|Year : 2017 | Volume
| Issue : 1 | Page : 1-8
Effectiveness of planned educational program on vaginitis and its preventive measures on adolescent female nursing student’s knowledge
Entisar M Youness Ahmed1, Ayat Masoud Omar2
1 Department of Obstetrics & Gynecological Nursing, Faculty of Nursing, Assiut University, Assiut, Egypt
2 Department of Maternity & Neonatal Health Nursing, Faculty of Nursing, Al-Fayoum University, Al-Fayoum, Egypt
|Date of Submission||22-Dec-2016|
|Date of Acceptance||30-Jan-2017|
|Date of Web Publication||13-Jun-2017|
Entisar M Youness Ahmed
Assistant Professor of Obstetrics and Gynecological Department, Department of Obstetrics and Gynecological Nursing, Faculty of Nursing, Assiut University, Assiut
Source of Support: None, Conflict of Interest: None
Reproductive tract infection (RTI) is generally seen as a silent epidemic. It is one of the major public health problems among adolescents that cause a considerable proportion of gynecological morbidity and maternal mortality in the developing countries. Vaginitis is one of the most prevalent infections among RTIs.
The aim of this study was to assess the effectiveness of planned educational program on vaginitis and its preventive measures on adolescent female nursing student’s knowledge.
A quasiexperimental pretest and post-test one-group only design was adopted for this study. The study was conducted at the Faculty of Nursing, Al-Fayoum University. Purposive sampling technique was used on a sample of 208 students. A structured self-administrative questionnaire was used.
The study revealed a highly statistically significant difference as regards total knowledge score level between pretest and post-test scores among students, which indicated an improvement in their knowledge about vaginitis.
The implementation of the planned educational program was effective in improving the knowledge of adolescent female nursing students as regards vaginitis and its preventive measures.
It is recommended that continuous nursing education be organized and implemented by specialized nursing staff to educate students as regards all updates of RTIs and its preventive measures.
Keywords: planned educational program, reproductive tract infections, vaginitis
|How to cite this article:|
Youness Ahmed EM, Omar AM. Effectiveness of planned educational program on vaginitis and its preventive measures on adolescent female nursing student’s knowledge. Egypt Nurs J 2017;14:1-8
|How to cite this URL:|
Youness Ahmed EM, Omar AM. Effectiveness of planned educational program on vaginitis and its preventive measures on adolescent female nursing student’s knowledge. Egypt Nurs J [serial online] 2017 [cited 2019 Aug 19];14:1-8. Available from: http://www.enj.eg.net/text.asp?2017/14/1/1/206938
| Introduction|| |
Adolescence is the period of bloom of life. Adolescent girls form a substantial and vital component of population because they are parents of tomorrow (Donati et al., 2010). In Egypt, adolescents represent around 25% of the country’s population, and represent an even greater proportion of the country’s human potential. Compared with boys, adolescent girls’ health, nutrition, education, and development are more neglected, and this has adverse effects on their reproductive health, especially in developing countries (Center of Disease Control and Prevention CDC, 2009). About 1.2 billion of them need proper education, health, and other life skills to ensure a better future for themselves and their countries. In the developing countries, the incidence and prevalence of RTIs are very high; they ranked as the second cause of morbidities among women of reproductive age, next to maternal morbidity and mortality-related causes (Rabiu et al., 2010).
Reproductive tract infections (RTIs), generally seen as a silent epidemic, is one of the major public health problems causing a considerable proportion of gynecological morbidity and maternal mortality in the developing countries. Vaginitis is considered the most common type of reproductive system infections and refers to any inflammation or infection of the vagina. This is a common gynecological problem found in girls of all ages, with most having at least one form of vaginitis at sometime during their life. Vaginitis can occur when the walls of the vagina become inflamed or some irritant has disturbed the balance of the vagina (Gor, 2015).
