Anshu Thesis Updated
Anshu Thesis Updated
Anshu Thesis Updated
By
MS. ANSHU
Dissertation submitted to
Pt. B. D. Sharma University of Health Science, Rohtak, Haryana
i
DECLARATION BY THE CANDIDATE
I, Ms. Anshu, MSc. Nursing Final year student hereby declare that this
dissertation/thesis entitled “A comparative study to assess the effectiveness of
pranayam on quality of life and blood pressure among menopausal women of
selected community area of Bhiwani” is a bonafied and genuine research work
carried out by me under the guidance of Mr. Vikas Choudhary, Dept. of
Community Health Nursing, Sisar Khas, Meham, Rohtak, Haryana.
ii
iii
CERTIFICATE BY THE GUIDE AND CO-GUIDE
iv
ENDORSEMENT BY THE PRINCIPAL/HEAD OF THE
INSTITUTION
Ms. Om Devi
Principal
Satya College of Nursing
Sisar Khas, Meham, Rohtak, Haryana
v
ACKNOWLEDGEMENT
The Essence of all beautiful art, all Great art, is gratitude. Gratitude can never
be expressed in words but this is only deep perception, which makes the words to
flow from one’s inner heart.
The Success of this study would not have been possible without the help
guidance and contributions of some of the teacher well-wisher and other and the
investigator wishes to thank them all.
It gives me great pleasure to thank with deep sense of gratitude and respect to
my Guide Mr. Vikas Choudhary, and Co- Guide Ms. Seema, Dept. of
Community Health Nursing, Satya College of Nursing, Sisar Khas, Meham,
Rohtak, Haryana,for the guidelines, encouragement and co-operation for the
completion of this study.
My Sincere thanks to All Experts for doing the translation of the tool and for
editing this thesis.
vi
I am grateful to the Administrator of Satya College of Nursing, Sisar Khas,
Meham, Rohtak, Haryana,for permitting me to conduct the study.
I extend my deepest gratitude to all the experts who have contributed with
their valuable suggestions in validating the tool.
My Sincere thanks to all the Participants who formed the core and base of
this study for their whole hearted co-operation.
Ms. Anshu
vii
ABSTRACT
viii
0.902 which was not statistically significant at p=0.375 level. Thus the research
hypothesis stated that there is a significant relationship between Pranayama on
selected menopausal symptoms among menopausal women was accepted.
Therefore Nurse Midwife must continue to pranayama among menopausal women to
bring the positive outcome.
ix
TABLEOFCONTENTS
Operational definition 7
Assumptions Delimitations 8
Projected outcome 8
Summary 8
23 – 28
III RESEARCH METHODOLOGY
Research Approach Research Design 23
Variables under the study 24
Research Setting 25
Population 25
Sample 25
Sample size 25
Sampling Technique 25
Criteria for Sample selection 25
10
Reliability of the Tool 27
Ethical consideration 27
Pilot study 27
Data Collection Procedure 27
Data Analysis Procedure 28
V DISCUSSION 62 – 67
VII REFERENCE 72 – 77
ANNEXURES 78 – 102
11
LISTOFTABLES
TABLENO. TITLE PAGENO.
12
LIST OF FIGURES
13
Percentage distribution of pre and posttest level of
14 50
headache in Experimental and control group.
14
LIST OF ABBREVIATIONS
MC : Menstrual Cycle
BP : Blood Pressure
15
Chapter I
Introduction
1
CHAPTER –I
INTRODUCTION
Pranayama is the yogic practice of focusing on breath. In Sanskrit, prana means "vital
life force", and yama means to gain control. In yoga, breath is associated with the
prana, thus, pranayama is a means to elevate the prana shakti, or life energies.
Pranayama is described in Hindu texts like the Bhagavad Gita and the Yoga Sutras of
Patanjali. Later in Hatha yoga texts, it meant the complete suspension of breathing.
Macdonell gives the etymology as prana (prāṇa), breath, + āyāma and defines it as the
suspension of breath.[1]
Pranayama is the fourth "limb" of the eight limbs of Ashtanga Yoga mentioned in
2
verse 2.29 in the Yoga Sutras of Patanjali.[8][9] Patanjali, a Hindu Rishi, discusses
his specific approach to pranayama in verses 2.49 through 2.51, and devotes verses
2.52 and 2.53 to explaining the benefits of the practice.[10] Patanjali does not fully
elucidate the nature of prana, and the theory and practice of pranayama seem to have
undergone significant development after him.[11]. He presents pranayama as
essentially an exercise that is preliminary to concentration.
