KNOWLEDGE AND ATTITUDE REGARDING MENSTRUAL DISORDERS AMONG
UNDERGRADUATE STUDENTS AT SCHOOL OF HEALTH SCIENCES,
UNIVERSITI SAINS MALAYSIA
RABIATUL ATHIRAH RUSMAN 134154
SCHOOL OF HEALTH SCIENCES UNIVERSITI SAINS MALAYSIA
2020
KNOWLEDGE AND ATTITUDE REGARDING MENSTRUAL DISORDERS AMONG
UNDERGRADUATE STUDENTS AT SCHOOL OF HEALTH SCIENCES, UNIVERSITI SAINS
MALAYSIA
BY
RABIATUL ATHIRAH RUSMAN
Dissertation submitted in partial fulfilment of the requirements for the degree of Bachelor of Nursing (Honours)
June 2020
i
CERTIFICATE
This is to certify that the dissertation entitled “Knowledge and Attitude Regarding Menstrual Disorders among Undergraduate Students at School of Health Sciences, Universiti Sains Malaysia” is the bona fide record of research work done by Ms Rabiatul Athirah binti Rusman during the period from September 2019 to August 2020 under my supervision. I have read this dissertation and that in my opinion it conforms to acceptable standards of scholarly presentation and is fully adequate, in scope and quality, as a dissertation to be submitted in partial fulfilment for the degree of Bachelor of Nursing (Honours).
Main supervisor,
………
ASSOC. PROF. DR JAYAH K. PUBALAN Senior Lecturer
School of Health Sciences Universiti Sains Malaysia Health Campus
16150 Kubang Kerian Kelantan
Date: ……….
ii
DECLARATION
I hereby declare that this dissertation is the result of my own investigations, except where otherwise stated and duly acknowledge. I also declare that it has not been previously or concurrently submitted as a whole for any other degrees at Universiti Sains Malaysia or other institution. I grant Universiti Sains Malaysia the right to use the dissertation for teaching, research, and promotional purposes.
………
RABIATUL ATHIRAH BINTI RUSMAN (134154) Bachelor of Nursing (Honours)
School of Health Sciences Universiti Sains Malaysia Health Campus
16150 Kubang Kerian Kelantan
Date: ………
iii
ACKNOWLEDGEMENT
Thanks God for the Blessing who has given me the strength and patience to complete this dissertation successfully. First at all, I would like to express my gratitude to my supervisor, Assoc. Prof. Dr. Jayah K. Pubalan, for her generous guidance, enduring patience, indulgence, understanding, support, thoughtful comments, and encouragement during the preparation of this dissertation.
I would like to extend my appreciation and gratitude to the Dean of the School of Health Sciences who allowed me to carry out this study in this School, to every respondent who have been so nice to me and vender their cooperation during my data collection time. Also, thanks to all my friends for their on-going support and motivation during this challenging and hard times in completing this dissertation especially to my final year project teammates, Ms Suniesa A/P Phian, Ms Celene Cheong and Mr Pugelalaggen A/L Suppramaniam including my bestfriends Mr Najmi Taufiq, Ms Hanis Syafikah Mustakim and Ms Siti Sarah Shueib for their continues emotional support.
Last but not least, warm, and special thanks to my beloved family for their spiritual support to encourage me to complete this dissertation especially my parents, Rusman bin Abd Wahab and Rozita binti Abd Latiff who endured this process with me and gave fully financial support to me. Not forgetting all my beloved siblings, my little brother (Rafiuddin Azim Rusman) sisters (Rabiatul Adilah Rusman, Rabiatul Aisyah Rusman) who gave me the strongest motivation and encouragement to complete this dissertation.
iv
TABLE OF CONTENTS
CERTIFICATE ... i
DECLARATION ... ii
ACKNOWLEDGEMENT ... iii
TABLE OF CONTENTS ... iv
LIST OF TABLES ... viii
LIST OF FIGURES ... ix
LIST OF ABBREVIATION ... x
ABSTRAK ... xi
ABSTRACT ... xii
CHAPTER 1
(
INTRODUCTION) ... 11.1 Background of Study ... 1
1.2 Problem Statement ... 2
1.3 Research Objectives ... 4
1.3.1 General Objective ... 4
1.3.2 Specific Objectives ... 4
1.4 Research Questions ... 5
1.5 Research Hypotheses ... 5
1.6 Conceptual and Operational Definitions ... 6
1.7 Significance of the Study ... 7
CHAPTER 2 (LITERATURE REVIEWS) ... 9
2.1 Introduction ... 9
2.2 Menstrual Disorders ... 9
2.2.2 Knowledge on Menstruation and Menstrual Disorders among Female ... 12
2.2.4 Attitude on Menstruation and Menstrual Disorders among Female ... 13
2.3 Factors Associated with Menstrual Disorders ... 14
2.4 Conceptual Framework ... 14
CHAPTER 3 (RESEARCH METHODOLOGY) ... 19
3.1 Introduction ... 19
3.2 Research Design ... 19
v
3.3 Population and Setting ... 19
3.4 Sampling Plan ... 20
3.4.1 Sample ... 20
3.4.2 Sampling Method ... 21
3.4.3 Sampling size ... 23
3.5 Variables ... 23
3.5.1 Variables Measurement ... 23
3.5.2 Variables scoring ... 24
3.6 Instrumentation ... 25
3.6.1 Instrument ... 25
3.6.2 Validity and Reliability ... 26
3.7 Ethical Issues and Ethical Consideration ... 26
3.7.1 Privacy and confidentiality ... 27
3.7.2 Vulnerability Issue ... 27
3.7.3 Community Sensitivities and Benefits ... 27
3.7.4 Declaration of Interest ... 28
3.7.5 Honorarium and Incentives ... 28
3.8 Data Collection Plan ... 28
3.9 Data Analysis ... 31
CHAPTER 4 (RESULTS) ... 32
4.1 Introduction ... 32
4.2 Socio-Demographic Characteristics ... 32
4.3 Knowledge Level of Undergraduate Students Regarding Menstrual Disorders ... 34
4.4 Attitude Level of Undergraduate Student Regarding Menstrual Disorders ... 37
4.5 Factors associated to Knowledge Level regarding Menstrual Disorders ... 39
4.5.1 Age with Knowledge regarding Menstrual Disorders ... 41
4.5.2 Race with Knowledge Level regarding Menstrual Disorders ... 41
4.5.3 Program of Study with Knowledge Level regarding Menstrual Disorders .... 41
4.5.4 Information Source with Knowledge level regarding Menstrual Disorders .. 42