According to WHO, the prevalence of vaginitis is 10–25% and is seen among adolescents worldwide. In Egypt, the prevalence of vaginitis is not clearly calculated because of many causes. In addition, the vaginal environment is influenced by a number of different factors, including a female’s health, personal hygiene, medications, hormones (particularly estrogen), and the health of her sexual partner (World Health Organization, 2010). A disturbance in any of these factors can trigger vaginitis (Rani and Bonu, 2003). In this fast moving world, often with fragmentation of countries and cultures, and restless society, the adolescents have to face problems related to sociocultural conditions. Generally, female adolescents with self-reported symptoms of gynecological morbidities do not seek treatment because of existing taboos and inhibitions as regards sexual and reproductive health. They hesitate to discuss the reproductive problem, especially due to shame and embarrassment (Petrova et al., 2015). Preventing RTIs is the most effective way of reducing the adverse consequences. Preventing the spread of RTIs requires that female adolescents at risk of acquiring infection must change their hygienic practices and behaviors. It includes the following: improving knowledge on reproductive physiology, improving menstrual and personal hygiene, reducing the use of harmful substances, improving nutrition, providing appropriate help-seeking behavior, improving health services, and changing sexual behaviors and practices (Salhan, 2011).
As adolescents are often victims of various gynecological morbidities, nurses can take an active part in empowering and educating them to avoid and combat RTIs through improved their awareness and clarify the misconceptions as regards RTIs (Ching, 2014 and Rabieipoor et al., 2015).
Significance of the study
Various studies on women in developing countries have found RTIs prevalence rates ranging from 52 to 92% (Prasad et al., 2005). Female adolescents alone have an estimated incidence of vaginitis of 10–25%. Vaginitis is one of the most prevalent infections among RTIs, especially among adolescents (Ram et al., 2011).
Thus, the researchers found that there is a good chance to study the effectiveness of the educational program among female nursing students, who represent a part of the adolescents in their society, as regards their knowledge about vaginitis. The researchers by implementing this study tried to increase the student’s knowledge about vaginitis and its preventive measures. Nursing students who are educated about vaginal infection and its prevention can educate others on RTI in their community and clinical areas.
| Aim|| |
The aim of this study was to assess the effectiveness of planned educational program about vaginitis and its prevention among adolescent female nursing students.
| Methods|| |
A quasiexperimental pretest and post-test one-group only design was adopted for the study.
The study was conducted at the Faculty of Nursing, Al-Fayoum University.
Purposive sampling of the female nursing students in the second year (N=208) of the faculty of Nursing at Al-Fayoum University who met the inclusion criteria was carried out. The study was conducted from October 2014 to the end of January 2015.
Adolescents in the age group of 18–21 years and not enrolled to a specific medical or nursing gynecological course were included in the study.
Adolescent female students who receive planned educational program on vaginitis will have high knowledge score in post-test than in pretest.
Tools of data collection
A structured self-administrative questionnaire was constructed to assess the student’s knowledge about vaginitis based on a review of the literature. The questionnaire included two sections.
Section 1 included data related to sociodemographic characteristics (age, religion, mother’s educational level, type of family, residence, housing condition, and marital status).
Section 2 consisted of multiple-choice questions to assess the student’s knowledge as regards vaginitis and its prevention (anatomy of the reproductive system, causes, types, diagnosis, complications of vaginitis, and its preventive hygienic measures).
Each correct answer was assigned a score of ‘1’, and a score of ‘0’ was assigned for wrong answer. The maximum score is when the respondents obtain 30 grades, which represents 100% and is categorized into three levels as follows: good knowledge score, ≥75%; average knowledge score, 50–75%; and poor knowledge score, ≤50%.
The content validity of the tool was ensured by reviewing of the tool by five experts in the field of Obstetrics and Gynecological Nursing, Obstetrics and Gynecological Medicine, and Nursing Education.
Before conducting the study, an official permission was obtained from the Dean of the Faculty of Nursing at Al-Fayoum and Assiut Universities. Thereafter, written consent was obtained from each student recruited in the study.
The study was conducted through three phases
Preparatory (program development) phase
The educational program was developed on the basis of the review of related research studies and review of the literature. It was tailored to the identified needs and demands of students in English language. The program was then tested for validity. A pilot study was conducted on 10% of the participant students (20 students) to assess the reliability and applicability of the questionnaire, and accordingly the necessary modifications were carried out. The students of the pilot study were included in the study sample.