Yoga teachers including B. K. S. Iyengar have advised that pranayama should be part
of an overall practice that includes the other limbs of Patanjali's Raja Yoga teachings,
especially Yama, Niyama, and Asana.[12]
Hatha yoga
The Indian tradition of Hatha Yoga makes use of various pranayama techniques. The
15th century Hatha Yoga Pradipika is a key text of this tradition and includes various
forms of pranayama such as Kumbhaka breath retention and various body locks
(Bandha).[13] Other forms of pranayama breathing include Ujjayi breath ("Victorious
Breath"), Sitali (breathing through the rolled tongue),[14] Bhastrika ("Bellows
Breath"), Kapalabhati ("Skull-shining Breath", a Shatkarma purification),[15] Surya
Bhedana ("Sun-piercing Breath"),[16] and the soothing Bhramari (buzzing like a
bee).[17] B. K. S. Iyengar cautions that pranayama should only be undertaken when
one has a firmly established yoga practice and then only under the guidance of an
experienced Guru.[12]
Yoga as exercise
The yoga scholar Andrea Jain states that pranayama was "marginal to the most widely
cited sources" before the 20th century, and that the breathing practices were
"dramatically" unlike the modern ones; she writes that while pranayama in modern
yoga as exercise consists of synchronising the breath with movements (between
3
asanas), in texts like the Bhagavad Gita and the Yoga Sutras of Patanjali, pranayama
meant "complete cessation of breathing", for which she cites Bronkhorst 2007.[20]
[21]
Buddhism
According to the Pali Buddhist Canon, the Buddha prior to his enlightenment
practiced a meditative technique which involved pressing the palate with the tongue
and forcibly attempting to restrain the breath. This is described as both extremely
painful and not conducive to enlightenment.[22] In some Buddhist teachings or
metaphors, breathing is said to stop with the fourth jhana, though this is a side-effect
of the technique and does not come about as the result of purposeful effort.[23]
The Buddha did incorporate moderate modulation of the length of breath as part of
the preliminary tetrad in the Anapanasati Sutta. Its use there is preparation for
concentration. According to commentarial literature, this is appropriate for beginners.
[24]
Indo-Tibetan tradition
Benefits
Pranayama, the practice of controlled breathing, can be found as a part of many types
of yogas. This practice is believed to help encourage relaxation and improve
breathing. Although limited in nature, research studies on a small group of subjects
indicate pranayama to have a positive impact on lung function and lung parameter as
4
an adjunctive treatment.[29] Long term and large scale studies would be needed in
order to validate the research and confirm the effects of pranayama and reach global
acceptance.[30]
Effectiveness
Risks
Although relatively safe, Hatha Yoga is not risk free. Beginners should avoid
advanced moves and exercise within their capabilities. Functional limitations should
be taken into consideration.[36] According to at least one study, pranayama was the
yoga practice leading to most injuries, with four injuries in a study of 76 practitioners.
There have been limited reports of adverse effects including haematoma and
pneumothorax, though the connections are not always well established.[36]
MENOPAUSE
Menopause, also known as the climacteric, is the time in women's lives when
menstrual periods stop permanently, and they are no longer able to bear children.[37]
Menopause usually occurs between the age of 48 and 52.[38] Medical professionals
often define menopause as having occurred when a woman has not had any menstrual
bleeding for a year.[39] It may also be defined by a decrease in hormone production
by the ovaries.[40] In those who have had surgery to remove their uterus but still have
ovaries, menopause may be considered to have occurred at the time of the surgery or
when their hormone levels fell. Following the removal of the uterus, symptoms
typically occur earlier, at an average of 45 years of age.[41]
In the years before menopause, a woman's periods typically become irregular,[42, 43]
which means that periods may be longer or shorter in duration or be lighter or heavier
in the amount of flow. During this time, women often experience hot flashes; these
5
typically last from 30 seconds to ten minutes and may be associated with shivering,
sweating, and reddening of the skin. Hot flashes can last from four to five years.
Other symptoms may include vaginal dryness, trouble sleeping, and mood changes.
The severity of symptoms varies between women. While menopause is often thought
to be linked to an increase in heart disease, this primarily occurs due to increasing age
and does not have a direct relationship with menopause. In some women, problems
that were present like endometriosis or painful periods will improve after menopause.
Menopause is usually a natural change. It can occur earlier in those who smoke
tobacco. [44] Other causes include surgery that removes both ovaries or some types
of chemotherapy. At the physiological level, menopause happens because of a
decrease in the ovaries' production of the hormones estrogen and progesterone. While
typically not needed, a diagnosis of menopause can be confirmed by measuring
hormone levels in the blood or urine. [45] Menopause is the opposite of menarche,
the time when a girl's periods start. [46]
6
STATEMENTOFTHEPROBLEM
OBJECTIVES
RESEARCH HYPOTHESIS
OPERATIONAL DEFINITIONS
Outcome
The process of inhale and exhale the breath through right nose by closing the
left nose, repeat the same for left nose by closing the right nose and these
can be repeated for 10 to 15 times twice a day for 4 weeks in morning and
evening before food.
7
Menopausal Women
ASSUMPTIONS
1. Menopausal women may experience some menopausal symptoms.
DELIMITATIONS
PROJECTEDOUTCOME
CONCEPTUAL FRAMEWORK
The conceptual frame work and the model for the present study is based on
Weidenbach’s helping art of clinical nursing theory [1964]. It describes a desired
situation and a way to attain it. It directs action towards the implicit goal. This
theory consist of three factors central purpose, prescription, and realities. A nurse
develops a prescription based on central purpose and implements it according to
the realities of the situation.
8
1. Central purpose is the model refers to what to accomplish. It is the overall
goal towards which a nurse strives. It transcends the immediate intent of
the assignment or basic by specifically directing towards the patient good.