4.6 Factors associated to Attitude Level regarding Menstrual Disorders ... 43
4.6.1 Age with Attitude Level regarding Menstrual Disorders ... 45
4.6.2 Race with Attitude Level regarding Menstrual Disorders ... 45
4.6.3 Program of Study with Attitude Level regarding Menstrual Disorders ... 45
4.6.4 Information Source with Attitude Level regarding Menstrual Disorders ... 46
vi
CHAPTER 5 (DISSCUSSION) ... 47
5.1 Introduction ... 47
5.2 Knowledge Level Regarding Menstrual Disorders among Undergraduate Students 47 5.3 Attitude Level Regarding Menstrual Disorders among Undergraduate Students .... 48
5.4 Socio-Demographic Factors Associated with Knowledge Level regarding Menstrual Disorders ... 49
5.4.1 Age ... 50
5.4.2 Race ... 50
5.4.3 Programmes of Study ... 51
5.4.4 Information Source Regarding Menstrual Disorders ... 51
5.5 Socio-Demographic Factors Associated with Attitude Level regarding Menstrual Disorders ... 52
5.5.1 Age ... 52
5.5.2 Race ... 53
5.5.3 Programmes of Study ... 53
5.4.4 Information Source Regarding Menstrual Disorders ... 54
5.5 Strengths and Limitations of Study ... 54
CHAPTER 6 (CONCLUSION) ... 56
6.1 Introduction ... 56
6.2 Summary of the Study Findings ... 56
6.3 Implication and Recommendation ... 57
6.3.1 Implication to Nursing Practices ... 57
6.3.2 Implication to Nursing Education ... 57
6.3.3 Recommendation for Further Research ... 58
6.4 Contribution to Theory ... 58
6.4 Conclusion ... 59
REFERENCES ... 60
APPENDICES APPENDIX A ... 65
APPENDIX B ... 69
APPENDIX C ... 70
APPENDIX S ... 74
APPENDIX P ... 75
APPENDIX E ... 76
vii
APPENDIX F ... 77
APPENDIX G ... 78
LAMPIRAN C ... 81
LAMPIRAN P ... 87
viii
LIST OF TABLES
Table 3.1: Total number of Female Undergraduate Students in School of Health
Sciences ... 20 Table 3.2: Table 3.2: The Total Number of Selected Female Undergraduate Students from Different Programmes in School of Health Sciences, USM ... 22 Table 3.3: Independent and Dependent variables ... 24 Table 4.0: Socio-demographic Characteristics ... 32 Table 4.1: Frequency and Percentage of Respondent’s Knowledge on Menstrual
Disorders ... 33 Table 4.2: Frequency and Percentage of Respondent’s Attitude on Menstrual Disorders ... 36 Table 4.3: Association of Selected Socio-demographic Characteristics (Age, Race, Program of Study, Information Source regarding Menstrual Disorders) and Knowledge Level regarding Menstrual Disorders ... 38 Table 4.4: Association of Selected Socio-demographic Characteristics (Age, Race, Program of Study, Information Source regarding Menstrual Disorders) and Attitude Level regarding Menstrual Disorders ... 42
ix
LIST OF FIGURES
Figure 2.1: Theoretical Framework of HBM ... 16 Figure 2.2: Conceptual Framework of Menstrual Disorders Modified from HBM ... 18 Figure 3.1: Flow Chart of Data Collection ... 29 Figure 4.0: Knowledge Level Regarding Menstrual Disorders among Undergraduate Students in School of Health Sciences, USM ... 35 Figure 4.1: Attitude Level Regarding Menstrual Disorders among Undergraduate
Students in School Of Health Sciences, USM ... 37
x
LIST OF ABBREVIATION
PPSK : Pusat Pengajian Sains Kesihatan
PPSP : Pusat Pengajian Sains Perubatan
PPSG : Pusat Pengajian Sains Pergigian
USM : Universiti Sains Malaysia
HBM : Health Belief Model
SPSS : Statistical Package for Social Science
xi
PENGETAHUAN DAN SIKAP TERHADAPAT GANGGUAN HAID DI KALANGAN PELAJAR SARJANA MUDA DI PUSAT PENGAJIAN SAINS
KESIHATAN, UNIVERSITI SAINS MALAYSIA ABSTRAK
Gangguan haid adalah lazim berlaku dalam kalangan golongan muda seperti pelajar sarjana muda. Kurang kesedaran terhadapap gejala dan rawatan awal boleh menyumbang kepada masalah ginekologi. Walaupun pelajar sarjana muda kelihatan sudah biasa mengalami gangguan ini, tahap pengetahuan dan sikap mereka terhadap gangguan ini masih tidak dapat dikenal pasti. Oleh sebab itu, kajian ini bertujuan untuk mengenalpasti tahap pengetahuan dan sikap pelajar sarjana muda di Pusat Pengajian Sains Kesihatan, USM Kampus Kesihatan. Sejumlah 231 orang pelajar sarjana muda, berumur antara 18 hingga 29 tahun daripada lapan program (Audiologi dan Patologi Pertuturan, Bioperubatan, Dietetik dan Pemakanan, Kesihatan Persekitaran dan Pekerjaan, Sains Forensik, Sains Sukan, Sinaran Perubatan, Ijazah dan Diploma Kejururawatan) terlibat di dalam kajian ini. Kajian ini telah dijalankan dengan menggunakan reka bentuk keratan rentas. Data telah diperolehi melalui satu set soal selidik yang diadaptasi dari Nor Asyikin et al. (2016) dan dianalisa menggunakan SPSS versi 24. Ujian Pearson Chi-Square telah digunakan untuk mengenalpasti faktor yang berkaitan dengan tahap pengetahuan dan sikap pelajar. Kebanyakkan responden kajian ini mempunyai tahap pengetahuan yang baik mengenai gangguan haid (n=202, 87.4%). Diantara empat faktor yang mempengaruhi, hanya Program Pengajian didapati signifikan dengan tahap pengetahuan mengenai gangguan haid (p = 0.002). Selain daripada itu, kebanyakkan pelajar universiti mempunyai tahap sikap yang rendah terhadap gangguan haid (n= 158, 68.4%). Di antara empat faktor yang sama juga, hanya Program Pengajian didapati signifikan dengan tahap sikap pelajar mengenai gangguan haid (p = 0.001). Penemuan ini menunjukkan keperluan untuk meningkatkan tahap kesedaran dan menambah baik tahap pengetahuan dan sikap berkenaan gangguan haid dalam kalangan pelajar universiti sebagai langkah pencegahan masalah ginekologi di masa hadapan.
Kata Kunci: Gangguan Haid, Tahap Pengetahuan, Tahap Sikap, Pelajar Sarjana Muda
xii
KNOWLEDGE AND ATTITUDE REGARDING MENSTRUAL DISORDERS AMONG UNDERGRADUATE STUDENTS AT SCHOOL OF HEALTH
SCIENCES, UNIVERSITI SAINS MALAYSIA ABSTRACT
Menstrual disorders are very common among young adults like undergraduate students.
