubal surgery d.Through tubal radiation 35 Which of the following is the treatment of unexplained infertility? a.Assisted reproductive therapy b.Assisted reproductive technology
  • c.Assisted reproductive treatment d.Assisted reproductive terminology 83 36. Which statement is true regarding artificial insemination? a.In this concentrated sperm is injected through a catheter within the uterine cavity b.In this concentrated drug is injected through a catheter within the uterine cavity c.In this concentrated dye is injected through a catheter within the uterine cavity d.In this concentrated ovum is injected through a catheter within the uterine cavity 37. Which of the following is treated by Artificial Insemination Donor? a.Hypospadiasis b.Azoospermia c.Undescended testes d.Hydrocele 38. Which statement is true regarding artificial insemination donor? a.Donor should be non-vegetarian and healthy. b.Donor’s culture, race and religion should be matched with husband. c.Donor’s family background and native place should be matched with husband. d.Donor’s blood group, hair, skin & eye color should be matched with husband. 39. Which of the following technology is included in assisted reproductive technology? a.IVF b.MRI c.EEG d.ECG 40. What do you mean by Surrogacy? a.Child adoption b.Surrogate mother
  • c.In Vitro Fertilization d.Twin pregnancy 84 ANSWER KEY ITEM ANSWER NUMBER MARKS ITEM ANSWER ALLOTED NUMBER MARKS ALLOTED 1 d 1 21 b 1 2 b 1 22 c 1 3 c 1 23 a 1 4 C 1 24 a 1 5 b 1 25 a 1 6 b 1 26 d 1 7 a 1 27 c 1 8 c 1 28 d 1 9 b 1 29 a 1 10 C 1 30 b 1 11 a 1 31 a 1 12 c 1 32 d 1 13 b 1 33 d 1 14 d 1 34 c 1 15 c 1 35 b 1 16 c 1 36 a 1 17 a 1 37 b 1 18 a 1 38 d 1
  • 19 d 1 39 a 1 20 c 1 40 b 1 92 BLUE PRINT QUESTION NUMBER KNOWLEDGE COMPREHENSION ANALYSIS TOTAL, 1 1 1 2 1 1 3 1 1 4 1 1 5 1 1 6 1 1 7 1 1 8 1 1 9 1 1 10 1 1 11 1 1 12 1 1 13 1 1 14 15 1 1 1 1 16 1 1 17 1 1 18 1 1 19 20 1 1 1 1
  • 21 1 1 22 1 93 23 1 1 24 1 1 25 1 1 26 1 1 27 1 1 28 1 1 29 1 1 30 1 1 31 1 1 1 1 33 1 1 34 1 1 35 1 1 36 1 1 37 1 1 38 1 1 39 1 1 32 1 40 1 TOTAL 14 6 20 40 35% 15% 50% 100% PERCENTAGE 1
  • 94 ANNUXRE-IV LETTER REQUESTING OPINION AND SUGGESTION OF EXPERTS TO VALIDATE THE TOOL From: Ms: Hem kumari 2nd year M.Sc. Nursing Sophia Nursing college To, Through the Principal Sophia nursing college Sub: Request for expert opinion and suggestions to establish content validity for research tool. Respected Sir/Madam, I Ms. Hem kumari 2 nd year M.Sc Nursing (OBG Nursing)student of Sophia Nursing College have selected the following topic for my dissertation to be submitted to Jiwaji University in partial fulfillment for a Master of science in Nursing. Topic: A study to assess the effectiveness of video-assisted teaching programme knowledge of infertility among infertile couples in selected hospitals of Haryana. Herewith I have enclosed: • Statement of the problem, objectives of all study and operational definitions • Blue print of the tool • Tool containing baselines Performa, questionnaire • Criteria checks list I request you to go through the items and give your valuable suggestions and opinion to develop the content validity of the tool. Kindly suggest modification, addition, deletions if any in the remark column.