2. Prescription refers to the plan of care for a patient. It specifies the nature
of action that will fulfill the nurse’s central purpose and the rationale of
the action
1. Agent
2. Recipient.
3. Goal
4. Means
5. Framework.
9
that will fulfill the central purpose (reduce the level of menopausal symptoms) by
identifying the various means to achieve the goal. Thus the investigator selected
two groups where pranayama is provided for one group and mass health
education was given for the other group after the study.
a) Agent-investigator
b) Recipient-menopausal women
d) Means-pranayama.
e) Environment–home/community setting.
10
FIGURE: 1 Shows MODIFIED WEIDENBACH’S HELPING ART OF
CLINICAL NURSING THEORY (1964)
11
SUMMARY
This chapter consists of introduction, background, significance and need for the
study, title, statement of the problem, objectives, variables, hypothesis,
operational definition, assumptions delimitations, and projected outcome.
12
Chapter II
Review of Literature
13
CHAPTER - II
REVIEW OF LITERATURE
SECTION–A GENERALINFORMATIONABOUTYOGAANDPRANAYAMA
14
as anxiety, postural balance, migraine, academic performance, and childhood neglect.
Anxiety, stress, and depression were other common denominators. Eight studies were
on cardiorespiratory systems, including exercise capacity, cardiac rehabilitation,
myocardial infarction, and hypertension. Three studies were on diabetes, evaluating
the effect of yoga. Five studies focused on cognition, health status, and autonomic
regulation and few others included cancers, infertility, ulcerative colitis, urinary
incontinence, restless leg syndrome, rheumatoid arthritis, chronic pain, and metabolic
syndrome. Finally, most studies were on non-communicable diseases with one
exception, human immunodeficiency virus; two randomized controlled trials were
dedicated to it. Yoga has been studied under a wide variety of clinicopathological
conditions in the year 2020. This landscape review intends to provide an idea of the
role of yoga in various clinical conditions and its future therapeutic implications. 54
Manisha R. Kadam, Kavita V. Et. Al. (2019), The Objective of this study is
to study the concept of Bhramari Pranayam literally and to understand the effect of
the Bhramari Pranayam. Method:-Literary study has been compiled from Yogic texts
and all relevant books for study of Bharamari Pranayama and Yoga and source of
internet for research papers based on Bhramari Pranayam. Pranayama: -Pranais the
breath of life of all beings in the universe. Pranais usually translated as breath.
Pranayama is a conscious prolongation of inhalation, retention and exhalation. The
Bhramari Pranayamis one of the type of Pranayama. In this Pranayaminhalation and
exhalation through nostrils slowly and deeply takes place. While exhaling, will have
to produce sound (humming sound) like bumble bee strictly through nasal airways. It
is a method of harmonizing the mind and directing awareness inwards. Conclusion:-
The vibration of the humming sound creates a soothing effect on the mind and
nervous system. Bhramari Pranayam is one of the type of Pranayam which relieves
stress and helps in alleviating anger, anxiety and insomnia, increasing the healing
capacity of the body.56
Kumar Sharma Yatendra, Kumar Sharma Sushil, Et. Al. (2018) In the
world of yoga there are ―Eight limbs path‖ which helps in different aspects like
coordination of body and mind and helps to create positivity of mind and help the
body healthy and fit by which the functioning of the body improves. In today‘s
modern life various type of disease and deformity takes place most of the things takes
15
place due to unbalanced food, & other. The mind is always wondering and being
rebellious, never focusing on the moment. It is the mind job to think, it is relentlessly
interpreting everything. That is seen, perceived and experienced and this pattern of
habit goes through change to behavior and attitude. Many people who practice yoga
do so to maintain their health and well-being, improve physical fitness, relieve stress,
and enhance quality of life. In addition, they may be addressing specific health
conditions, such as back pain, neck pain, arthritis, and anxiety. Basically yoga has
been more effective than control and waitlist control conditions, although not always
more effective than treatment comparison groups such as other forms of exercise.
More randomized controlled studies are needed in which yoga is compared to active
exercise groups. Having established the physical and mental health benefits of yoga
makes it ethically questionable to assign participants to inactive control groups.
