This slide is published to give the PhD scholar an idea for their viva-voce defence. The slide was created while adhering to all of the slides' principles. This slide contains all of the scientific information that the researchers collected while working on their thesis.

1. Ph.D. Scholar
Mrs. Vijaya Rahul Kumbhar
Under the guidance of
Dr. (Mrs.) Nilima Rajan Bhore
Dean, Faculty of Nursing/Principal, Bharati Vidyapeeth (Deemed to be University)
College of Nursing, Sangli
HEARTY WELCOME
PANEL OF EXAMINERS
Ph.D- FINAL OPEN DEFENCE AND VIVA-VOCE EXAMINATION
Effectiveness of Self Instructional Module vs. Audio CD-ROM
Regarding Reproductive Health on Knowledge and Self-Reported
Practices among Adolescent Blind Students in selected Blind Schools
of Western Maharashtra, India."
SUMITTED TO
BHARATI VIDYAPEETH (DEEMED TO BE UNIVERSITY), PUNE

2. Indian agency for Prevention of
Blindness (IAPB-2019) –
Global age -standardized
prevalence rate among blind men
and women –
 male -10-14 years is 0.04% and 15-19
years is 0.05%, respectively.
 Female-10-14 years is 0.05% and 15-19
years is 0.06%, respectively.
Universally-
 93600 visually impaired
people - school going
adolescence.
 The prevalence rate of
school aged adolescence
was 5%.
 Almost 1.5 million blind
adolescence were
younger than 18 years of
age; out of them 0.1
million were in Asia.
Data information Benchmark of the study-
Local, National and International
UNICEF –
 1.2 billion youths-periods of
adolescence, 243 million were in
India, who occupied a quarter
(34.8%) of India’s population.

3. Prevalence Rate of Visually impaired Youngsters in
Maharashtra
Six regions with 60
residential blind schools
4568 Population -
age between 7-18
years
India-12 for every
10000 blind -
age between 7-18
years
Male and Female
Western Zones of the
Maharashtra-530
youngsters
224-Samples age
between 13-18 years
0.008% 0.007%

4. SDG-2030- 4th goal –
imparting gender equality, education
and provides opportunities for
maintaining and sustaining the
educational outcome for both the
boys and girls.
Judith –
in the present scenario the
issues like reproductive health is
totally ignored by the society
-visual disabilities are asexual
and need not to be presented to
the unnecessary information;
withholding of an information
Worldwide-
Around 103 million youths -
Millennium goal -essential
educational intervention on sexual
and reproductive health among
teenagers.
Texas Blind school -Canadian -
sexual health education there
ought not to be any disparities
in access to information on
reproductive health against
gender, religion and ethnic-
cultural background or
disability.
Ontologic: Nature of reality

5. Braille is generally composed
with the cells of 6 raised dots
and the presence or absence of
dots gives the coding for the
symbol, providing 64
characters in braille alphabet.
In India Bharati-Devanagari braille
alphabet means Shree – Lippi
braille transformer drives index
braille/ braille embosser to print in
all languages i.e. Marathi, Hindi,
Sanskrit, Kannada, Guajarati,
Tamil, Malayalam and all other
regional script.
International languages
since two centuries i.e.
American, Arabic, Bharati-
Devanagari, British, Chinese,
Croatian, Czech, Dutch,
Unified English, French,
German, Italian, Japanese,
Korean, Portuguese,
Québécois, Spanish, Swedish,
Vietnamese braille alphabet.
 People with visual impairment
have an access of auditory tool
i.e. listening to a book on CD
player known as audio book.
 available in audio cassettes and
some are available as
electronic files which can be
downloaded and listened too.
MEDIUM OF EDUCATION AND STUDY MATERIAL

6. AICB organization –
need to cooperate in determining and
continuing the services for the
development of the blind through
developing materials in large print or
Braille, radio, cassette tape or audio-CD to
improve the accessibility of the health care
services.
On the other side of the coin, very few
studies through the qualitative and
quantitative approach were attempted to
discover the problems faced by the blind
adolescents and to intervene in enhancing
the knowledge and improving the practices
regarding reproductive health among blind
adolescents through use of appropriate
educational material.
Several governmental and non governmental
organizations at national and international
level have highlighted that the blind
teenagers undergoing the remarkable
changes during adolescence phase, who are
exposed to a multiple need and assistance
that require the individual specific
approach through the proper guidance and
counseling services, psychological support
and appropriate educational intervention.
EPISTEMOLOGIC
Guided by all these aspects on knowledge
and practices of reproductive health and
targeted population, the researcher
thought to use the quantitative research
approach and decided to help them with
the required information and prepared
the teaching material in the form of self-
instructional module in the Marathi
Devnagari Braille script and audio CD-
ROM in Marathi respectively.

