Effect of Self-Care Guidelines on Quality of Life, Knowledge and practices among Faculty of Nursing Students with Vaginal Infection

Introduction

The reproductive tract infection (RTI) or genital tract infection (GTI) is a global health problem which affects men, women, families and communities. 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 (1). These infections threat the adolescent’s health and may have severe conse­quences such as infertility, ectopic pregnancy, chronic pel­vic pain, abortion and an increased risk of HIV transmis­sion. Therefore, proper prevention and treatment of this infection are of great importance (2).

Vaginitis is a general term that refers to inflammation of the vaginal wall. Almost 90% of the cases are caused by bacterial vaginosis, candidiasis, and trichomoniasis. Some predisposing factors for vaginitis include hormonal change (pregnancy, contraception, menopause), diabetes, long term using of antibiotics and corticosteroid, frequent douching, tight-fitting nylon pants, obesity; physical activity deficiency; high intake of sugar, carbohydrates, cola, and alcohol; low intake of dairy products; low vitamin C; stress; sleep disorders; and low immune system (3).

Nowadays, considering the importance of the self-care guidelines in health promotion, lifestyle modification, disease preven­tion is very important. Self-care consists of all activities related to disease management, health protec­tion, prevention, and treatment which are conducted by individuals themselves (2). Knowledge and awareness about self-care guideline for vaginitis play crucial role in indi­viduals’ attitude, behavior and practice. Education of healthy practice skills and helping patients to acquire knowledge in order to make them follow self-care behaviors will result in disease prevention which improves their quality of life (4).

World Health Organization Quality Of Life (WHOQOL-BREF) scale includes the following four domains: (1) Physical Health (2) Psychological Health (3) Social relationship (4) Environment. It also contains items about general health. Recurrent vaginal infection may impact negatively on adolescent female’s social, personal and work relationships significantly affecting their quality of life. The primary role of the nurse in managing vaginal infections is to provide health education in order to modify the unhealthy behaviors and to prevent the occurrence as well as recurrence of vaginal infections to improve their quality of life.(5,6)

Studies worldwide involving different levels of society report the highest prevalence of vaginal infection.  According to WHO the prevalence of vaginitis is 10-25%. The frequency of genital infection in the study conducted among the female students at Sakarya University was 13.0% (Sevil S., et al., 2013)(7).  While the prevalence of vaginitis and vaginosis among female students in University of Calabar 70% were infected (J. A. Lennox, et al., 2013)(8). The prevalence of vaginal infection among University female students in Medellín, Colombia was 30.7% (Juan F. Z., et al., 2017)(9). The study conducted among female students of Michael Okpara University of in Nigeria revealed that 74% of  female students had both symptomatic and asymptomatic lower genital tract infection (Udenze C., et al., 2014) (10). In a study conducted among female students of a hostel in the University of Calabar the prevalence of genital infection was 29.4% (E. N. Mbim, et al., 2017) (11).

 In Egypt, a study conducted in Al-Fayoum University revealed that the prevalence of vaginal infection among faculty of nursing students was 76.0% (Youness E.M., et al., 2017) (12).  While the study conducted in Mansoura University revealed that the prevalence of vaginal infection among faculty of nursing students was 53.4% (Khedr N. F., et al., 2015) (13). The study conducted in Ain shams University revealed that the prevalence of vaginal infection among faculty of nursing students was 60.6% (Emam W. M., et al., 2015) (14). While the study conducted in Benha University revealed that the prevalence of vaginal infection among faculty of nursing students was 65.7% (Mohamed H. A., et al., 2013) (15).

So, the primary role of the nurse appears in early detection and early management of vaginal infections, providing health education in order to modify the unhealthy behaviors, and preventing the occurrence as well as recurrence of vaginal infections. (6)

Aim of the study

The current research aimed to evaluate the effect of self-care guidelines on quality of life, knowledge and practices among faculty of nursing students with vaginal infection.