  • , Thanking you, Yours Sincerely, 95 ANNEXURE-V CERTIFICATES FOR THE CONTENT VALIDITY This is to certify that the tool developed by Ms Hemkumari M.Sc Nursing student of Sophia College of Nursing Gwalior (affiliated to Jiwaji University) is validate by me. He can proceed with this tool and can conduct the main study for dissertation entitled “The effectiveness of video-assisted teaching programme knowledge of infertility among infertile couples in selected hospitals of Haryana’’ Date Name Place Signature Desiginaton
  • 96 LIST OF TABLES S.NO TABLES 1 Schematic representation of research design PAGE NO 30 2 Distribution of items according to the content areas based on 34 3 tree domains in the blue print Distribution of items and percentage of marks according to 35 4 the three aspects of area Description of baseline variables 5 Distribution of knowledge level regarding infertility among 49 42 infertile couples in the pre-test 6 Distribution of knowledge level regarding infertility among 49 infertile couples in the post-test 7 Comparison of mean and standard deviation of knowledge 51 score regarding infertility in pre-test and post-test 8 Paired t test value of pre-test and post-test knowledge score of 52 infertile couples regarding infertility 9 Association between the pre-test knowledge score with 53 selected demographic variables of infertile couples
  • XVI LIST OF FIGURES S.NO FIGURES PAGE NO 1 Conceptual framework based on Ludwig Von Betanffy’s 2 3 4 5 6 7 8 general system theory Plan of intervention Distribution of subjects based on age in years Distribution of subjects according to gender Distribution of subjects according to education Distribution of subjects according to occupation Distribution of subjects according to duration of treatment Distribution of subjects according to previous knowledge Distribution of knowledge level regarding infertility 9 12 33 43 44 45 46 47 48 50 among infertile couples in pre-test and post-test XVII ANNUXRE-VI Criteria for validation of questionnaire on knowledge regarding on infertility among infertile couples
  • Kindly go through the items in the structured knowledge questionnaire regarding accuracy, relevancy, and appropriateness of content. There are 4 response columns in the scale, namely Not relevant, Somewhat relevant, Quite relevant, Highly relevant. Place a tick mark ( ) in the specific column. If you disagree to any of the items place your comments in the remark column. Rating scale for base line variables Item No Not relevant Somewhat relevant Quite relevant Highly relevant Remarks 1 2 3 4 5 6 Rating scale for knowledge questionnaire Questionnaire on knowledge regarding infertility Item Not relevant Somewhat Quite Highly No relevant relevant relevant 1 2 3 4 97 5 6 7 8 Remarks
  • 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 98 ANNUXRE- VII LIST OF EXPERTS
  • 1. Dr. Anjali Gupta Sarvodaya Hospital Faridabad 2. Dr. Seema Sharma Sarvodaya Hospital Faridabad 3. Dr. Manju Goyal Sarvodaya Hospital Faridabad 4. Mrs. Vishnupriya.K Principal Sophia Nursing college Gwalior 5. Mrs. Vishnupriya.K Associate Professor Sophia Nursing college Gwalior 99 6. Mrs. Vijaylaxmi Principal
  • Lingaya’s Nursing College Faridabad . 7. Mrs. Manju Rajput Associate professor Florence Nursing College Faridabad . 8. Mrs. Lily basu Associate professor Ahilya Bai Nursing College Delhi 100 LIST OF ANNUXRES
  • S.No ANNUXRES 1 Permission letter for conducting the research study 2 Informed consent 3 PAGE No Tool Part-I Baseline variables Part-II Knowledge questionnaire on infertility 4 Letter requesting opinion and suggestion of experts to validate the tool 5 Certificate for the content validity 6 Criteria for validation of questionnaire 7 List of experts 8 Structured teaching program on Infertility XVIII “ A STUDY TO ASSESS THE EFFECTIVENESS OF VIDEO ASSISTED TEACHING ON KNOWLEDGE REGARDING INFERTILITY AMONG INFERTILE COUPLES IN SELECTED HOSPITALS AT HARYANA’’ BY
  • Ms. HEMKUMARI Dissertation submitted to Jiwaji University Gwalior Madhya Pradesh In partial fulfillment of the requirement for the degree of MASTER OF SCIENCE In OBSTETRIC AND GYNAECOLOGICAL NURSING Under the guidance of MRS. VISHNUPRIYA.K PRINCIPAL SOPHIA NURSING COLLEGE GWALIOR MADHYA PRADESH I