The planned educational program was conducted through two sessions per 2 days a week; the session duration was around 2▒h from the beginning of the study. The study was carried out during the period from October 2014 to February 2015. The program covered the following areas: structure and functions of the reproductive system, definition of vaginitis, incidence, predisposing factors, diagnostic measures, complications, and preventive measures of vaginitis.
The participating students (N=208) were divided into seven groups of 30 each. The pretest questionnaire was administered to all participant students before conducting the program. Those who consented to participate in the study were given the self-administered questionnaire along with the instructions for filling it up. The researchers were available all the time to respond to any question or clarifications.
The educational program was implemented for each group, emphasizing on the principles of adult learning and enhancing active participation, interaction, and critical thinking. Different teaching methods were used, such as figures and models, by the researchers, in addition to a booklet given to each student at the end of the session, which was in clear English language and had sufficient information about the topic of vaginitis.
The effectiveness of the program was evaluated immediately after the pretest and after 2 months of implementation of the program using the same self-administered questionnaire administered to 203 students because five students were absent and dropped out from the study.
The study protocol was approved by pertinent research and ethical committees. Informed consent was taken from every student before inclusion in the study. Participants were assured that all data are highly confidential; anonymity was also assured by assigning a code number for each student instead of names to protect their privacy. Data were available only to the researchers and the participants.
The data were coded for entry and analyzed using SPSS Statistical Package for Social Science, USA (version 18.0). Data were presented using descriptive statistics in the form of frequencies and percentages. Interval and ratio variables were presented in the form of mean and SDs, and tested using Student’s t-test. Pearson’s r was used to test correlation. The significance level was chosen as P less than 0.05.
| Results|| |
To fulfill the aim of the current study, the results are presented in the following order.
[Table 1] shows that the mean age of the participant students was 19.2±0.53 years; most of them (98.5 and 69.2%) were living in urban areas with nuclear family. As regards mother’s education, nearly more than half of them (51.4%) had completed their secondary education and 96.6% were housewives. Moreover, the great majority of students (97.5%) were unmarried.
|Table 1: Distribution of studied students as regards sociodemographic characteristics|
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[Table 2] illustrates that there was a statistically significant difference (P<0.001) as regards the mean of pretest and post-test knowledge of the students in relation to the anatomy of the reproductive system, natural defense mechanism of the female genital system, and characteristics of normal vaginal discharge (2.5±1.6 vs. 5.6±0.6). However, the majority of the students who had poor knowledge score on previous items in pretest showed good level of knowledge score in post-test (72.6, 55.3, and 69.2% vs. 99.1, 84.9, and 73.9%, respectively).
|Table 2: Knowledge of the studied students as regards the anatomy of the female reproductive system|
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As regards knowledge of the studied students about vaginitis, [Table 3] shows that more than two-thirds of the studied students had poor score on knowledge related to the predisposing factors, types, symptoms, diagnosis, and complications of vaginitis in pretest (75.5, 100.0, 68.8, 68.8, and 75.5%, respectively). Meanwhile, these percentages changed to be good in after receiving the program (51.0, 72.9, 88.6, 76.9, and 64.7%, respectively) with a highly statistically significant difference (P=0.001).
[Table 4] shows that the mean of post-test knowledge score (8.3±0.8) of the studied students was higher than that of the mean pretest knowledge score (3.5±2.6) in relation to general hygienic measures that prevent vaginitis and conditional hygienic measures (as regards menstrual and sexual relation hygiene). The scores predicted that there was a significant difference between the mean pretest and post-test at P less than 0.001 level.
|Table 4: Knowledge of the studied students as regards preventive hygienic measures of vaginitis|
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In [Table 5], the results illustrate that more than two-thirds of studied students (76.0%) had previously experienced symptoms of vaginitis and only 30.8% of them tried to seek gynecological care; meanwhile, 69.2% of them did not seek gynecological care.
|Table 5: Knowledge of the studied students as regards experiencing condition of vaginitis and seeking gynecological care|
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It is obvious from [Figure 1] that there was a statistically significant difference (P<0.001) as regards the pretest and post-test total knowledge score level among the studied students. Nearly more than two-thirds of them (71.6%) had poor knowledge score related to vaginitis and its preventive measures in pretest. Meanwhile, the great majority of them (93.6%) found that they had good knowledge score in post-test.