Research Hypothesis

Students who receive self-care guidelines regarding vaginal infection will have higher knowledge, good practices and better quality of life score than before they receive it.

Subjects and Methods

Research Design: Quasi-experimental design (time series) has been utilized in this study.

Setting: The present study was conducted among nursing students in the Faculty of Nursing at El-Minia University.

Sample type: A purposive sample was used,

Sample Size: the actual sample size (214) that was selected from the total number (854) after filling questionnaires (who are suffering from vaginitis). Inclusion Criteria: female students suffer from vaginal infection symptoms and female students willing to participate. Exclusion Criteria:  female students have chronic disease as D.M, cancer, and female students have other infection except vaginal infection and use long term antibiotics.

Tools of the study:

Four tools for data collection were used in the present study:

The First Tool (pretest):

Arabic structured interviewing questionnaire was used that was developed by the researcher based on relevant literature, aim of the study and the data needed to be collected.  It is divided into two parts.

Part (I): It was used to assess socio-demographic characteristic: such as (name, age, academic level, residence, marital status, economic status, mother’s education and telephone no).

Part (II): It was used to assess vaginal infection characteristic: that includes (8) questions MCQ (does she suffer from vaginal infection or not, Signs and symptoms present, what did she do when she suffer from vaginal infection, period of the beginning of vaginal infection symptoms at this episode (days), number of vaginal infection episodes per year, number of visits for treatment from vaginal infection per year, kind of treatment used and barriers to seek gynecologist when exposed to vaginal infection).

The Second Tool: Knowledge Assessment Tool (pre/post):

It is a self-administered assessment tool developed by the researcher after revising relevant literature. It was designed to assess student's knowledge regarding vaginal infection that includes (11) questions MCQ about (definition, causes, types, risk factors, signs and symptoms, complication, management and its prevention). In addition to 2 questions (source of knowledge about vaginal infection and the preferred method to improve the knowledge about vaginal infection). Regarding scoring system: knowledge questions were given scores (2, 1 or zero). It was assigned to each answer representing (good, average, poor) respectively.  Total knowledge score was classified as: poor (˂50%), average (50%-75%), good (> 75%).

The Third Tool:  Practices Assessment Tool (pre/post):

It is a self-administered assessment tool developed by the researcher after revising relevant literature. It was designed to assess student’s self-care practices in dealing with vaginal infection, that includes (21) questions about the practices regarding vaginal infection.  Regarding  practices scoring system, questions were given scores (2, 1 or zero) as it was assigned to each answer. Total practices scores were classified as: unsatisfactory (< 60%) and satisfactory (≥ 60%).

4. The Fourth Tool: Quality Of Life Measuring Scale (pre/post):

World Health Organization Quality Of Life (WHOQOL-BREF): It contains 26 questions, including (2) general questions, and the remaining (24) questions divided into four domains: physical health (Q 3, 4, 10 and 15 to 18), psychological (Q 5, 6, 7, 11, 19 and 26), social relationships (Q 20 to 22), and environment (Q 8, 9, 12 to 14 and 23 to 25). WHOQOL-BREF scores are from 1 to 5 on a response scale. The WHOQOL-BREF scores are calculated according to an algorithm 26 that considers the number of answered questions in each of the domains and standardizes the scores of all domains from zero to 100, with zero being the worst possible health condition and 100 being the best health condition. The algorithm inverts the score values for questions (3, 4, and 26) to calculate the final score (WHO, 1997).

Validity:

The questionnaire was piloted on panel of 5 experts of Obstetrics and gynecological staff, and nursing professors who reviewed the instruments for clarity, relevance, comprehensiveness, understanding, applicability and easiness.

Reliability:

Alpha Cronbach’s test was used to check the stability of the internal consistency of instrument.

Pilot study:

It was carried out on 10% of the total study sample (20 female students). It was conducted to evaluate the applicability and clarity of the tools, assessment of feasibility of fieldwork and to detect any possible obstacles that might face the researcher and interfere with data collection. Necessary modifications were done based on the pilot study findings such as (omission of some questions from tool and adding another) in order to strengthen their contents or for more simplicity and clarity. The pilot sample was included in the main study sample.