7. • To assess the level of knowledge and self-reported practices
regarding reproductive health among the participants of Group-1
before and after the administration of self - instructional
module.
• To assess the level of knowledge and self-reported practices
regarding reproductive health among the participants of Group-2
before and after the administration of audio- CD-ROM.
Effectiveness
within group
• To compare the effect of self-instructional module versus audio-
CD-ROM regarding reproductive health on knowledge and self-
reported practices.
Comparison
between
two group
• To find the correlation between pre-test scores of knowledge
with self-reported practices; and the correlation of post-test
knowledge with post-test self-reported practices scores of male
and female adolescents in both groups with the use of self-
instructional module and audio-CD-ROM.
• To associate the findings of pre-test knowledge and self-reported
practices scores with Gender among the participants from group
1 with the use of self-instructional module and group-2 with the
use of audio- CD-ROM.
Correlation
and
Association
OBJECTIVES OF THE STUDY

8. HYPOTHESIS OF THE STUDY
The null hypothesis: (Group-1-Self-Instructional Module and Group-2-
Audio-CD-ROM)
H0-1 – (Pre-post test)
 There is no difference in the
knowledge regarding
reproductive health before and
after the intervention in the
group-1 and group-2 at 0.05
level of significance.
 There is no difference in the
self-reported practices
regarding reproductive health
before and after the
intervention in the group-1 and
group-2 at 0.05 level of
significance.
H0-2 –(post-post test)
 There is no difference in the
knowledge regarding
reproductive health after the
intervention among the group-1
and group-2 at 0.05 level of
significance.
 There is no difference in the
self-reported practices regarding
reproductive health after the
intervention among the group-1
and group-2 at 0.05 level of
significance.

9. HYPOTHESIS OF THE STUDY
H0-3-Correlation
H0-4- association
 There is no significant
correlation of pre-test
knowledge score with pre-test
self-reported practices scores
of male and female in both the
group-1 and group-2.
 There is no significant
correlation of post-test
knowledge score with post-test
self-reported practices scores
of male and female in both the
group-1 and group-2.
There is no significant association
between the findings of pre-test
knowledge scores and self-
reported practice scores with
Gender in both the group 1 and
group-2.

10. Institutional Ethical Committee
(IEC) –
IEC of Bharati Vidyapeeth
Deemed University, College of
Nursing, Pune. .(Ref
No.BVCON/EC/607/20 Dated-
03/10/2016.
Consent from the participants:
Informed written consent was taken
from the students of 18 years of age.
Other minors’ of 13-17 years of age the
permission was sought from the
directors and principals of the schools as
a guardian.
Permission from the apex
concerned authority:
Written permission obtained from
the director/ principal of the
respective selected blind
schools.
Authority was assured about
maintenance of confidentiality
and anonymity in the
information related to school
data.
Assent:
refers to the child’s affirmative
agreement to participate.
Researcher had obtained written
assent from the participants as
well, as evidence of respect for
the adolescent’s right to self-
determination.
ETHICAL CONSIDERATION

11. System theory is first proposed by
Ludwig Von Bertalanffy (1901-1972)
General System Theory
General system theory is a general science of ‘Wholeness’.
System theory has been applied in developing nursing theories and
conducting nursing research.
Characteristics of systems theory:
“Systems” refers specifically to self-regulating systems.
Systems are self-correcting through feedback.
Systems have a structure that is defined by its parts and processes.
Systems are generalizations of reality
The various parts of a system have functional and structural relationships
between each other.
Systems tend to function in the same way.
Every living organism is essentially an open system.

13. DELIMITATIONS
 The participants were only those residing in blind schools. The
non-residential adolescent blind students were not included.
 There are many aspects of reproductive health in adolescents.
However, the study is investigating only selected aspects of
reproductive health as considering the vulnerable population.
 Researcher corrected the answer by taking the help of the teacher
to cross-check the answer, hence the questionnaire is in Braille
and also to maintain the objectivity of the study answer key was
not shown to the teacher before the pre-test.
 It is done only in blind schools of Western Maharashtra

14. SIGNIFICANCE/ SCOPE OF THE STUDY:
 One of the methods to endorse the reproductive health is through
appropriate and scientific education.
 It has been marked in the literature that reproductive health education at
the blind schools is a cost effective and best method of developing healthy
lifestyles.
 The significance of the study to compare the effect of SIM and Audio-CD-
ROM in enhancing the knowledge and improve the practices among the
adolescent blind students of Western Maharashtra.
 Globally, conducting research studies is critical in this area, mainly for the
adolescent blind students.
 The facts that would be generated from this study has the likely to
improve curriculum development in nursing education and training
approaches used at the school level in order to help this targeted
population to maintain and promote their reproductive health as a part of
their general health.

15.  These two educational teaching materials will be in the hope of bridging the
accessibility of knowledge and practices gap between the genders.
 The findings of the study will redound to the benefit of blind society
considering that self-instructional module and Audio-CD-ROM plays an
important role in enhancing knowledge about reproductive health has a great
impact on blind adolescent’s reproductive life by improving their practices as
well.
 The greater demand for the education methods in Braille script and audio
format on reproductive health background justifies the need for more
effective life changing- teaching approaches.
 Thus, the school teacher, care takers that apply the recommended approach
derived from this study will be able to train the adolescent blind student
better regarding reproductive health.
 For the researcher, the study was helped to uncover the thrust area on
interesting population through the educational process that many researchers
were not able to explore. Thus a new concept of teaching to the adolescent
blind students arrived at.
SIGNIFICANCE/ SCOPE OF THE STUDY:

16. SR
NO
SECTIONS NO OF
REVIEWS
1 Literature related to reproductive health among adolescents
with Visual impairment .
8
2 Literature related to knowledge and practices related to
reproductive health among adolescents.
20
3 Literature related to use of braille and audio-CD-ROM in
teaching technology for the visually challenged people.
5
4 Literature related to the effectiveness of various
educational materials related to reproductive health on
knowledge, attitude and practices among adolescents
9
5 Literature related to reports of National and International
organizations related to reproductive health.
6
The related literature are grouped into the following sections:
REVIEW OF LITERATURE:
The literatures taken for the review are from the year 1995 onwards till date as the adolescents
reproductive health issues have gained acknowledgment in the International Conference on
Population and Development (ICPD), Cairo, 1994.