Lack of awareness towards the symptoms and early treatment can lead to another gynaecology diseases. It seems that the female undergraduate students used to experience this disorder however it is unsure that their knowledge and attitude towards the symptoms that they experienced were good or poor. Thus, this study aimed to assess the knowledge and attitude level regarding menstrual disorders among undergraduate students at School of Health Sciences, USM Health Campus. Total of 231 undergraduate students, aged between 18 to 29 years old from the eight programmes (Audiology and Speech Pathology, Biomedicine, Dietetic and Nutrition, Environmental and Occupational Health, Forensic Science, Sport Science, Medical Radiation, Degree Nursing and Diploma Nursing) involved in this study. A cross-sectional study design was employed. Data was collected through a set of questionnaires adapted from Nor Asyikin et al. (2016) and analysed using SPSS version 24. Pearson Chi-Square Test was used to identify the association between socio-demographic characteristics with knowledge and attitude level. The majority of the respondents in this study had good knowledge level regarding menstrual disorders (n=202, 87.4%). Among the four factors, only Program of Study was found significant association with knowledge level regarding menstrual disorders (p= 0.002). On the other hand, most of the undergraduate students had poor attitude level regarding menstrual disorders (n=
158, 68.4%). Among the four factors also, only Program of Study was found significant association with attitude level regarding attitude (p = 0.001). These findings revealed that there was a need to increase university students’ awareness and improve their knowledge and attitude level regarding menstrual disorders among undergraduate students as a preventive measure for further gynaecology problems.
Keywords: Menstrual Disorders, Knowledge Level, Attitude Level, Undergraduate Students
1 CHAPTER 1 INTRODUCTION
1.1 Background of Study
Menstruation is a natural phenomenon that involving the discharge of blood from the uterus through the vagina that occur at more or less regular monthly intervals during the reproductive life of females that begins during adolescence (Rafique & Al-Sheikh, 2018). According to World Health Organization (2019), adolescence is defined as the age between 10 and 19 years old whereby significant physical, physiological, and psychological changes can be seen including menstruation. Serious gynaecological pathology may be rare in this age group, but menstrual disturbances are common and can add further disruption to this reproductive maturation phase for these adolescences and their families (Sivadasan et al., 2014).
According to Nor Asyikin et al. (2016) have revealed high prevalence in menstrual disorders among teenagers and young women in Malaysia. Common menstrual disorders reported were 96% in premenstrual syndrome followed by 94% having dysmenorrhoea, 47% experienced heavy bleeding and 18% for irregular bleeding, oligomenorrhoea and amenorrhoea. Sultan and Sahu (2017) also reported that around 52%
of adolescent Indian girls complain of dysmenorrhoea while 14% has irregular menses, 22% have backache and 10% excessive bleeding and only 2% complains of breast pain or tenderness. While in Italy, Rigon et al. (2012) stated that 3% of the girls having polymenorrhagia, 3.4% experiences oligomenorrhea, 56% from the girls reported having abdominal pain due to menstruation and about 6.2% of the girls were suffering from dysmenorrhea. These revealed that there was common pattern of menstrual disorders that
2
affected young women across many countries and frequent menstrual disorders reported during adolescence is dysmenorrhea and followed by premenstrual syndrome.
These menstrual disorders can be seen as an earlier symptom for another diseases for example hormonal imbalances, structural abnormalities in the uterus, thyroid problems, blood clotting disorders, liver, or kidney disease, or ectopic pregnancy (Healthy Women, 2019). These diseases can be treated and avoided by gaining adequate knowledge regarding menstrual disorders. According to Arlinghaus and Johnston, (2018) knowledge is not enough to change behaviour or attitudes but it is important because it is critical to explain to the person why behavioural changes need to be made. Thus, this explain the importance of knowledge and attitude in preventing further complication due to menstrual disorders.
1.2 Problem Statement
Menstrual disorders are one of the major problems that women all around the world may encounter. Menstrual disorders are generally perceived as secondary health concerns and it is a reason for increasing 1% of gynaecological visit (Sivadasan et al., 2014). It can be seen that awareness on menstruation disorder still in shallow among women society especially in adolescent girls where there only seek for medical intervention when the disorder already become a chronic health problem. According to Esimai and Esan (2010), awareness on menstrual disorder was poor where only 29%
from the student alert with the menstrual disorder and only few of them decided to seek help for menstrual abnormalities.
3
Sultan and Sahu (2017) reported that most of the adolescent girls had incomplete and accurate information regarding menstruation as they found that most of the girls (41%) did not know the source of menstrual bleeding. The girls mostly gain information regarding menstruation only from mother (70%) which same with results obtained by Koujan et al. (2017), Santina et al. (2013), Karout et al. (2012) and Omidyar and Begum (2010). Hence, inaccurate information can affect their perception and belief towards menstrual disorders. Negative perception towards menstrual disorder can lead to negative attitude and practices. This is very worrisome because negative practice such as improper menstrual hygiene can induce to other health concern. Dasgupta and Sarkar (2008) found that the attitude towards menstruation depends on how much the information, knowledge, and level of awareness an individual acquired. This situation may cause the girls to become ignorance with their disorder and in the long term may place them at risk for more serious gynaecology diseases.
Menstrual disorders do have economic consequences in terms of health care cost due to consumption of expensive medication and laboratory tests. As well as these can give impact on their normal functioning and social life as menstrual disorder are responsible for changes in physical, behavioural, and emotional of women during menstruation. There can be other consequences such as limitation on attendance at work and school absenteeism among female adolescents which can influences academic achievements and employment prospects (Karout et al., 2012)
The researcher experiences with friends and colleagues regarding menstrual disorders also give some ideas to conduct this study. According to researcher’s observation, some of friends do have experience with menstrual disorders but mostly treat it as common pain that they have to gone through in each menstrual cycle. Some of them also does not know the important of remembering and knowing their menstruation cycle.
4
The most significant experience that inspired the researcher is the death of closed relative due to her lack of awareness in seeking early medical treatment for her menstrual disorders that resulting to final stage cervical cancer.
Through this study, the knowledge and attitude level regarding menstrual disorder were assessed among female undergraduate students in School of Health Sciences, Universiti Sains Malaysia Health Campus.
1.3 Research Objectives
1.3.1 General Objective
To assess the knowledge and attitude level regarding menstrual disorders among undergraduate students at School of Health Sciences, USM Health Campus.
1.3.2 Specific Objectives
1) To identify the knowledge level regarding menstrual disorder among undergraduate students at School of Health Sciences, USM Health Campus.
2) To identify the attitude level regarding menstrual disorder among undergraduate students at School of Health Sciences, USM Health Campus.
3) To determine the association between selected demographic data (age, race, program of study and information source regarding menstruation and menstrual disorders) with knowledge level regarding menstrual disorders among undergraduate students at School of Health Sciences, USM Health Campus.
4) To determine the association between selected demographic data (age, race, program of study and information source regarding menstruation and menstrual disorders) with attitude level regarding menstrual disorders among undergraduate students at School of Health Sciences, USM Health Campus.
5 1.4 Research Questions
1) What is the knowledge level regarding menstrual disorder among undergraduate students at School of Health Sciences, USM Health Campus?
2) What is the attitude level regarding menstrual disorder among undergraduate students at School of Health Sciences, USM Health Campus?