Shorter sessions should be investigated for cost-effectiveness and for daily practice.53
16
Pallav Sengupta, Et. Al. (2012), Thousands of years ago yoga originated in
India, and in present day and age, an alarming awareness was observed in health and
natural remedies among people by yoga and pranayama which has been proven an
effective method for improving health in addition to prevention and management of
diseases. With increasing scientific research in yoga, its therapeutic aspects are also
being explored. Yoga is reported to reduce stress and anxiety, improves autonomic
functions by triggering neurohormonal mechanisms by the suppression of
sympathetic activity, and even, now-a-days, several reports suggested yoga is
beneficial for physical health of cancer patients. Such global recognition of yoga also
testifies to India's growing cultural influence.52
SECTIONB - STUDIESRELATEDTOMENOPAUSALSYMPTOMS
17
article aims at exploring the commonalities and differences between yoga and
physical exercise in terms of concepts, possible mechanisms and effectiveness for
health benefits. A narrative review is undertaken based on traditional and
contemporary literature for yoga, along with scientific articles available on yoga and
exercise including head-to-head comparative trials with healthy volunteers and
patients with various disease conditions. Physical exercises and the physical
components of yoga practices have several similarities, but also important
differences. Evidence suggests that yoga interventions appear to be equal and/or
superior to exercise in most outcome measures. Emphasis on breath regulation,
mindfulness during practice, and importance given to maintenance of postures are
some of the elements which differentiate yoga practices from physical exercises. 60
Holger Cramer, Carol Krucoff, Et. Al. (2013) While yoga is gaining
increased popularity in North America and Europe, its safety has been questioned in
the lay press. The aim of this systematic review was to assess published case reports
and case series on adverse events associated with yoga. Medline/Pubmed, Scopus,
CAMBase, IndMed and the Cases Database were screened through February 2013;
and 35 case reports and 2 case series reporting a total of 76 cases were included. Ten
cases had medical preconditions, mainly glaucoma and osteopenia. Pranayama, hatha
yoga, and Bikram yoga were the most common yoga practices; headstand, shoulder
stand, lotus position, and forceful breathing were the most common yoga postures and
breathing techniques cited. Twenty-seven adverse events (35.5%) affected the
musculoskeletal system; 14 (18.4%) the nervous system; and 9 (11.8%) the eyes.
Fifteen cases (19.7%) reached full recovery; 9 cases (11.3%) partial recovery; 1 case
(1.3%) no recovery; and 1 case (1.3%) died. As any other physical or mental practice,
yoga should be practiced carefully under the guidance of a qualified instructor.
Beginners should avoid extreme practices such as headstand, lotus position and
forceful breathing. Individuals with medical preconditions should work with their
physician and yoga teacher to appropriately adapt postures; patients with glaucoma
should avoid inversions and patients with compromised bone should avoid forceful
yoga practices.59
Andreas Michalsen, Sat Bir S. Khalsa, Et. Al. (2012) This report
summarizes the current evidence on the effects of yoga interventions on various
18
components of mental and physical health, by focussing on the evidence described in
review articles. Collectively, these reviews suggest a number of areas where yoga
may well be beneficial, but more research is required for virtually all of them to
firmly establish such benefits. The heterogeneity among interventions and conditions
studied has hampered the use of meta-analysis as an appropriate tool for summarizing
the current literature. Nevertheless, there are some meta-analyses which indicate
beneficial effects of yoga interventions, and there are several randomized clinical
trials (RCT’s) of relatively high quality indicating beneficial effects of yoga for pain-
associated disability and mental health. Yoga may well be effective as a supportive
adjunct to mitigate some medical conditions, but not yet a proven stand-alone,
curative treatment. Larger-scale and more rigorous research with higher
methodological quality and adequate control interventions is highly encouraged
because yoga may have potential to be implemented as a beneficial
supportive/adjunct treatment that is relatively cost-effective, may be practiced at least
in part as a self-care behavioral treatment, provides a life-long behavioural skill,
enhances self-efficacy and self-confidence and is often associated with additional
positive side effects.58
19
Menopause-Specific Quality of Life Questionnaire. Occurrence of vasomotor
symptoms was average with 60% of them reporting hot flushes and 47%
sweating. Most prevalent psychosocial symptoms reported were feeling of anxiety
and nervousness (94%) and overall depression (88%). Physical symptoms were
quite varying in occurrence with some symptoms such as feeling tired or worn
out, decrease in physical strength and lack of energy occurring in 93% of the
women to only 5% suffering from growth of facial hair. Overall sexual changes
were reported among 49% who reported of avoiding intimacy with a partner and
26% complained of vaginal dryness. The results support that menopause causes
both physical and psychiatric problems. Education, creating awareness and
providing suitable intervention to improve their QOL are important which should
be imparted to menopausal women at both individual and community level.63
Min-Ju Kim, Juhee Cho, Et. Al. (2014) Physical activity may be an
effective way of preventing or attenuating menopause-related symptoms, and it
has been shown to improve quality of life in menopausal women. However, there
have been some inconsistencies regarding between exercise and menopausal
symptoms, and study investigating this association has been scarce in Korea. In
this study, the association between physical activity and menopausal symptoms in
perimenopausal women in Korea was assessed. This cross-sectional observational
study was conducted between November 2012 and March 2013. In total, 2,204
healthy women aged 44–56 years were recruited from a healthcare center at the
Kangbuk Samsung hospitals for investigating women’s attitudes towards
menopause. To investigate the influence of physical activity on perimenopause-
associated symptoms, 631 perimenopausal women were selected for this study.
Their physical activity levels were assessed using the International Physical
Activity Questionnaire (IPAQ) short form. The Menopause-specific Quality of
Life (MENQOL) questionnaire was used to assess menopause-related
symptoms.61
20
Gayathry Nayak, Asha Kamath, Et. Al. (2014) Perimenopausal period
is characterized by a continuous decline in ovarian function due to which women
are vulnerable to various physical and psychological symptoms affecting their
quality of life. Currently these symptoms are managed by hormone replacement
therapy. However, hormonal therapy can cause complications including
malignancy which has resulted in search for various alternative therapies to
improve the quality of life (QOL). Yoga is one such alternative therapy shown to
enhance the QOL at all stages of human life associated with the chronic illness.