17. The related literature are grouped into the following sections:
REVIEW OF LITERATURE:
SR NO SOURCE OF FORMAT
1. Books
Obstetric and gynecology Nursing
NursingTheory
Research & bio statistics
2. National blind association (NAB) ,World Union of Blind report
3. Report by World health organization ,UNICEF
4. Websites , UN NEWS report, Blogs
Nursing library
Pubmed
Delnet,Ncbi
5. M. Sc Dissertations: Published/Unpublished
Peer reviewed journals

18. Research approach: Quantitative research approach
Research design : Quasi-experimental two group pre-test-post-test design.
Group Pre-test( 1st
day)
Treatment Post-test( 15th day)
Group-1-Adolescent blind
students with the use of
SIM
O1 X O2
Group-2-Adolescent blind
students with the use of
Audio-CD-ROM
O1 X O2
RESEARCH METHODOLOGY

20. Sample size and Sampling technique
 The mixed method by using
multiphase approach:
 1st phase-
zones for the selection of cities as Pune,
Satara, Kolhapur, Sangli and Solapur.
the schools were selected from
randomly assigned cities in group-1 with
the use of SIM and group-2 with the use
of Audio-CD-ROM.
Therefore no chance for participants
being the same or contaminated during
the intervention phase.
 2nd phase-
Non-probability convenience
sampling was used; participants
fulfilling the criteria were
identified as samples were easy
to contact as they were
residing in the blind school.
The participants were allocated
in a group-1 with the use of SIM
and in a group -2 with the use
of Audio-CD-ROM.
100 (10% drop out was considered and final the sample size was 112)
Taking the factors into consideration those 112 samples were selected for a
group-1 with the use of SIM and 112 samples were selected for a group-2 with the
use of Audio CD-ROM. So, total 224 samples were selected for final data
collection.

21. DESCRIPTION OF TOOL
Tool was prepared and described in three sections
 Section-I- Dealt with the demographic Performa of the characteristics
of participants.
 Section-II- Structured knowledge questionnaire for assessing
knowledge regarding reproductive health included 24 questions on
reproductive Health.
 Section-III-Dichotomous structured self-reported practices in Marathi
Braille script on reproductive health was prepared.
 It is made separate for male (III a) and female (IIIb) as the practices
differ and gender-specific approach.

22. Construction of Self- instructional module in Marathi Braille script and
Audio-CD-ROM in Marathi language-
 Selected 10 topics on adolescents reproductive health - the extensive
reviews and experts suggestions after the content validity and finalize the
content of the topic in english and translated in Marathi.
 Marathi editing was done by the expert with certification of the editing.
 NFBM Braille publishing center, Alandi which is run by the national
Federation of the Blind, Maharashtra - development of the SIM, structured
knowledge questionnaire and self-reported practices in Marathi Braille
script.
 The draft of SIM, structured knowledge questionnaire and self-reported
practices in Marathi Braille script by using Arial Unicode MS with 18 No
font size.
 The Authentication certificate was received by the NFBM braille publishing
center, Alandi on 27/06/2017 for the accuracy of the content.

23. Development of Audio-CD-ROM-
 Audio CD-ROM was prepared on the same validated content which was
used in preparation of SIM.
 The audio recording was done in researchers own voice and one of a
nursing student. The two voices with voice modulations were used to
generate the interest among adolescent blind students in listening the
audio CD-ROM.
 The consent from the person who enacted i.e. one of a nursing student
was obtained before the preparation of audio-CD-ROM.
 The Authentication certificate was received by the Composer of Audio-CD-
ROM by keeping the factors taking into consideration in audio-effect,
clarity, interest building, attention span and size of Audio CD-ROM.
 Audio-CD- ROM was prepared in WAV file, 972 MB, Time limit-01:01:09
hours and Mp3 file 111MB, time limit- 01:01:09 hours.


24. VALIDITY/RELIABILITY/PILOT STUDY
Validity of the tool -established
by 22 experts
 Validity of the Self-instructional
module and Audio-CD-ROM:
 Self-instructional module in
Marathi Braille script was
validated by the director of Braille
press and
 Audio-CD-ROM in Marathi language
was validated by the sound
engineer those who involved in
composition of the Audio-CD-ROM.
The reliability of tool-test-retest method. It
was done at the interval of 2 hours.
- The reliability coefficient `r` was found to
be -
 structured knowledge questionnaire in
Marathi Braille r=0.84
 structured self-reported practice
questionnaire in Marathi Braille
 0.75 for males and
 0.83 for female
 This result indicates that the tool was
reliable to conduct the study
 Pilot study : 24 samples were recruited from that 12 each were taken for group with
the use of SIM and Audio CD.
 The findings of the pilot study revealed that the tool was reliable and it was feasible
to conduct the final study and did not reveal any major problem.