3) Is there is any association between selected demographic data (age, race, program of study and information source regarding menstruation and menstrual disorders) with the knowledge level regarding menstrual disorder among undergraduate students at School of Health Sciences, USM Health Campus?
4) Is there is any association between selected demographic data (age, race, program of study and information source regarding menstruation and menstrual disorders) with the knowledge level regarding menstrual disorder among undergraduate students at School of Health Sciences, USM Health Campus?
1.5 Research Hypotheses
Hypothesis 1 Hо: There is no significant association between selected demographic data (age, race, program of study and information source regarding menstruation and menstrual disorders) with the knowledge level regarding menstrual disorder among undergraduate students at School of Health Sciences, USM Health Campus
Hᴀ: There is a significant association between selected demographic data (age, race, program of study and information source regarding menstruation and menstrual disorders) with the knowledge level regarding menstrual disorder among undergraduate students at School of Health Sciences, USM Health Campus
6 1.6 Conceptual and Operational Definitions
Knowledge
Knowledge is defines as facts, information, and skills acquired through experiences or education; the theoretical or practical understanding of a subject.
Knowledge also refers to awareness or familiarity gained by experience of a fact or situation (Oxford Dictionary, 2019). In this study, female student’s understanding and knowledge regarding menstrual disorders have been assessed in the section B (Knowledge) of the questionnaires
Attitude
According to Psychology Dictionary (2013), attitude is an enduring and general evaluation or cognitive schema relating to an object, person, group, issue, or concept.
Strength and valence can be vary. Thus, an attitude can be negative or positive. This can Hypothesis 2 Hо: There is no significant association between selected
demographic data (age, race, program of study and information source regarding menstruation and menstrual disorders) with the attitude level regarding menstrual disorder among undergraduate students at School of Health Sciences, USM Health Campus
Hᴀ: There is a significant association between selected demographic data (age, race, program of study and information source regarding menstruation and menstrual disorders) with the attitude level regarding menstrual disorder among undergraduate students at School of Health Sciences, USM Health Campus
7
also refer to any subjective belief or evaluation associated with an object. In this study, female student’s attitude towards menstrual disorders will be determined in the section C (Attitude) of the questionnaires.
Menstrual Disorders
Menstrual disorders are the discomfort that women experiences during menstruating which affected by several factors depending on the health, lifestyle, economic status and etc. of the person. It also affecting women’s monthly menstrual cycle (Naveed et al., 2013). In this study, menstrual disorders will be referring to poly or oligomenorrhea, amenorrhea, menorrhagia, dysmenorrhea, and premenstrual syndrome.
Undergraduate Students
An Undergraduate student is defined as a university student who has not received a first degree (Cambridge University Press, 2019). In this study, the undergraduate students only include the female gender from School of Health Sciences, Universiti Sains Malaysia.
1.7 Significance of the Study
This study provided the information on the knowledge and attitude level regarding menstrual disorders among undergraduate female students in School of Health Sciences, Universiti Sains Malaysia. The information gained can help in improving awareness and alertness regarding women menstruation cycle among female students at School of Health Sciences, USM. Thus, improving the quality of life when the women have proper information regarding menstruation and society start to see women in a more accurate
8
light and respect menstruation as an essential human process nor a subject of shame or nervous laugh.
It is hoped also that the findings will assist the needs for health education especially for the female adolescent who just experiences menstruation in order to prevent, reduce the effect of menstrual diseases and encourage them to seek early treatment or suitable intervention if there any abnormalities present. Menstrual disorders still be considered as sensitive issue to be openly discussed especially in certain culture that associate menstruation with mystical phenomenon which closely related with taboo. By advancement in knowledge regarding menstrual disorders, it is hope that the society able to change this stereotype on menstrual disorders through the health education and awareness programme plan in future.
9
CHAPTER 2
LITERATURE REVIEWS
2.1 Introduction
This chapter reviewed the current literature related to menstruation and menstrual disorders in terms of knowledge, attitude, and menstrual disorders. The literature search was done by using main keywords menstrual disorders including knowledge and attitude on menstruation and menstrual disorders. This chapter also discussed the theoretical framework that was used in this study.
2.2 Menstrual Disorders
They are four types of menstrual disorders according to their menstrual characteristics. Type 1 is menstrual disorders of intensity where it deals with the intensity of menstruation including poly and oligo menorrhea. Type 2 is called as disorders of frequency where it considers the frequency menstruation and includes also poly and oligo menorrhea. Type 3 is the disorder of duration which considers the duration of menstruation that includes amenorrhea and menorrhagia while Type 4 is disorders of pain which includes dysmenorrhea and premenstrual syndrome (Koujan et al., 2017).
Polymenorrhea is a term used to describe a menstrual cycle that is shorter than 21 days compared to normal menstrual cycle which is between 24 to 38 days long (Healthline, 2018). Oligomenorrhea refers to menstrual periods that occur more than 35 days. It usually is not a cause of concern, except if periods occur less 3 months apart (Naveed et al., 2013).
10
Amenorrhea may be primary or secondary. Primary amenorrhea is defined as the failure to reach the menarche where there is no pubertal development by 13 years of age and five years after breast development or if the patient is 15 years or older. Secondary amenorrhea is the interruption in normal regular menses for three months until six months (Klein & Poth, 2013). Secondary amenorrhea is more common than primary amenorrhea according to Naveed et al. (2013). However, secondary amenorrhea mostly causes by pathological reasons which can be attributed to polycystic ovary syndrome , hypothalamic amenorrhea, hyperprolactinemia, or primary ovarian insufficiency (Klein & Poth, 2013)
Menorrhagia is menstrual bleeding that more than 8-10 days with loss of blood over 80 ml per cycle (Naveed et al., 2013). Menorrhagia could vary from irregular bleeding to heavy menstrual bleeding which interferes with the women’s physical, emotional, social, financial, and material quality of life (Bhatiyani et al., 2017).
Dysmenorrhea also can be primary and secondary. Primary dysmenorrhea is defined as painful menses in women with normal pelvic anatomy that usually begins during adolescence (French, 2005). Symptoms shown including crampy lower abdominal and pelvic pain that radiates to thighs and back without associated pelvic pathology (Naveed et al., 2013). Secondary dysmenorrhea is result of an existent pelvic discomfort and it begins several years after the menarche and the pain last more during menstruation (Botell & Bermudez, 2012). It frequently associated with pelvic pathology such as uterine fibroids, endometriosis and pelvic inflammatory (Naveed et al., 2013).
Premenstrual syndrome used to affect millions of women between ages of 25 and 35 years old during their reproductive years. It characterized by emotional and physical symptoms that consistently occur during the luteal phase of the menstrual cycle (Dickerson et al., 2003). Steiner and Born, (2000) claimed that more than 200 symptoms
11
have been associated with premenstrual syndrome, but irritability, tension, and dysphoria are the most prominent and consistently described.