|Figure 1: Distribution of the studied students according to their total knowledge score level|
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[Table 6] demonstrates that the majority of the studied students (92.7%) had no previous knowledge as regards vaginitis and its prevention, and the most common source of knowledge reported by those who had previous knowledge about vaginitis (7.3%) was their friends and their family members in 80.0 and 66.6%, respectively.
|Table 6: Distribution of the studied students according to the source of previous knowledge about vaginitis|
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[Table 7] demonstrates that there was a highly statistically significant relation between the studied student’s total score of pretest knowledge as regards vaginitis and its preventive measures with their residence, type of family, and mother’s education (P<0.002, 0.001, and 0.001, respectively).
|Table 7: Relationship between total score of pretest knowledge level and selected sociodemographic characteristics among studied students|
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| Discussion|| |
The first step of any educational plan is the recognition and prioritization of the educational requirements. Educational needs reflect the gap between what an individual knows and what he or she must know and do. The gap may be due to lack of knowledge (Crow and Nelson, 2012). Therefore, through this study, researchers tried to highlight the state of knowledge before and after equipping students and providing them with educational program to help and empower them.
Our present study confirmed that the mean age of studied students was 19.2±0.53 years; more than half of them were living in urban areas with nuclear family. As regards father’s education, nearly one-third of them had secondary education. Meanwhile, more than half of the participants’ mothers had completed their secondary education and were housewives. Moreover, the majority of them were unmarried. In line with these findings, Amira et al. (2012) who studied the health practices among female students at Benha University as regards prevention of RTIs, showed that the mean age of students was 20.1±0.5 years; the majority of them were single, more than half of them were living in rural areas, and half of their mothers had completed only their basic education. Moreover, this result is in agreement with that of Ibrahim et al. (2007), who studied the prevalence of symptoms and complaints of RTI among single female adolescents at El Minia University through an educational intervention. They reported that the majority of female students were single and between 18 and 19 years of age, more than three-quarters of them were from rural areas, and more than one-third of their mothers could not read and write; less than half of them had completed only primary education. In the current study, the mean score of knowledge of the studied students as regards the anatomy of the female reproductive system, natural defense mechanism in the female genital system, and characteristics of normal vaginal discharge reported that there were statistically significant differences (P<0.001). This may be attributed to the insufficient basic information gained from their basic and academic study about these topics. Lack of knowledge in pretest might be attributed to the fact that mothers themselves suffer from lack of information about reproductive problems and may not feel comfortable in discussing such issues. Moreover, this is in accordance with the findings of Chauhan et al. (2014), who studied the effectiveness of planned teaching program about knowledge related to RTIs among rural women and similarly reported the mean pretest and post-test knowledge related to anatomy, physiology of reproductive tract, and types of genital tract infections. Thus, it is interpreted that planned teaching program was effective in increasing the knowledge of women as regards RTIs. This was evident in the study by Amira et al. (2012). As regards students’ knowledge about RTIs, the majority of the studied students had unsatisfactory knowledge score level about RTIs. This finding is supported by Ibrahim et al. (2007), who revealed that most of the students had unsatisfactory knowledge score level about RTIs. Only few students had satisfactory knowledge score level. Moreover, the present study showed that more than two-thirds of studied students had inadequate score of knowledge related to the leading factors, types, symptoms, diagnosis, and complications of vaginitis in pretest. Meanwhile, these percentages improved after receiving the program with statistically significant differences (P=0.001). These results are in partial agreement with those of Renju (2010), who revealed that the majority of the adolescent girls had moderate knowledge, and no one had adequate knowledge in the pretest. However, in the post-test, all (100%) of the adolescent girls had gained adequate knowledge as regards vaginitis and its prevention. This may be due to the variation in the sample size. Knowledge of studied students, either married or unmarried, as regards the preventive hygienic strategies of vaginitis in the present study indicated that the scores predicted the presence of the significant difference between the mean pretest and post-test scores at P less than 0.001 level. Li et al. (2010) studied the knowledge, behaviors, and prevalence of RTIs on rural women as regards reproductive health behaviors; the study consisted of a series of personal hygiene questions related to reproductive health and indicated that only about or less than one-fourth of women in the sample were washing during menstruation, changing their undergarment daily, and washing before and after sexual intercourse, and about half were taking a shower daily.