25. Section-I – SECTION I: Analysis of demographic characteristics
Table No-2: Distribution of demographic characteristics in the group-1 and group-2
Demographic
characteristics
SIM (n=112) Audio CD-ROM (n=112)
Freq. & % Freq. & % Freq. & % Freq. & %
Gender Male Female Male Female
56(50) 56(50) 56(50) 56(50)
Age in Years
13-15 21 (37.5) 29 (51.7) 37 (66.07) 23 (41.1)
16-18 35 (62.5) 27 (48.3) 19 (33.93) 33 (58.9)
Previous information regarding reproductive health
Yes 17 (30.4) 15 (26.8) 13 (23.2) 19 (33.9)
No 39 (69.6) 41 (73.2) 43 (76.8) 37 (66.1)
If yes, Sources of information
Family Member 1 (5.9) 2 (13.3) 2 (15.4) 1 (5.3)
Friend 11 (64.7) 4 (26.7) 8 (61.5) 6 (31.6)
Residential school 5 (29.4) 9 (60) 3 (23.1) 12 (63.1)
N =112+112

26. SECTION I: Analysis of demographic characteristics----Contd…..
Demographic
characteristics
SIM (n=112) Audio CD-ROM (n=112)
Freq. & % Freq. & % Freq. & % Freq. & %
Person with whom do you discuss your queries regarding reproductive health
Friends 24 (42.9) 17 (30.4) 28 (50) 9 (16.1)
Mother 7 (12.6) 5 (8.9) 3 (5.4) 6 (10.7)
School Teachers 5 (8.9) 9 (16.1) 7 (12.5) 10 (17.9)
Residential school
caretaker
10 (17.8) 19 (33.9) 13 (23.2) 29 (51.7)
Doctors 10 (17.8) 6 (10.7) 5 (8.9) 2 (3.6)
N =224

27. Table No-3.:Distribution of knowledge score on reproductive Health in the
Group-1(SIM) among adolescent blind students
Level of Knowledge
score
Pre-test
Frequency
(%) Post-test
Frequency
(%)
Poor /(0-8) /< 50% 77 68.75 0 0.00
Average / (9-16)/ 50-75% 27 24.10 49 43.75
Good/ (17-24) >75% 8 7.14 63 56.25
Total 112 100 112 100
N=112

28. STUDY FINDINGS:
 68.75% of Participants -poor
score,
 After the intervention of SIM- no
participants had shown poor
score,
 43.75% of students had shown
average score
 56.25% had obtained good score
in knowledge domain.
 This showed that, adolescent
blind students’ knowledge was
increased after the intervention
of self–instructional module
regarding reproductive health.
SUPPORTIVE STUDY:
 Ashika in her research findings says
that, 74.57% of the adolescence had
shown poor performance in
knowledge score before the
intervention and after the
administration of educational
strategies like lecture method.
 The adolescence are performed
64.28% had average score and 30.36%
of participants shown good knowledge
score on the sexuality and
reproductive health
 Further discussed that the
adolescences involved in the
intervention had low chances of
being involved in risky behavior than
those adolescence who have no
knowledge.
DISCUSSION WITH SUPPORTIVE LITERATURE

29. Table No-4.:Distribution of knowledge score on reproductive Health in the
Group-2 (Audio-CD-ROM) among adolescent blind students
Level of Knowledge
score
Pre-test
Frequency (%)
Post -test
Frequency
(%)
Poor /(0-8) /< 50% 63 56.25 0 0.00
Average / (9-16)/ 50-75% 47 41.96 33 26.47
Good/ (17-24) >75% 2 1.79 79 70.53
Total 112 100 112 100
N=112

30. STUDY FINDINGS:
 56.25% of subjects had shown poor
score,
 41.96 % had obtained average score,
 1.79% of students shown good score.
 After the intervention of Audio-CD-
ROM ,no participants had shown poor
performance.
 26.47% of students had shown
average score
 70.53% had obtained good score in
knowledge domain.
 This showed that, adolescent blind
students’ knowledge was increased
after the intervention of Audio-CD-
ROM regarding reproductive health.
SUPPORTIVE STUDY:
 Mariana Lopez, Gavin Kearney
(2018), conducted the study on the
use of audio descriptive film and
TV especially for the visually
impaired population.
 There is enhancement of the
knowledge among the visually
impaired students .
 59% of blind participants showed
that it is easy method to access the
information and complement that,
there should be an original
soundtrack.
DISCUSSION WITH SUPPORTIVE LITERATURE

31. Table No.6: Comparison of knowledge score on reproductive health in the
group-1 and group-2
Knowledg
e score
Group-1(SIM) Group-2 (Audio-CD-ROM) MW test
Z value
P value
Mean Median SD Mean Median SD
Pre-test 7.67 6 1.672 8.34 8 2.396 1.34 0.18
Post -test 13.39 14 4.563 17.56 18 2.784 10.65 <0.0001
N=112+112