Among these menstrual disorders, dysmenorrhea was relatively common among the female followed by premenstrual syndrome. A cross-sectional school survey on menstruation among adolescent girls in Malaysia by Lee et al. (2006) reported that 68 % from 2411 female participants having dysmenorrhea supported by Abdelmoty et al., (2015) where 93% from sample of 402 respondents also suffer from dysmenorrhea. This result however was at variance with Houstan et al. (2006) as the study suggesting that premenstrual syndromes are the most prevalent menstrual disorders. Premenstrual syndrome also closely related with dysmenorrhea as adolescent girls commonly complain of premenstrual syndrome when they actually experiencing dysmenorrhea or psychosocial problems (McEvoy et al., 2004).
Menstrual patterns are also influenced by a number of host and environmental factors (Rowland et al., 2002). Behavioural risk factors such as smoking, alcohol consumption, attempts to lose weight and physical activities may increase the prevalence for menstrual disorders especially smoking. Smoking seemed to increase the prevalence of menorrhagia and irregular cycle. It also shown there is an association between smoking, short cycle length and irregular cycles according to Lee et al. (2006). Other factors associated with menstrual disorders include attempts to lose weight as there is an association between menstrual disorders especially PMS with increasing body mass index (BMI) according to Lee et al, (2006). However, the association between being overweight and menstrual dysfunction is still inconsistence. Another potentially modifiable risk factors toward menstrual disorders is mental health problems including depression, anxiety, and disruption of social network (Rowland et al., 2002).
12
2.2.2 Knowledge on Menstruation and Menstrual Disorders among Female
Menstruation is a normal physiological process in the female reproductive life that signifies a transition from girlhood to womanhood. However, this transitional period is accompanied by a change in the physical, psychological, and social aspects of a women’s life reflecting the culture, beliefs, and menstrual-related misconception of their societies.
Thus, correct knowledge is very important for the women to adequately prepare themselves and prevent reproductive ill-health ( Koujan et al., 2017).
In regard of knowledge on menstruation and menstrual disorders, it is still low level in both men and women, however, women knowing more that the men. This can be happened because the women experiences the menstruation itself compared to men (Nor Asyikin et al., 2016). Study by Abdelmoty et al. (2015) in Egypt revealed that women knowledge regarding menstruation is also incomplete as 91% from the female respondent in the study stating that menstruation has a “cleansing” effect ridding the body from “dirt”
while only approximately 9% correctly know about the source and function of menstruation. Incomplete knowledge among women may be happened as they only seek the information from their mother/sisters or they guessed about menstruation without consulting other peoples (Fehintola et al., 2017).
Seeking information from the mother is a good thing as the mother is more experienced and the connection of mother-daughter relationship can improve the effectiveness of learning but if the information provided were incorrect and no adequate enough for the daughter, the inadequate knowledge of mother was passed on to these young girls (Sultan & Sahu, 2017). However, the findings from Abdelmoty et al. (2015) and Fehintola et al. (2017) were in contrast from Olowokere et al. (2014) and Titilayo et al. (2009) studies that done in Nigeria where they reported that majority of the female
13
respondents had a good knowledge about menstrual disorders and discomfort associated with it. Differences in knowledge level reported by these studies may influenced by location of the study as menstrual practice and belief may be differences in certain culture and country.
2.2.4 Attitude on Menstruation and Menstrual Disorders among Female
Women’s attitude towards menstruation are mixed, with positive and negative feelings and they different from culture to culture (Amaral et al., 2005). In a cross- sectional study on menstrual patterns and disorders among secondary school adolescents in Egypt, they suggested that the attitude towards menstrual disorders were shaped by largely negative cultural belief and influenced by a variety of factors such as genetic characters, environmental conditions, family demography, nutritional and health status.
Half of the participants also decline in participate due to cultural menstrual taboos giving a response rate of 51.5% which is considerably low compared to other studies (Abdelmoty et al., 2015).
Some of the women still did not perceive the menstruation as natural process and considered menstruation and menstrual disorders that they encountered as a personal matter and feel uncomfortable in discussing it with other people which may produce confusion and a sense of inadequacy leading to negative attitude. They also did not anticipate the onset of menstruation as they felt that menstruation was bothersome, something that they did not like, and it was to be feared ( Koujan et al., 2017). However, proportion of good attitude among women was good compared to the men according to Nor Asyikin et al., (2016). This is similar to a study conducted in New Delhi, India to examine the knowledge and attitude of men and women for menarche and menstruation, where more number of women had positive attitude towards menstruation (Kumar, 2016).
14
2.3 Factors Associated with Menstrual Disorders
There are several factors associated with menstrual disorders as reported in the literature. This includes lifestyle characteristics, body mass index (BMI), smoking, stress level, dietary habits, socio-demographic characteristics, and family history.(Rafique &
Al-Sheikh, 2018; Bae, Park, & Kwon, 2018). Bhatiyani et al. (2017) highlighted the lack of awareness on these factors associated with menstrual disorders was a significant association with the prevalence of menstrual disorders. For the purpose of this study however, the researcher only focusing on sources of previous information regarding menstrual disorder and selected socio-demographic characteristics (age, race, program of study). While all the other factors will be excluded from this proposed study due to time and finances constrain.
2.4 Conceptual Framework
This study utilized the health belief model (HBM) as the conceptual framework.
According to Champion and Skinner (2008), the HBM was developed in the 1950s by a group of United State Public Health Service social psychologists: Hochbaum, Rosenstock and Kegels. It has been used to explain how changes and maintenance of health-related behaviours guides health behaviour interventions.
This theoretical framework is one of the longest established theoretical models that were designed to explain health behaviour by better understanding people’s beliefs about health (Nutbeam & Harris, 2002). According to Abraham and Sheeran (2005), beliefs provide a crucial link between socialization and behaviour. Beliefs are modifiable and can differentiate between individuals from the same background. If persuasive techniques can be used to change behaviour-related beliefs and such interventions result
15
in behaviour change, this provides a theoretical and practical basis for evidence-based health education.
HBM consists of four components that predict the actions of a person. The components include perceived susceptibility to the problem, perceived seriousness of consequences of problems, perceived benefits of specific action and perceived barriers to acting as shown (Champion & Skinner, 2008). Perceived susceptibility refers to the likelihood of getting a disease or condition. Thus, the HBM predicts that individuals who perceive that they are susceptible to a disease will engage in behaviours that would help reduce the risk of developing the disease. Second component of perceived severity where the HBM also suggests that the more serious that individuals perceive a health problem is, the more likely they will engage in behaviours to prevent is from occurring or reduce its severity. Third component of HBM which is perceived benefits, the HBM proposes that the more benefits that individuals perceive that a particular action will have regarding a perceived threat, the more likely they will engage in that behaviour regardless of objective facts regarding the effectiveness of the action. The last component of HBM perceived barriers where it suggests that the perceived benefits must outweigh the perceived barriers in order for behaviour change to occur (Champion & Skinner, 2008)
16
As mentioned earlier, HBM used in this study help to guide the researcher to understand the undergraduate student’s knowledge and attitude regarding menstrual disorders. Refer to Figure 2.2 for the conceptual framework of menstrual disorders modified from HBM.