There are very few scientific studies regarding the effect of yoga on
perimenopause and in this study we investigated the effects of yoga therapy on
physical and psychological symptoms using the standardized questionnaire. To
study the effect of yoga therapy on physical, psychological, vasomotor and sexual
symptoms of perimenopause. It is a prospective non-randomized control study of
216 perimenopausal women with 12 weeks of intervention. The subjects were
divided in two groups with either yoga therapy [n = 111] or exercise [n = 105] as
the interventional tool. The symptoms control and QOL before and after
intervention in both the groups were assessed by using the menopausal QOL
questionnaire. The perimenopausal symptoms in all the four domains were
improved by yoga therapy, thus significantly improving the overall QOL
compared to the control group. This study clearly demonstrates the effectiveness
of yoga therapy in managing the distressing perimenopausal symptoms. It is easy,
safe, non-expensive alternative therapy helping the well-being of perimenopausal
women and must be encouraged in the regular management of perimenopausal
symptoms. The study participants were, on average, 48.5 ± 2.7 years old and had
a mean body mass index of 22.8 ± 3.1 kg/m2. The total MENQOL score and the
psychosocial and physical subscores exhibited U-shaped trends in relation to the
level of physical activity. Multiple linear regression analysis adjusted for
confounding variables showed that perimenopausal women who performed
moderate physical activity reported significantly lower psychosocial (β = -0.413,
P = 0.012) and physical symptoms (β = -0.445, P = 0.002) than women who
performed low physical activity. By contrast, a high level of physical activity did
not influence the MENQOL total score and subscores relative to the low activity
group. In addition, no associations were observed between physical activity and
21
the vasomotor and sexual symptoms in any group. Moderate level of physical
activity was associated with reduced psychosocial and physical menopause
symptoms in perimenopausal Korean women. Although these findings must be
confirmed by prospective longitudinal studies, they suggest that physical activity
may improve the symptoms of menopause, thereby increasing quality of life.62
22
Chapter III
Research Methodology
23
CHAPTER – III
RESEARCHMETHODOLOGY
RESEARCHDESIGN
The study designed chosen for the study is quasi experimental research
design. It was represented as
Group Pre test Intervention (pranayama) Post test
assessment assessment
Experimental O1 X O2
Control O1 - O2
VARIABLES
RESEARCHSETTING
24
POPULATION
Target Population:
Accessible Population
SAMPLE
Menopausal women aged between 45-50 years who fulfilled inclusion criteria.
SAMPLESIZE
The sample size comprises of 60 menopausal women who fulfilled the inclusion
criteria.30 samples each in experimental and control group.
SAMPLINGTECHNIQUE
CRITERIAFORSELECTIONOFSAMPLES
Inclusion Criteria
1. The women who were in the age group of 45–50yrs.
Exclusion Criteria
1. Menopausal women with medical disorders such as diabetes Mellitus and
hypertension etc.,
25
3. Women who were not willing to participate.
I. Literature review
DESCRIPTIONOFTHETOOL
Section-B: Modified menopausal rating scale scores between 0-3 which indicates
0= Not experiencing
1= Once in a week
2= 2-3Times in a week
3= Daily experiencing
Scoring key:
0–5 - MILD
6–10 - MODERATE
11–15 - SEVERE
VALIDITYOFTHETOOL
The validity was obtained from nursing experts, yoga professor and gynecologist.
All the correction said by the experts was incorporated into the study.
26
RELIABILITY OF THE TOOL
ETHICAL CONSIDERATION
The study was conducted after the approval of dissertation committee. The
consent was taken from village administrative officer and medical officer before
proceeding with study. menopausal women were explained clearly about the
study purpose and consent from menopausal women was obtained before
intervention. All information about samples was kept confidential.
PILOTSTUDY
Pilot study was conducted from ……… consent was obtained from village
administrative officer before proceeding with study, 6 menopausal women who
fulfilled inclusion criteria were selected and assigned to the experiment and
control group. A brief introduction about self and study were explained. Consent
was obtained and confidentiality of the response was assured. Pre-test was done
by modified menopausal rating scale. Menopausal women in experimental group
practiced pranayama and then the level of menopausal symptom was assessed by
using same scale.
But in control group post-test was assessed without any intervention and
the reliability of the tool was established by using inter-rater reliability method
(r=0.8). This trial run study revealed the clarity, feasibility and practicability in
all aspects to conduct the study.
DATA COLLECTION
The main study was conducted from ……... Written consent was obtained from
village administrative officer before proceeding with study. Menopausal women
who fulfilled inclusion criteria were selected and assigned to the experimental
and control group. A brief introduction about self and study were explained.
27
Consent was obtained and confidentiality of the response was assured. Pre-test
was done by using structured interview questionnaire method and by using
modified menopausal rating scale. Menopausal women in experimental group
practiced pranayama daily in the morning and evening for 15 minute. In control
group menopausal women were not practiced pranayama. Following last day
intervention post-test were done by the same questionnaire and by using modified
menopausal rating scale. After the study a mass health education was given to the
control group.