32. STUDY FINDINGS:
No significant difference in pre-test
knowledge score among the group-1 and
group-2
but shows a significant difference in
the post test knowledge score between
the group-1 and group-2 as p<0.0001.
On comparison of pre-test with post-
test scores it shows a significant
difference in the group-1 and group-2.
Hence, SIM and Audio both are
effective in increasing the knowledge
among adolescent blind students on
reproductive health. Therefore, the
finding concluded with the null
hypothesis H0-1 was rejected and
research hypothesis H1 was accepted.
SUPPORTIVE STUDY:
 The review article written by Maurice
Belote(2002), in Texas school for the blind
and visually impaired mentioned that along
with issues of sexuality at the early
developmental stages adolescence with
visual impairment has to be trained on the
skills that will help them in instructional
activities on prevention of sexual
harassment .
 And also the parents and the caregivers
should have healthy communication channel
between the adult-child which ultimately
will lead to effectiveness in reducing the risk
taking sexual behavior.
 Hence the child will learn the appropriate
behavior such as bad touch and good touch
as we expect.
DISCUSSION WITH SUPPORTIVE LITERATURE

33. Table No.8. Comparison of post test knowledge score of group-1 and
group-2 among the male and female blind adolescents.
Gender Mean
knowledge
score
SD Z value p value Inferences
Male –Post test-15th day
Gr-1 SIM 15.20 3.083 4.38 <0.00001 Highly
Significant
Gr-2 Audio CD 17.48 2.397
Female–Post test-15th day
Gr-1 SIM 17.20 3.053 0.792 0.215 Not
Significant
Gr-2 Audio CD 17.64 2.907
N = 224

34. STUDY FINDINGS:
 In a group of males, there is statistically highly significant difference in
mean knowledge score as ‘p’-value was 0.00001 which was less than 0.05
level of significance.
 In a group of females, there is no statistically significant difference in mean
knowledge score of SIM and Audio-CD-ROM, as p’-value was 0.215 which was
more than 0.05 level of significance, but group-2 received information with
Audio-CD has slightly larger mean.
 Hence from both the group of male and female we can conclude that Audio-
CD-ROM was more effective in increasing the knowledge than the use of SIM
on reproductive health.
DISCUSSION WITH SUPPORTIVE LITERATURE

35. Table No-9. Distribution of practice score on reproductive Health in the Group-1 (Self-
instructional Module) among female adolescent blind students
Level of Practices score Pre test Post-test
Frequency (%) Frequency (%)
Unsatisfactory (0-9)/< 60% 53 94.64 26 46.43
Satisfactory (10-17)/>60% 3 5.36 30 53.57
Total 56 100 56 100
N=56

36. STUDY FINDINGS:
In female blind adolescents that, the
percentages in unsatisfactory practices
were
Reduced from 94.64% to 46.43% and
satisfactory practices were improved
from 5.36% to 53.57% after the
administration of SIM.
Total 16 female blind student’s
practices were improved on
reproductive health.
This showed that among the female
blind students self-reported practices
score was improved after the
administration of self –instructional
module on reproductive health.
SUPPORTIVE STUDY:
Beena Joshi, S.L. Chauhan. U.M.
Dhonde et al; revealed the
findings in schools and colleges on
the reproductive health
knowledge, attitude and
reproductive health problems
among adolescents aged 11-19
years explored that adolescent
girls mostly suffered with the
menstrual problem followed by
vaginal discharge and itching of
genitalia
DISCUSSION WITH SUPPORTIVE LITERATURE

37. Table No-11 :Distribution of practice score on reproductive Health in the Group-2
among male adolescent blind students
Level of Practices score Pre test Post test
Freq. % Freq %
Unsatisfactory (0-5)/< 60% 44 78.57 14 25.00
Satisfactory (6-8)/>60% 12 21.43 42 75.00
Total 56 100 56 100
N=56

38. STUDY FINDINGS:
 Among male adolescent blind students,
the percentages for unsatisfactory
practices were
 Reduced from 78.57% to 25% and
satisfactory practices were improved
from 21.43% to 75% after the
administration of Audio-CD-ROM.
 Total 28 male blind students’ practices
were improved on reproductive health.
 This showed that among the male
blind students self-reported practices
score was improved after the
administration of Audio-CD-ROM on
reproductive health.
SUPPORTIVE STUDY:
 Mohammad Reza, et.al.(2006),
reported that, there was high
prevalence rate and lack of
knowledge among the adolescent
males in Iran. 0
 So educational program is
required to impart the information
and skills to have healthy and safe
sexual and reproductive life
DISCUSSION WITH SUPPORTIVE LITERATURE

39. Table No.13. Comparison of post test self-reported practices of group-1
and group-2 among the male and female blind adolescents.
Gender Mean knowledge
score
SD Z value p value Inferences
Male –Post test-15th day
Gr-1 SIM 6.76 1.144
0.024 2.005 Significant
Gr-2 Audio CD 6.23 1.64
Female–Post test-15th day
Gr-1 SIM 10.33 2.691
0.161 0.993
Not
Significant
Gr-2 Audio CD 10.82 2.443
N = 224