Based on this model, the researcher assumed that undergraduate students need to alert that they were at risk for menstrual disorders. They should also know these menstrual disorders may lead to any gynaecology problems. By perceived susceptibility towards menstrual disorders, they will more employ in behaviours to prevent likeliness to get menstrual disorders or to reduce the severity. They perceived benefits of learning by producing positive attitude and perception on menstrual disorders for example seeking early treatment and be more open up in discussing menstrual related problem between male and female students. Comfort and motivation can be provided more accurately as both sides understand well how the disorders occurred. The benefits that the researcher
Figure 2.1: Theoretical Framework of HBM (Adapted from Champion & Skinner, 2008)
17
assume the undergraduates obtain will out weight the perceived barriers in behaviour change. All these components will lead to behaviour change as the students self-efficacy increase and they believe themselves with the knowledge they gain can lead to positive attitude toward menstrual disorders.
18
Every undergraduate student employed in changing
behaviours
• Gain adequate knowledge regarding menstrual disorders
• Have good
understanding regarding menstrual disorders
• Removed all the negative perception on menstrual disorders
by disorders Benefits gained by
changing behaviours
• Practiced positive perception on menstrual disorders
• Apply the knowledge on menstrual disorders
• Practiced good attitude on menstrual disorders
Perceived threat
Outcome expectations
Self-efficacy (Perceived
ability to carry out recommende
d action) Every undergraduate student
knows their demographic data can affect their roles on
preventing and treat menstrual disorders
syndrome
Overcome barrier on menstrual disorders
• Lack of awareness on menstrual disorders
• Afraid in medical intervention regarding menstrual disorders
• Not open up in discussing regarding menstrual disorders
Figure 2.2: Conceptual Framework of Menstrual Disorders Modified from HBM
19 CHAPTER 3
RESEARCH METHODOLOGY
3.1 Introduction
In this chapter, all the information about the study in terms of research design, the population and setting of the study, the sampling method, variables, instrumentation, ethical consideration, data collection plan including data analysis plan were discussed.
3.2 Research Design
This study applied descriptive study using quantitative approach to assess the knowledge and attitude level regarding menstrual disorders among undergraduate students in School of Health Sciences, Universiti Sains Malaysia through a cross sectional survey. The data collected from the entire population and basic statistics such as frequency, percentage, mean, standard deviation and distribution score were reported.
Cross-sectional studies were characterized by the collection of relevant data at a given point in time. Therefore, there was no time dimension involved in cross-sectional studies, as all these data were collected and mostly referred to the time at or around the time of the data collection (Kesmodel, 2018).
3.3 Population and Setting
There are three different school in USM Health Campus which are School of Health Sciences, School of Medical Sciences and School of Dental Sciences. This study however only included female undergraduate students from School of Health Sciences because it has a greater number of undergraduate students (1040 students) as compared to other two schools; PPSP (691 students) and PPSG (262 students) (PPSG Academic Office; PPSP Academic Office, PPSK Academic Office, 2019). Table 3.1 below shows
20
the total number of females undergraduate students based on programmes in School of Health Sciences, USM.
Table 3.1: The Total Number of Female Undergraduate Students from Different Programmes in School of Health Sciences, USM.
Gender Programs
Female Undergraduate
Students
Audiology and Speech Pathology 62
Biomedicine 77
Dietetic and Nutrition 176
Medical Radiation 87
Environment and Occupational Health 90
Forensic Sciences 80
Sport Sciences 56
Degree Nursing and Diploma Nursing 246
TOTAL 874
3.4 Sampling Plan
3.4.1 Sample
The sample obtained by following the inclusion and exclusion criteria as below:
Inclusion criteria
1) Undergraduate students from the eight programmes at School of Health Sciences (Audiology and Speech Pathology, Biomedicine, Dietetic and Nutrition,
21
Environmental and Occupational Health, Forensic Science, Sport Science, Medical Radiation, Degree Nursing and Diploma Nursing)
2) Age range from 19-30 years old 3) Female that already achieved menarche Exclusion criteria
1) Undergraduate students from School of Medical Sciences and School of Dental Sciences in Health Campus, USM
2) Undergraduate School of Health Sciences students that undergoing industrial training outside the campus.
3.4.2 Sampling Method
This study applied simple random sampling method to select the suitable respondents. Simple random sampling is a part of the sampling techniques in which each sample has an equal probability of being chosen and meant to be an unbiased representation of the total population (The Economic Times, 2014). Simple random sampling also considered as convenience and fair way to select a sample from a larger population since every member of the population has an equal chance of getting selected (Investopedia, 2019). The name lists of undergraduate female students of PPSK according to each programme were obtained. From the name lists, those in odd number were selected as the respondents. Table 3.2 below shows the number of selected female undergraduate students according to each programme in PPSK.
22
Table 3.2: The Total Number of Selected Female Undergraduate Students from Different Programmes in School of Health Sciences, USM
Gender Programs
Selected Female Undergraduate
Students
Audiology and Speech Pathology 31
Biomedicine 38
Dietetic and Nutrition 35
Medical Radiation 33
Environment and Occupational Health 33
Forensic Sciences 33
Sport Sciences 28
Degree Nursing and Diploma Nursing 37
TOTAL 268
Initially, the sample here were the undergraduate students from School of PPSK in Health Campus, Universiti Sains Malaysia that suit the inclusion criteria. Timetables of eight programmes in School of PPSK were obtained from each class representative.
Selected respondents from the name list according to the courses were approached after end of their class. Information regarding the study were explained and consent were obtained. Then, a set of questionnaires were passed to the selected students who were voluntary participating. They were asked to complete the questionnaires and submit it to the researcher after completing the questionnaires within 15 to 20 minutes.
23 3.4.3 Sampling size
The overall population of the undergraduate students in School of Health Sciences was 1040 students where there were 874 of female students. This number was too large and may be costly, energy and time consuming. Thus, the calculation was done using Raosoft Sample Size Calculator (APPENDIX S). Margin error was set at 5% and confidence interval was set at 95% and the sample size obtained was 268 students and 10% from the sample size were added as drop-out. Thus, the target samples involved in this study:
268 + drop out of 10% = 268 + 26.8
= 294.8
= 295 samples
3.5 Variables
3.5.1 Variables Measurement
There were two types of variables that used in his study which were independent and dependent variables. The independent variable was the variable that is believed to affect the dependent variable, but cannot be affected by dependent variable (Kowalczyk, 2015).
The variables were shown in the Table 3.2 below:
24 Table 3.3: Independent and Dependent Variables
Variables Criteria
Independent • Socio-demographic - Age
- Race
- Program of study
- Information source regarding menstruation and menstrual disorders
Dependent • Knowledge level regarding menstrual disorders
• Attitude level regarding menstrual disorders
3.5.2 Variables scoring
In Section A, information on socio-demographic characteristics were assessed through question number 1 to number 4. The respondent’s knowledge level regarding menstrual disorders were assessed in Section B with 15 items questions. Three point Likert scale (Correct/Incorrect/Not Sure) were used as the response were scored as ‘1’ for
‘correct’ response and ‘0’ for ‘incorrect’ and ‘not sure’ response. Reversed scoring was done for negative knowledge items. The score for knowledge level were categorised into good and poor knowledge using the agreed cut-off point of 53%. Respondents with score percentage below the cut-off point were considered to have poor. This cut-off point was based on consensus of the expert’s opinion on the previous study by Nor Asyikin et al.