Ethical consideration:

All official permissions to carry out the study were secured from pertinent authorities. All students were informed about the importance and aim of this study. Oral consent was obtained from all the participants. All students were informed that their participation is voluntary and their rights to withdraw at any time, and confidentiality of the information obtained. Also, the students were informed that the collected data would be used only for the purpose of the present study, as well as for their benefit.

Procedure:

An official written approval letter clarifying the purpose of the present study was approved from the Dean of the Faculty of Nursing at Minia University, Vice dean of student’s affairs, The head of each department, Ethical committee and Post graduate committee in faculty of nursing as an approval for data collection to conduct this study.

The current study was achieved through three phases: assessment phase (pre-test), implementation phase (conducting education program), follow up and evaluation phase (post-test).

1. Assessment phase (pre-test)

During assessment phase the researcher held the first meeting with each academic level in their faculty during one of their free classes or between lectures to introduce herself and briefly explained the nature and the purpose of the study. They were informed that participation in this study was voluntary and they had the right to withdraw at any time. Oral approval of students to share in this study was achieved.

After obtaining the acceptance from the students to participate in the current study, the researcher provided an overview and clarification about the assessment tools questions to the whole class. Then, the self-administered questionnaire was distributed to each student to assess the data related to socio-demographic data and the presence of vaginal infection symptoms. The questionnaire took about 15 minutes to be completed.

The second meeting was conducted after analysis of the first self-administered questionnaire that was distributed in the first meeting to select only the students who suffer from vaginal infection symptoms. The researcher distributed the pretest questionnaire on the selected students who suffer from vaginal infection to assess their knowledge and their practices as well as their quality of life regarding vaginal infection. It was filled by the students in a time ranged from 20 to 25 minutes to be completed.

2. Implementation phase (conducting education program)

After assessing the students’ knowledge, practices and their quality of life regarding vaginal infection by pretest self-administered questionnaire. The total sample (214) was divided into small groups 8 groups each group ranged from 25-30 students. The total number of educational program sessions was 16 sessions, two sessions for each group (2 days/week), each session was conducted for one hour in the time they are free by organization with the students and with the staff members for each department.

Health education sessions were given to the students in the form of lectures and group discussion by using audio-visual aids, it emphasized on improving student’s knowledge and self-care practices. An additional 15 minutes were assigned at the end of the lecture for an open discussion with the students about this topic and feedback from the students was obtained to ensure that the students got the maximum benefits.

Booklet and brochures containing information about vaginal infection were distributed to students at the end of session. It consists of two parts. The first part includes the anatomy of female reproductive system and its function. The second part is concerned to providing the student with the essential information about vaginal infection (definition, causes, risk factors, common types, signs and symptoms, diagnosis, complication, management and its prevention as well as the healthy practices that reduce the risk of recurrence,……etc). Also, the researcher communicated with students via telephone call for instruction and reinforcement.

3. Follow up and evaluation phase (post-test):

Three evaluations were done for each student. The first one was at the beginning of the study as a baseline data (pre-test). The second evaluation was conducted after one month from the education program. The third evaluation was conducted after three months from the second evaluation in order to detect the effect of self-care guidelines on quality of life, knowledge and practices of students regarding vaginal infection (follow up post-test).

The effect of self-care guideline was done through comparing between the pretest and posttest that were conducted after one month and three months of intervention to assess their knowledge and their practices regarding vaginal infection as well as their quality of life were assessed. The data was collected through a period of 8 months from October 2017 to May 2018. 

Statistical analysis

The collected data were organized; categorized, analyzed using the statistical package for social studies (SPSS). Data were presented using descriptive statistics in the form of frequencies and percentages for qualitative variables, mean and standard deviations for quantitative variables. The statistical test such as chi-square test was to determine relation between qualitative data and r-test was used. Statistical significance difference was considered when p-value ≤ 0.05, and high significance when p-value ≤ 0.001 and no statistical significance difference was considered when p-value > 0.05.