40. STUDY FINDINGS:
 Male blind adolescent students in level of
self-reported practices was found significant
as Z- value was 0.024 and p-value was 2.005
which was less than 0.05 level of significance
and the result was found to be statistical
significant.
 Therefore the researcher concluded that Null
hypothesis H02 was rejected and
researchable hypothesis H2 was accepted.
 It represents that SIM is more effective than
Audio-CD –ROM in improving the self-reported
practices among male blind adolescents.
 In a level of self-reported practices among
female blind adolescents was found
statistically not significant as Z- value was
0.161 and p-value was 0.993 which was
greater than 0.05 level of significance.
Therefore, it was concluded that Null
hypothesis H02 was accepted and research
hypothesis H2 was rejected.
SUPPORTIVE STUDY:
 This finding is in accordance with the
review article written by Shreya
Pareek (2015) highlighted that,
Mahantesh visually impaired faced
difficulties during his academy because
he had faced the difficulties as he had
to depend on the other to study, it
was difficult for him to understand the
lessons from chapters due to lack of
availability of the books in Braille and
audio-format.
 Further, Mahantesh quoted that,
keeping this difficulty in mind he
started a 5000 digital book library and
made the university syllabus available
in audio-format and so these books
can be accessed by the blind students
in their mobile phones in audio-format
also.
DISCUSSION WITH SUPPORTIVE LITERATURE

41. Table No.14 :Correlation between the scores of pre-test knowledge score and
pre-test self-reported practices in male and female adolescents of group-1
Gender correlation(r) Knowledge
with practices
T value p value Inferences
Male 0.057 12.821 0.00001 *Significant
Female 0.229 2.652 0.00046 *Significant
N =112

42. STUDY FINDINGS:
 In male adolescent blind students the
correlation of pre-test knowledge score
with pre-test self-reported practices had
positive correlation and was low degree
of significant.
Whereas, in female adolescent blind
students the correlation of pre-test
knowledge score with pre-test self-
reported practice had positive correlation
and was low degree of significant.
This proves that, the hypothesis H3 is
accepted and H03 is rejected, it means
that, adolescent blind students’
knowledge was poor hence their
practices were also very poor before the
intervention of SIM.
SUPPORTIVE STUDY:
 Dr. Amira A. El-Beih, Dr. Abd El-
Moniem A et al.
 The study findings revealed that 65.7%
of the samples had suffered from
reproductive tract infections, 81.5% of
females had unsatisfactory knowledge
score about the anatomy and
physiology and RTI as well as 93.0% had
unhealthy practice scores on
prevention of RTIs.
 Furthermore, there was a strong
positive correlation between the
students ‘total knowledge score level
and total practice score level
(p<0.0001). The study concluded with
the recommendation of development
of strategies on awareness and
provision of appropriate reproductive
health services for improving the
female adolescent student’s health.
DISCUSSION WITH SUPPORTIVE LITERATURE

43. Table No.15. Correlation between the scores of pre-test knowledge and pre-test
self-reported practices of male and female adolescents in group-2
Gender correlation coefficient
of knowledge wih
practice (r)
t value p value Inferences
Male 0.293 14.125 0.0001 **Highly Significant
Female 0.517 1.382 0.085 Not Significant
N =112

44. STUDY FINDINGS:
Male blind students the correlation of pre-test
knowledge score with pre-test self-reported
practices had positive correlation and was
highly significant to corresponding ‘p’ value
was less than 0.05 level of significance
Whereas, in female adolescent blind students
the correlation of pre-test knowledge score with
pre-test self-reported practices had moderate
correlation and was not significant to
corresponding ‘p’ value was more than 0.05
level of significance.
This proves that the hypothesis H3 was
rejected and H03 was accepted, it means in
male adolescent blind students’ knowledge
was good hence their practices were also
improved and in female adolescents blind
students knowledge was poor hence their
practices were also very poor before
administration of Audio CD-ROM.
SUPPORTIVE STUDY:
 These finding congruent with the
findings of Jeyanthi P.(2018)
finding revealed on the visually
challenged girls that a low positive
correlation (0.24) between pre-
test knowledge scores and pre-test
practice (r= 0.20, r=0.24, r=0.25).
It indicates the significant
similarity between the knowledge
and practice on menstrual hygiene
and management of minor
ailments of menstruation before
and after audio drama.28
DISCUSSION WITH SUPPORTIVE LITERATURE

45. Table No.16:. Correlation between the scores of post-test knowledge and post-test
self-reported practices of male and female in group-1
Gender correlation coefficient (r) t value p value Inferences
Male 0.749 2.886 0.004 *Significant
Female 0.821 3.786 0.001 *Significant
N =112
The above table No.16. findings revealed that in male adolescent blind students
correlation of post-test knowledge score with post-test self-reported practice score
was positive correlation and was significant. Whereas, in female adolescent blind
students correlation of post-test knowledge score with post-test self-reported
practice score showed positive correlation and was significant as to corresponding
‘p’ value was less than 0.05 level of significance in group1.
This proves that the hypothesis H3 is accepted and H03 is rejected. It signifies
that, after administration of SIM the both male and female adolescent blind
students’ knowledge was increased and their practices were also improved
proportionally.

46. Table No.17:. Correlation between the scores of post-test knowledge and post-test
self-reported practices of male and female in group-2
Gender correlation coefficient (r) t value p value Inferences
Male 0.249 28.986 0.0001 * Highly Significant
Female 0.196 13.443 0.001 **Significant
N =112
In male adolescent blind students correlation of post-test knowledge score with
post-test self-reported practice score had positive correlation and was highly
significant
In female adolescent blind students for post-test knowledge score with post-test
self-reported practice score showed positive correlation and was significant.
This proves that the hypothesis H3 is accepted and H03 is rejected.
So it was observed that the post test knowledge was increased hence their
practices were also improved after the administration of Audio-CD-ROM.