28
Chapter IV
29
CHAPTER–IV
DATAANALYSISANDINTERPRETATION
ORGANISATION OF DATA
The findings of the study were grouped and analyzed under the following sections:
30
SECTION-A
TABLE I
n=60
Experimental Group Control Group
Demographic Variables
No. % No %
.
Age in years
45 - 46 years 8 26.67 8 26.67
47 - 48 years 12 40.00 12 40.00
49 - 50 years 10 33.33 10 33.33
Education
Illiterate 6 20.00 7 23.33
Primary 13 43.33 11 36.67
Higher secondary 9 30.00 8 26.67
Graduate 2 6.67 4 13.33
Occupation
Govt. employee - - 3 10.0
0
Private 3 10.00 9 30.00
House wife 27 90.00 18 60.00
Type of work
Sedentary 10 33.33 11 36.6
7
Moderate 14 46.67 13 43.33
Heavy 6 20.00 6 20.0
0
Type of food
Vegetarian 3 6.67 3 10.00
Non vegetarian 27 93.33 27 90.0
31
0
Mode of delivery
Normal delivery 17 56.6 15 50.0
7 0
Number of delivery
1 3 10.0 8 26.6
0 7
2 16 53.3 11 36.6
3 7
32
Considering the type of work, in experimental group 14(46.67%) were
moderate workers, 10(33.33%) were sedentary workers, 6(20.00%) were Heavy
workers, and in control group 13(43.33%) were moderate workers, 11(36.67%)
were sedentary workers,6(20,00%)were Heavy workers.
33
60 ExperimentalGroup
ControlGroup
P 50
e 40% 40%
r 40 33.33%33.33%
c
26.67% 26.67%
e 30
n
t 20
a
g 10
e
% 0
45-46years 47 -48 years 49 -50 years
34
Figure (iii) Shows the percentage distribution of educational status in
menopausal women
35
100 Experimental Group 90%
90 Control Group
P 80
e 70 60%
r
60
c
50
e
n 40 30%
t 30
a 20 10% 10%
g
10 0
e
0
Govt.employee Private Housewives
36
ExperimentalGroup
60
ControlGroup
P 46.67%
e 50 43.33%
r
36.67%
c 40 33.33%
e
n
t 30
a 20% 20%
g
20
e
10
0
Sedentary Moderate Heavy
37
90% 90%
100 Experimental Group
P 90 Control Group
e 80
r 70
c 60
e 50
n
40
t
30
a
20 10% 10%
g
e 10
0
Vegetarian Non-vegetarian
38
80 Experimental Group
70 Control Group
P 56.67%
e 60 50%
50%
r 43.33%
50
c
e 40
n
t 30
a 20
g
e 10
0
Normaldelivery LSCS
39
Figure (viii) shows the percentage distribution of number of delivery
40
SECTION–B
TABLE–II
n=30
With regard to hot flashes, majority 16(53.33%) had severe level, 12(40%)
had moderate level, 2(6.67%) had no hot flashes, and none of them are in mild
level of hot flashes.
Considering the fatigue, majority 18(60%) had severe level, and 12(40%)
had moderate level of fatigue, none of them had mild level, and none of them had
no fatigue
41
Regarding headache, majority 15(50%)had severe level,12(40%)had
moderate level, and 2(6.67%)had no symptom of headache and 1(3.33%) mild
level of headache.
7 Hotflashes 66.6
63.33%
Profusenightsw 6
6 Fatig
53.3
Heada 50
5 Insom
P
40
e 36. 40%4
r 4 67
c 30
e 3
n
t 2
a
42
TABLE–III
The table III shows that the frequency and percentage distribution of
pretest level of selected menopausal symptoms in the control group.
With regard to hot flashes, majority 14(46.67%)had severe
level,13(43.33%)had moderate level, 3(10%) had no hot flashes, and none of
them had mild level of hot flashes.
With respect to profuse night sweating, majority 15(50%) had moderate
level , 13(43.33%) had severe level, 2(6.67%) had no profuse night sweating and,
none of them had mild level of profuse night sweating.
Considering the fatigue, majority 16(53.33%)had severe level and
14(46.67%)had moderate level and none of them had mild level, and none of
them had no symptom of fatigue.
Regarding headache, majority 18(60%) had severe headache, 11(36.67%)
had moderate and 1(3.33%) had no headache and none of them had mild level of
headache.
With respect to insomnia, majority 16(53.33%) had severe level,
13(43.33%)had moderate level, 1(3.33%)had no insomnia and none of them had
43
mild level of insomnia.
44
TABLE-IV
n=30
45
Regarding headache, majority 21(70%) had moderate headache,
7(23.33%) had mild and 2(6.67%) had no symptom of headache and none of
them had severe level of headache.
10 Hotflas
0
hes
9 Profuseni
80
0
% ghtsweati
8 73.33% ngFatigu
0 7
0 e
P 7 Heada
0 60
e
% che
r 6 Insom
c 0 46.6
46.6
nia
e 5 7%
7%
n 0
t
4
a 0 30 26.67%
g 23.