(2016)
In Section C, the respondents’ attitude level regarding menstrual disorders were assessed with 8 questions. Attitude component used 5-Likert scale response (Strongly agree/Agree/Neutral/Disagree/Strongly disagree). For the positive attitude item, scores of
‘4’, ‘3’, ‘2’, ‘1’ and ‘0’ for ‘strongly agree’. ‘Agree’, ‘neutral’, ‘disagree’, and ‘strongly
25
disagree’. Respondents who answered ‘agree’ and ‘strongly agree’ for positive item and
‘disagree’ or ‘strongly disagree’ for negative items was considered as having positive attitude. The scoring was reversed for negative attitude items. However, in this study, there was no extreme answer. Thus, for analysis response of similar direction were combined (strongly agree/agree as agree, neutral as neutral, disagree/strongly disagree as disagree). The total score was transformed into percentages by dividing the score with the possible maximum score and multiplied by 100. For the attitude score, according to the previous study by Nor Asyikin et al. (2016), experts agreed to decide 80% as the cut-off point as good attitude.
3.6 Instrumentation
In this study, the data were collected through a set of self-administered questionnaires, which were the questions adapted from Nor Asyikin et al. (2016)
3.6.1 Instrument
The questionnaire was divided into three main section: Section A, Section B and Section C
Section A: Socio-demographic Data
The socio-demographic data were obtained from the respondents including age, race, courses, and information source regarding menstruation.
Section B: Knowledge on menstrual disorders
The knowledge on menstrual disorders among undergraduate students at School of Health Sciences, USM were obtained through 15 items questions.
26
Section C: Attitude regarding menstrual disorders
In this section, 8 items questions were used to assess the attitude level regarding menstrual disorder among undergraduate students at School of Health Sciences, USM.
3.6.2 Validity and Reliability
The questionnaire in Section B and Section C, the attitude items had been validated in previous study in North-eastern state of Peninsular Malaysia by group of experts consisting of an obstetric and gynaecologist, two family medicine specialists, a medical statistician expert in questionnaire development and validation. The Cronbach’s alpha was used to verify the face and content validity of the questionnaire. The coefficients obtained for the knowledge component ranged from 0.708 to 0.895 while for the attitude component, coefficients ranged from 0.600 to 0.824. Hence, it was a valid questionnaire to be used in this study.
As this study were conducted on different population compared to previous study by Nor Asyikin et al., (2016), a pilot study already being carried on 10% of the sample from the respondent that fulfilled the inclusion criteria of the study. The Cronbach’s alpha obtained for knowledge items was 0.705 while for attitude items was 0.748 for this population of study. The respondent who already participated in the pilot study were excluded from main study because of the experienced gained by respondents in pilot study may bias the results of the main study.
3.7 Ethical Issues and Ethical Consideration
Ethical approval from the USM Research Ethical Committee (Human) were obtained. The permission for collecting data of undergraduate students already gained from the Dean of the School of Health Sciences. Permission to used adapted questionnaire
27
already obtained from the original authors by Nor Asyikin et al. (2016). Verbal and written explanation about the purpose of the study were given to each respondent.
Furthermore, their rights to discontinue from the study were honestly explained to them.
3.7.1 Privacy and confidentiality
Respondents were informed that all the information gained from the questionnaire were keep confidential, anonymous, and used for academic and research purposes only.
It will not be publicly disclosed unless it was required by law. Only members of the research team, the Ethics Board of this study and the regulatory authorities have accessed to such information for the purpose of verifying clinical study procedures or data. All personal information was stored on computer and processed with it. This information were also be presented as group data and were not identify respondents individually 3.7.2 Vulnerability Issue
Involvement in this study was voluntary and they were able to give their own consent. Respondents had the full authority to drop out from the study at any time, without penalty or loss of benefit. This study was unlikely to pose any physical or biological threat to the respondents. If the result from this study suggest that the respondents having low level of score from the questionnaires, the result will be keep confidential. Intervention such as health campaign or seminar regarding menstrual disorders were suggested to improve the respondent’s knowledge and attitude regarding menstrual disorders.
3.7.3 Community Sensitivities and Benefits
Since this study concern sensitive issues and experiences, it may generate uncomfortable situations during answering the questionnaire. Respondents were assured on the importance of the study for the benefits of the community and health care providers
28
in providing current data and help in managing such taboo issues as well improving people perceptions on women health. Respondents received the correct information on menstrual disorders and assisted in creating better understanding about menstrual disorders after participating in this study. This can help respondents improve their knowledge and attitude regarding menstrual disorders.
3.7.4 Declaration of Interest
This study had no conflict of interest involved as this study was voluntary conducted by the researcher and no payment or money involved. As this study only involved one researcher, thus no misunderstanding occurred during this study.
3.7.5 Honorarium and Incentives
Small token of appreciation was given to the respondents as well as brochure/pamphlet on knowledge about menstrual disorders.
3.8 Data Collection Plan
Data of this study were collected after getting an approval from the Research Ethical Committee (Human) and the permission from the Dean School of Health Sciences.
Suitable respondents were identified according to the name list and contacted.
Appointment were made with them after class. Met up after the class were scheduled according courses. Written and verbal consent were given to them. Agreement to participate in this study were obtained by asking the respondents to sign the consent form.
Questionnaires were distributed after the respondents signed the consent forms. It took about 15 to 20 minutes for each respondent to complete the questionnaire.
29
Duration of respondents’ involvement included from the day the researcher made the appointment until when the respondents hand out their answered questionnaires.
Appointment were made a day before the met up. The study and consent were explained by the researcher in 5 minutes and the respondents answered the questionnaire in 15 to 20 minutes. After answering the questionnaires, token of appreciation was given and extra knowledge regarding menstrual disorders were delivered to them in 5 minutes. In a conclusion, duration of respondents’ involvement is around one day and 30 minutes.
30
Inclusion criteria
Suitable respondents were approached, and purpose of the study were explained
Disagree
Survey questionnaire were distributed and completed approximately within 15 to 20 minutes (n= 268)
Approval application were obtained from the USM Ethical Committee (Human)
Permission were granted by the Dean School of Health Sciences
Potential respondents were identified Exclusion criteria
Agree
Data were analysed
Gather all completed survey questionnaires Verbal & written consent
were attained
Figure 3.1 Flow Chart of Data Collection Reported the findings
31 3.9 Data Analysis
The Statistical Package for Social Science (SPSS) software, version 24 for Windows were used to process all the date gathered. Descriptive statistical were used to describe knowledge level and attitude level regarding menstrual disorders among undergraduate students at School of Health Sciences, USM. Frequency and percentage (%) were used to describe each categorical variable (Age, Race, Programme of Study, Information, and Source regarding Menstrual Disorders).