47. Table No-18 Analysis on association of the pre-test knowledge score with gender
in a group -1 and group-2
PRE-
INTERVENTION
LEVEL OF KNOWLEDGE chi square
χ2
p-value
at 0.05
Inferences
POOR AVERAGE GOOD Total
Self Instructional Module ( n=112)
MALE 36 17 3 56
1.0823 0.585
NOT
SIGNIFICANT
% 64.28 30.86 5.36
FEMALE 41 10 5 56
% 33.20 17.85 8.93
TOTAL 77 27 8 112
Audio CD-ROM-( n=112)
MALE 31 24 1 56
0.0371 0.982
NOT
SIGNIFICANT
% 55.36 42.25 1.79
FEMALE 32 23 1 56
% 57.14 41.07 1.79
TOTAL 63 47 2 112
N = 224

48. Table No-18 : Analysis on association of the pre-test scores of self-reported practices with
gender in group-1 and group-2
PRE-
INTERVENTION
LEVEL OF SELF REPORTED
PRACTICES
chi square
χ2
p-value Inferences
UNSATISFACTORY SATISFACTORY Total
Self Instructional Module ( n=112)
MALE 52 4 56
0.1524 0.696
NOT
SIGNIFICANT
% 92.86 7.14
FEMALE 53 3 56
% 94.64 5.36
TOTAL 105 7 112
Audio CD ROM ( n=112)
MALE 44 12 56
2.383 0.122
NOT
SIGNIFICANT
% 78.57 21.43
FEMALE 50 6 56
% 89.29 10.7
TOTAL 94 18 112
N = 224

49. STUDY FINDINGS:
 Chi-square was computed and it
was proved that there was no
association of pre-interventional
knowledge and self-reported
practice score with both male and
female blind adolescents in a group
with use of SIM and Audio CD-ROM,
hence the knowledge and self-
reported practices is not
dependent on gender
SUPPORTIVE STUDY:
 The study findings is lined with the
findings of the study reported by
Jeyanthi P. (2018) on the female
blind adolescents, chi-square was
computed and findings revealed
that, no significant association was
found between the levels of
knowledge and practices with
selected demographic variables
and menstrual variables.28
DISCUSSION WITH SUPPORTIVE LITERATURE

50. CONCLUSION
 strengthening and promoting for the reproductive life education under the
content of adolescent reproductive health.
 organized educational material and hard efforts to make the young people
aware about the sexual and reproductive issues.
 The encouraging interpretation drawn by the researcher was that blind
adolescents were not getting proper reproductive health education due to lack
of accessible resources leading to lack of knowledge and scientific information
through proper channel.
 In India, majority of the visually impaired need help of the health planners,
school care-takers, school teachers, parents and NGOs to prepare schemes for
welfare of this vulnerable population.
 The researcher tried hardly to meet the need of the blind adolescents to
broach the subject on reproductive health by preparing the self instructional
module in Marathi Braille script and audio- CD ROM in Marathi language.

51.  The result of the study portrays that,
self instructional module in Marathi
Braille script and audio- CD ROM in
Marathi language were effective to
increase the knowledge and improve
the self-reported practices among the
male and female blind adolescent
students, but the researcher also
observed that,
 the students who received the
information through Audio-CD-ROM was
more effective than in self-
instructional module in Marathi Braille
format due to the voice variations and
clarity in the audio effect enabled the
adolescent blind students to act out
the conversations included in the
audio-CD-ROM and
 also suggested the self-instructional
module needed to implement at
frequent intervals and educational
sessions should be in continue to the
student as they needed the extra time
to read the tactile format.
After taking the overall study
findings into consideration the
researcher suggests that as far as
reproductive health education is
concerned, it would be worth giving
in-depth education to the school
care-taker and school-teachers
also which will help the adolescent
blind students to receive the
scientific information from the
person who is known to them in
order to avoid the sexual issues
rising in this community
and ultimately this teaching
material(SIM and audio-CD-ROM also
help them to grab the scientific
information before they deal with
the adolescent blind students
reproductive issues.

52. IMPLICATIONS:
Nursing practice:
 The study conclusion would give
insight to the hospital based
Midwives, pediatric nurses and
student nurses collectively to play
a vital role in expanding the
adolescents reproductive health
services by using this self-
instructional module in Marathi
Devnagari script and audio-CD
ROM.
 Self-instructional module in
Marathi Devnagari script and audio-
CD ROM can make them available
to all the admitted adolescents
and young adults, with opportunity
for follow up- discussion with their
queries as this method can be
intervened along with their regular
nursing care as supplementary
remedy administered in the clinical
areas.
Nursing Education:
This Self-instructional module and audio-CD-
ROM can be used by the Nurse –educators.
Nurse educators can plan the scientific
sessions for the student nurses as they also
need the information regarding reproductive
health at their level.
The students’ nurses can impart the same
sessions on reproductive health by using the
same teaching material during their clinical
postings, at urban and rural community
health settings and during the school health
programme.
The short term course on adolescent
reproductive health can be started at
collegiate level.
Students should be taught to be insightful
while caring of such vulnerable population.
The finding of the study can be incorporated
while teaching the topic reproductive health.