3 %
e 33
0
%
2
0
6.67 6.67 6.67
% 3.33
1 % %
0 % 0 0 0 0
0 0
N Mil Moder Seve
o d ate re
Level of Menopausal Symptoms
46
TABLE-V
n=30
The table V shows the frequency and percentage distribution of posttest level
of selected menopausal symptoms in the control group.
47
With respect to insomnia, majority19(63.33%)each had severe level of
insomnia,9(30%)had moderate,1(3.33)had mild and1(3.33%)had no in somnia.
Figure (xi) Shows the percentage distribution of pre and posttest level of hot
flushes in Experimental and control group.
48
Figure (xii)Shows the percentage distribution of pre and post test level of
profuse night sweating in Experimental and control group.
49
Figure (xiii) Shows the percentage distribution of pre and post test level of
fatigue in Experimental and control group.
50
Figure (xiv)Shows the percentage distribution of pre and post test level of
headache in Experimental and control group.
51
Figure (xv)Shows the percentage distribution of pre and post test level of
insomnia in Experimental and control group
52
TABLE–VI
n=30
The table VI shows the comparison of pre test and post level of selected
menopausal symptoms in the experimental group.
53
Pretest 96.67%
100 90%
PostTest
90
P
80
e
r70
c
60
e
n50t
40
a
g30e
%20
10 10%
3.33%
0 0 0
Fig. (xvi):Percentage distribution of overall pre test and post level of selected
menopausal symptoms in the experimental group
54
TABLE–VII
n=30
The table VII shows the Comparison of pretest and post level of selected
menopausal symptoms in the control group.
With regard posttest majority 26(86.67%) are in severe level, 4(13.33%) are
in moderate level and none of them are in mild level of menopausal symptoms.
55
100 Pretest 90%86.67%
90 PostTest
p
80
e
r 70
c 60
e
n 50
t 40
a
30
g
13.33%
e 20 10%
%
10 0 0
0
Mild Moderate Severe
56
SECTION-D
TABLEVIII
n=60
p=0.000,(S)
p=0.375,(N.S)
The table VIII shows the comparison of pretest and post-test level of
menopausal symptoms score in the experimental and control group,
Considering the experimental group, the pretest mean score was 12.60 with
S.D1.48, regarding the post-test, the mean score was 8.17 with S.D 1.12. The
calculated‘t’valuewas24.130 which was statistically highly significant at p<0.001
level With respect in the control group, the pretest mean score was12.10 with S.D
1.35 and regarding the post-test the mean score was 12.30 with S.D 1.51. The
calculated ‘t’ value was 00.902 which was not significant at p=0.375, which
shows that there was no significant difference between the pretest and post-test
level of selected menopausal symptoms.
57
18 Experimental Group
16 Control Group
P
12.6% 12.1% 12.3%
e 14
r
12
c
e 10 8.17%
n
8
t
a 6
g
e 4
% 2
0
Pretest Post Test
Comparison of overall pre and post-test level of
mean score
58
SECTION–E
TABLE–IX
N=30
Mild Moderate
49-50years - - 9 30.0
Education 2=2.414
Graduate - - 2 6.7
Occupation 2=0.115
Govt.employee - - - - d.f=1p=0.735
59
Type of work 2=1.182
Heavy - - 6 20.0
1 - - 2 10.0 d.f=2
N.S–Not Significant
The table IX shows that none of the demographic variable had statistically
significant association with the post-test level of menopausal symptoms in the
experimental group.
60
TABLE-X
n=30
Moderate Severe
Education 2=3.280
Occupation 2=2.596
61
Sedentary 2 6.7 9 30.0 d.f=2p=0.726
N.S–Not Significant
The table X shows that none of the demographic variables had shown any
statistically significant association with the posttest level of selected menopausal
symptoms in the control group.
62
Chapter V
DISCUSSIONS
63
CHAPTER–V
DISCUSSION
This chapter discusses the findings of the study derived from descriptive and
inferential statistical analysis.
The demographic variables selected in the study were age, education, occupation,
type of work, type of food, mode of delivery and number of delivery.
64
Regarding the control group 12(40%) were aged between 47 – 48 yrs,
considering education 11(36.67%) were comes in majority under primary
education, regarding occupation, majority 18(60%) were house wives,
considering type of work 13(43.33%) were moderate workers, with respect to
type of food 27(90%) were non0vegetarian, regarding mode of delivery 15(50%)
were normal delivery and LSCS , considering number of children 16(53.33%)
had two children.
Here with the demographic variable, age in years and type of food shows the
homogenisity.
The First objective was to assess the pretest level of selected menopausal
symptoms among menopausal women in experimental and control group.
In the experimental group, considering the symptom, hot flashes majority
16(53.33%) had severe hot flashes, regarding the symptom profuse night
sweating, 19(63.33%) had severe level, with respect to the symptom fatigue,
18(60%) had severe level ,considering the symptom headache 15(50.0%) had
severe level, regarding the symptom insomnia 20(66.7%) had severe level, and in
control group, considering the symptom hot flushes 14(46.67%) majority are in
severe level, regarding the symptom profuse night sweating 13(43.33%) were in
severe level, with respect to the symptom fatigue 16(53.3%) were in severe level,
considering the symptom headache 18(60.0%) were in severe level, regarding the
symptom insomnia 16(53.33%) were in severe level.