Result

Table (1): Distribution of students’ regarding to their socio-demographic characteristics (n=214).

Table (1):  It illustrates distribution of the studied students regarding to their socio-demographic characteristics. Regarding Students’ age it ranges from 18-22 years old with mean age 19.9 ± 1.1 years. Regarding academic level, more than one third of the students (34.2%) at 2nd academic level. Concerning to residence, more than three quarters of the students (82.7%) were living in rural areas.  Regarding marital status, the majority of the students (94.4 %) were single. As regard motherיּs education, it is obvious that more than one third (39.3%) were illiterate. In relation to socioeconomic status the majority of students (87.4%) had moderate income.

Table (2): Distribution of students regarding to their vaginal infection characteristics (n=214).

Table (2): It shows distribution of the students regarding to vaginal infection characteristics. It was observed that, more than one third of students (41.6 %) suffer from candidiasis. Around two thirds of students (61.7%) the period of their symptoms last less than one week. Regarding to the number of vaginal infection episodes per year, around two thirds of students (63.1%) the symptoms occur three times or more per year. More than half of students (57.0%) not treated. As regard the barriers that prevent female students from seeking gynecologist when exposed to vaginal infection, it was observed that the shyness was the most pronounced barrier (58.0%).

Figure (1): The students’ sources of knowledge about vaginal infection.

Figure (1): Regarding distribution of the students regarding to their sources of knowledge about vaginal infection. It noticed that more than half (59.8 %) of them selected the mother as a source of information about infection.

Table (3): Distribution of students regarding to their total knowledge about vaginal infection pre and post educational program (n= 214).

** Highly statistically significant difference

Table (3): It illustrates distribution of students regarding to their total knowledge about vaginal infection pre and post educational program.  It showed that, there was a significant improvement in total knowledge about vaginal infection among students in post-test as compared to pretest assessment (p<0.0001).

Table (4): Distribution of nursing students’ pre and post one month and after 3 months regarding to their totally practice (n= 214).

** Highly statistically significant difference

Table (4): It illustrates distribution of students’ related to their total practice regarding vaginal infection. It was noticed that, there was a significant improvement in total practice regarding vaginal infection among the students in post-test as compared to pretest assessment (p < 0.0001).

Table (5): Mean and standard deviation of total quality of life scores among students’ pre, post one month and after 3 months (N = 214).

** Highly statistically significant difference

Table (5): It reveals that there is a highly significant difference between the mean score of total quality of life of the students in pretest and post-test after 1 month and 3 month. It showed a significant improvement in of quality of life among students in post-test as compared to pretest assessment (p < 0.001).

Figure (2): Distribution of students regarding their total quality of life scores in pretest and post 1 month and post 3 months.

Table (6): Relation between total knowledge of the students with their total practices; pre and post educational program (n=214).

                     *   Statistically significant difference

                    ** Highly statistically significant difference

Table (6): It illustrates the relation between total knowledge of the students and their total practices. It was observed that there were highly statistical significant relation between total knowledge of the students with their practices, (P value < 0.01).

Table (7): Relation between total knowledge and their total quality of life (mean and standard deviation) among students with their pre and post educational program (n = 214).

                NS = No significant difference             

Table (7): illustrates the relation between total knowledge of the students as regards to their total quality of life. It was observed that there was no statistically significant relation between total knowledge of the students with their total quality of life.

Table (8): Correlation between total quality of life, total knowledge and total practices scores among students pre and post educational program (n = 214).

NS = No significant difference                                ** Correlation is significant at the 0.01 level. 

Table (8): It illustrates the relation between the total quality of life of students with their total knowledge and their total practice. It was observed that there was positive correlation between their quality of life and their practices, pre and post educational program (p value 0.000). While there were no significant correlation between their quality of life and their knowledge, pre and post educational program (p value > 0.01).