53.  Nursing Administration:
Adolescent friendly clinic can
be initiated to impart the
education on reproductive
health at the hospital premises
with the help of self-
instructional module and Audio-
CD-ROM. Once the exclusive
instructional programme is
initiated, the director of
Nursing and nursing personnel
has the accountability to train
the nurses as a part of the
continuing nursing education.
Nursing Research:
This research report will be helpful
to the research scholars
(UG/PG/PhD) to get an insight
about the research methodology.
 The recommendations can be used
for the future research projects.
 The findings of the present study
emphasize the importance of
quantitative research methodology
in bringing out the existing
knowledge and practices and the
effect of SIM and Audio-CD-ROM
regarding reproductive health.
IMPLICATIONS

54. STRENGTHS OF THE STUDY:
 The first comparative study conducted to evaluate the effect of self-instructional
module in Marathi Braille script and Audio-CD-ROM regarding reproductive health
among adolescent blind students in Western Maharashtra.
 Evaluated the knowledge and self-reported practices on reproductive health among
the male and female comprised at the age group between 13 and 18 years.
 The Self-instructional module and Audio-CD-ROM resulted in significant improvement
in knowledge and self-reported practices among adolescent blind students.
 The same educational material should be implemented for all the adolescent blind
students in other regions of Maharashtra.
 Developed educational material on reproductive health for the adolescents’ blind
students should be available for health orientation and education in blind schools.
This can be readily made accessible for the references.

55. RECOMMENDATIONS:
 This study may be done in different blind schools of other regions of
Maharashtra as the present study was conducted in onlyWestern Maharashtra.
 Comparative study can be done to evaluate the impact of self instructional
module and audio-CD-ROM among residential and non-residential adolescent
blind students from schools of Maharashtra.
 The study may be replicated using larger population.
 The study may be replicated using samples of only adult blind and findings may
be observed.
 The study may be replicated using samples of school care takers, teachers and
the parents of adolescent blind students and findings may be observed.
 The study may be replicated using samples of adolescent students with normal
sight by using the self-instructional module in Marathi and Audio-CD-ROM
and findings may be observed.

56. Researcher’s Suggestions for improving knowledge and practices related to
reproductive health among blind adolescents:
 Longer interventions may be needed to significantly improve the Knowledge
and practices among this group in all over India by using the same
educational packages in different Braille language and audio-CD ROM
respectively.
 In addition to the findings emphasis that information on reproductive health
along with the healthy hygienic and sanitary practices should be included in
the school curriculum.
 Well-informed scientific information should be delivered continuously to this
vulnerable group.
 Nurse researcher can work as a counselor in residential blind schools to
conduct the sessions on sexual and reproductive health on regular visits.

57.  Web-based internet resources like Social networking sites such as WhatsApp,
Facebook, web pages, blogs, bulletin Newspapers and chartrooms considering the
affordability, availability and accessibility and should maintain the confidentiality on
online resources, so these sources can be used to provide the information on
reproductive health and can be reached to the potentially large number of
participants worldwide
 Touch and tell model or software can be prepared on reproductive health for blind
adolescents.
 Nurse midwives and the pediatric nurses can work together on intradepartmental
research project using different types of educational material for the persons with
disabilities.
 Further study can be conducted on reproductive health by including important aspects
like family planning, marriage and sexual health for adult blind those are working in
blind school workshops
 The study can be integrated in the national health program, but need to easily
accessible, available and reach to the blind society.

58. Personal Experiences of the Researcher-
The attitude of few directors were negative as reproductive health issue was not viewed in a positive way.
Researcher faced difficulties to get the permission from the blind schools. They granted the permission
only after having read the references which were provided prior to seek the permission.
 During the process of research study since personally have undergone many trials and difficulties to make
this study effective and useful for the society hence it is felt need for the researchers to have a good
characteristics like intellectual potentiality to answer the questions and doubts of the blind adolescents,
creative and critical thinking for preparation of SIM in Braille and Audio-CD-ROM on reproductive health.
 Researcher needs to have patience, honesty and sense of humor in handling the physically challenged. It
was novel experience in terms of knowing so closely what these women felt.
 It was emotionally draining, as well as inspiring and it felt wonderful to know how these blind
adolescents who were facing all odds in life and are still going for it.
 These group exhibited strength, a strong will power and represented themselves even though they were
struggling to prove their adulthood.
 Overall it was great and challenging experience as a researcher throughout the study and opportunity to
have intimate relationships with the adolescent blind students.

59. DISSEMINATION AND UTILIZATIONOFTHE FINDINGS-
The two articles were published on the pre-PhD and pilot study
work in UGC approved journals.
Findings of the final study will be published in Scopus and UGC
approved Journal (national and international) after the final Viva voce
presentation and referees approval.
The findings of the study will be disseminated in conference,
conference proceedings and will be disseminated to the blind
communities.
The teaching material i.e. SIM and audio-CD-ROM will be
published in Marathi and English language and Braille in the form of
chapters in book@ copyright.

60. Thank You