Another key finding reported in the present study is that more than two-thirds of the students had previously experienced symptoms of vaginitis and only one-third tried to seek medical care. Another study by Sabarwal and Santhya (2012), who studied treatment seeking for symptoms of RTIs among young women, found that the treatment seeking for any RTI infection was poor, whereas three-fifths of women discuss these complaints with husbands/partner, but only a few (more than one-fourth of them) prefer seeking treatment. Correspondingly, the study by Prusty and Unisa (2013), who studied RTIs and treatment-seeking behavior among married female adolescents in India, found that treatment-seeking behavior among female adolescents is poor; only 62% of the adolescents discuss the infections with their husbands/partner, whereas only one out of four of them go for treatment.
As regards total knowledge score level at pretest and post-test, the current study findings reported that more than two-thirds of the studied students had inadequate knowledge related to vaginitis and its preventive measures in pretest. Meanwhile, the great majority of them had adequate knowledge in post-test with a statistically significant difference (P<0.001). Hence, it is interpreted that planned teaching program as regards vaginitis and its preventive strategies was effective in increasing the level of students’ knowledge. Alka et al. (2014) supported the current study results. They found that the mean post-test knowledge score of the women was higher compared with the mean pretest knowledge score. The scores predicted that there was a significant difference between the mean pretest and post-test scores at P less than 0.05 level. Likewise, the findings reported by Yarmohammadi et al. (2015), who studied the effect of education on knowledge, attitude, and practices of patients with vaginitis, indicated a significant increase in the mean score of knowledge, attitude, and practice of patients in the intervention group. The present study reported that the great majority of studied students had no prior knowledge as regards vaginitis and its preventive strategies; only less than one-tenth of them had prior information on vaginitis from their friends and their family members. This finding reflects the importance of the role of the ideal and trusted source of gaining information. In line with these findings, Amira et al. (2012) reported that more than two-fifths of the studied students preferred to consult their mothers, and less than one-third of them mentioned doctors and friends as sources of advice. Sarhan (unpublished thesis) also revealed that more than two-thirds of adolescent girls at Benha City preferred to consult their mothers when having any genital symptoms indicating genital tract infection.
According to the current study findings, there was a highly statistically significant relation between student’s total score of pretest knowledge as regards vaginitis with their residence, type of family, and father’s and mother’s education (P<0.002, 0.001, 0.001, and 0.001, respectively). This is in partial agreement with the findings of Amira et al. (2012), who revealed that there was a highly statistically significant relation between students’ total knowledge score level and their residence and marital status. This can be attributed to lack of awareness in rural areas as compared with the urban areas. These findings are in agreement with the findings of Chauhan et al. (2014), who concluded that the mean pretest knowledge score for age group 15–30 years was higher than the mean for age group 31–45 years. The mean pretest knowledge score for those who had secondary and next grade education was 15.26, which is higher than that for who had primary education. As regards marital status, the mean pretest knowledge score of unmarried adolescents was 16.44, which is higher than for married adolescents. The calculated value is higher than table value. Hence, it is interpreted that there is an association between demographic variables with pretest knowledge score and the impact of program on the level of knowledge of students. However, these findings were incongruent with the findings of Renju (2010), who studied the effect of planned educational program about vaginitis on students’ knowledge and found that there was no association between pretest knowledge score and selected demographic variables.
| Conclusion|| |
On the basis of the findings of the current study, it is concluded that the implementation of planned educational program is effective as a method to improve the knowledge of adolescent nursing students as regards vaginitis and its preventive measures.
Continuous nursing education can be organized and implemented by specialized nursing staff to educate student nurses as regards all updates of RTI and its preventive measures so that nurses can educate others.
Further research studies are needed to investigate and develop strategies to improve factors facing adolescent students to use reproductive health services.
The authors would like to acknowledge the help of our nursing students for their valuable participation. 
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]