The descriptive statistical analysis was used to find the mean and standard deviation of the total score of the items in Section B. For objective 1 and 2, the frequency (f) and percentage (%) were used for each categorical knowledge and attitude items while for objective 3 and 4, Pearson Chi Square test was used to analyse data related to these objectives. The significance level was set at α = 0.05 and 95% of confidence interval were applied in this study.
32 CHAPTER 4
RESULTS
4.1 Introduction
This chapter presents the findings of the study which explored the knowledge and attitude level regarding menstrual disorders among undergraduate students in School of Health Sciences, USM. The knowledge and attitude level regarding menstrual disorders among undergraduate students were measured using the self- administered questionnaires adapted from Nor Asyikin et al. (2016). Altogether, 231 students from 268 targeted students participated and the response rate was 86%.
4.2 Socio-Demographic Characteristics
Table 4.0 shows respondents’ age which were from 18 to 29 years old. The majority of respondents were from 21 to 23 years old (n= 136, 58.9%). Malay was the highest ethnicity among the respondents (n= 186, 80.5%). Most of the respondents were from Dietetic and Nutrition program of study (n= 35, 15.2%). The mass media and school were chosen as the main information source regarding menstruation and menstrual disorders (n=157, 68%).
33
Table 4.0: Frequency and Percentage of Socio-demographic Characteristics (n=231)
Variables Frequency (%)
Age 18-20 79 (34.2) 21-23
24-29
136 (58.9) 16 (6.90) Race
Malay 186 (80.5)
China 27 (11.7)
Indian 13 (5.60)
Others: 5 (2.20)
Program of Study
Audiology and Speech Pathology 32 (13.9)
Degree and Diploma Nursing 34 (14.7)
Dietetic and Nutrition 35 (15.2)
Biomedicine 31 (13.4)
Sport Sciences 32 (13.9)
Environment Health 24 (10.4)
Sciences Forensic 28 (12.1)
Information source regarding menstruation and menstrual disorders
Mother Yes: 153 (66.2)
No: 78 (33.8)
Friends Yes: 131 (56.7)
No: 100 (43.3)
Journal Yes: 36 (15.6)
No: 195 (84.4)
Mass Media Yes: 157 (68.0)
No: 74 (32.0)
School Yes: 157 (68.0)
No: 74 (32.0)
Health Professional Yes: 96 (41.6)
No: 135 (58.4)
34
4.3 Knowledge Level of Undergraduate Students Regarding Menstrual Disorders
Respondent’s knowledge level regarding menstrual disorders was identified by the total score from 15 items as below:
No. Questions Female
Correct Incorrect Mean Std. Deviation F (%) F (%)
1 Average age of menarche is 12 years oldª
187 (81.0) 44 (19.0) 1.22 0.472
2 Normal length of menstrual cycle is 28 daysª
194 (84.0) 37 (16.0) 1.27 0.652
Secondary sexual characteristics includes:
3 Breast developmentª 227 (98.3) 4 (1.70) 1.02 0.173
4 Axillary hair growthª 209 (90.5) 22 (9.50) 1.12 0.399
5 First menstruationª 187 (81.0) 44 (19) 1.22 0.472
6 Pubic hair growthª 215 (93.1) 16 (6.9) 1.08 0.299
Normal menstrual blood characteristics includes:
7 Dark red blood 202 (87.4) 29 (12.6) 1.17 0.489
8 Smelly bloodᵇ 100 (43.2) 131 (56.7) 1.62 0.787
Knowledge on Symptoms of menstrual disorders PMS (Premenstrual Syndrome)
9 PMS lasted few days after menstruationª
84 (36.4) 147 (63.6) 1.99 0.847
10 Tension gives rise to PMSª
168 (72.7) 63 (27.3) 1.31 0.532
11 PMS symptoms
includes:
a) Stressª 208 (90.0) 23 (10.0) 1.12 0.372
b) Palpitationsª 101 (43.7) 130 (56.3) 1.62 0.599
c) Insomniaª 91 (39.4) 140 (60.6) 1.78 0.715
d) Fatigueª 209 (90.5) 22 (9.50) 1.11 0.375
e) Anxiousª 155 (67.1) 76 (32.9) 1.44 0.688
f) Forgetfulᵇ 179 (77.5) 52 (22.5) 2.09 0.729
g) Headachesª 176 (76.2) 55 (23.8) 1.32 0.620
Table 4.1: Frequency and Percentage of Respondent’s Knowledge on Menstrual Disorders (n = 231)
35 Table 4.1: continued
No. Questions Female
Correct F (%)
Incorrect F (%)
Mean Std.
deviation Dysmenorrhea
12 Dysmenorrhea symptoms includes
a) Lower abdominal painª
206 (89.2) 25 (10.8) 1.12 0.348
b) Felt during first day of
menstruationª
176 (76.2) 55 (23.8) 1.28 0.539
13 Causes of dysmenorrhea
a) Fibroidª 95 (41.1) 136 (58.9) 1.66 0.603
b) Uterine Cancerª 41 (17.7) 190 (82.3) 1.98 0.586 c) Cervical Cancerª 51 (22.1) 180 (77.9) 1.93 0.603 d) Endometriosisª 96 (41.6) 135 (58.4) 1.61 0.554 14 Causes of amenorrhoea
a) Obesityª 129 (55.8) 102 (44.2) 1.58 0.729
b) Brain cancerª 16 (6.90) 215 (93.1) 2.31 0.594 c) Hormonal
imbalanceª
208 (90.0) 23 (10.0) 1.10 0.300
d) Imperforated hymenª
61 (26.4) 170 (73.6) 1.83 0.571
e) Chromosome abnormalityª
97 (42.0) 134 (58.0) 1.68 0.653
15 Causes of
oligomenorrhoea
a) Hypothyroidismª 84 (36.4) 147 (63.6) 1.66 0.526 b) PCOS (Polycystic
Ovarian Syndrome) ª
133 (57.6) 98 (42.4) 1.43 0.514
c) Birth control pillsª 171 (74.0) 60 (26.0) 1.28 0.497
36
The descriptive analysis was used to identify the frequency (f) and percentage (%) of the respondents in each category. The score for knowledge level were categorised into good and poor knowledge using the agreed cut-off point of 53% after the total score been converted into percentage (Nor Asyikin et al., 2016). The result showed that most of the undergraduate students had good knowledge level regarding menstrual disorders (n=202, 87.4%) while the others had poor level regarding menstrual disorders (n=29, 12.6%).
Figure 4.0 below shows the knowledge level regarding menstrual disorders among undergraduate students in School of Health Sciences, USM.
Figure 4.0: Knowledge Level regarding Menstrual Disorders among Undergraduate Students in School of Health Sciences, USM (n=231)
87.40%
12.60%
Knowledge Level Regarding Menstrual Disorders (n=231)
Good Knowledge Poor Knowledge