The study findings were consistent with the study conducted by Rahman SA et al
(2004) to determine the menopausal symptoms among Sarawakian women using
modified MRS questionnaire among 356 women aged 40-65 years and were
interviewed to document 11 symptoms commonly associated with menopause.
The most prevalent symptoms reported were joint pain and muscular discomfort
[80.11%], physical and mental exhaustion [67.1%] and sleeping problems
(52.2%),followed by hot flashes and sweating (41.6%), irritability 37.9%, dryness
of vagina (37.9%), anxiety (36.5%), depressive mood (32.6%), other complaints
noted were sexual problem (30.9%), bladder problem (13.8%) and heart
discomfort (18.3%).
65
The Second objective was to assess the post-test level of selected menopausal
symptoms among the menopausal women in experimental and control group.
In experimental group the post-test level considering the symptom hot flushes
majority 18(60.0%), were in moderate level, with regard to profuse night
sweating 24(80.0%) were in moderate level, regarding fatigue 22(73.33%) were
in moderate level, considering headache 21(70.0%) were in moderate level, with
regard insomnia 14(46.67%) were in moderate level and in the control group, the
majority 13(43.33%) had moderate and severe level of hot flushes. Regarding
profuse night sweating majority 17(56.67%) had moderate level, with respect to
fatigue majority 23(76.67%) had severe level, considering headache majority
18(60.0%) had severe level, regarding insomnia majority 19(63.33%) had severe
level of insomnia.
The study findings were supported by J. Burt, J. et al, (2009) study aimed to
explore the efficacy of Yoga Therapy in the treatment for Sleep Disturbance or
Insomnia. Ten clients of a local Yoga Studio who were troubled by Insomnia
were invited to take part in a Yoga Therapy Program. The Program consisted of
six weekly one hour Yoga Therapy sessions at the Studio as a group, the
techniques learned were applied at home between sessions. Pre-test were
conducted to all participants. Tool used were 5 point scale from worst to best. Pre
and post-Program Pittsburgh Sleep Quality Index questionnaires were completed.
Results shows that Participation in the Yoga Therapy Program were excellent, as
completion of the questionnaires. Occupational functioning improved 24.6%,
Physical functioning improved 16.1%, Social functioning improved 20.6%;
General Health improved 9.1%, Quality of Life improved 31.25% and Emotional
Health improved 36.7%. It Concludes that the Yoga Therapy Program resulted in
a significant improvement in Participant’s sleep patterns using easily replicated
Yoga, breathing and relaxation techniques.
66
24.130 which was statistically highly significant at p<0.001 level.
Hence the research hypothesis H1 stated that “there will be a significant relation
between pranayama on selected menopausal symptoms among menopausal
women” was accepted.
The study findings were supported by Little, M. et al (2010) who conducted a
study to gauge the impact of a prescribed pranayama practice on Emotional
Intelligence, in particular its influence on an individual’s outlook on life and their
response/reactions to life. This multiple case study (N=8) of four weeks duration
evaluated the effects of a daily practice of nadi shodhana (alternate nostril
breathing) on Emotional Intelligence (EI). Participants were recruited from fitness
centres and Yoga schools in suburban Melbourne and the randomly selected
group consisted of eight females with an age range of 18 to 50. Participants were
taught the nadi shodhana breathing practice and asked to practice it for eight
rounds after rising each morning. A ‘self-reporting’ Trait Emotional Intelligence
questionnaire was used in beginning, midway and at the end of the study. The
four categories of EI measured :well-being, self-control, emotionality and
sociability. The result shows there was improvement noted in the areas of Self
Control. This study did show improvement in two of the areas of EI, following
the daily practice of nadi shodhana pranayama.
The conceptual framework of this study was based on modified Weidenbach’s
helping art of clinical nursing theory [1964]. The investigator adopted this model
and perceived apt in enabling to assist the outcome of pranayama on selected
menopausal symptoms. This model views the menopausal symptoms among
menopausal women as an individual unique experience that is in need for relief
from menopausal symptoms. The central purpose of the study is to reduce
severity of menopausal symptoms among menopausal women. The investigator
planned the prescription that would fulfill the central purpose (reduce severity of
menopausal symptoms) by identifying the various means to achieve the goal.
Thus the investigator selected two groups where pranayama was provided for one
group and mass health education was given for the other group after the study.
The study findings concluded that the women in experimental group had
reduction in the selected menopausal symptoms when compared with control
group after the intervention; hence pranayama can be incorporated as an effective
therapy in managing selected menopausal symptom among menopausal women.
67
The Fourth objective was to associate the post-test level of pranayama
among menopausal women with their selected demographic variables in
experimental and control group
The association table reveals that none of the demographic variables had shown
any statistically significant association with the post-test level of menopausal
symptoms in the experimental group.
68
Chapter VI
69
CHAPTER–VI
This chapter presents the summary of the study and conclusion drawn. It
clarifies the Nursing implication, Recommendation and Limitation of the study in
different areas of life Nursing practice, Nursing administration, Nursing
education, Nursing research.
70
The following Research Hypothesis was set for the study
H1: There is a significant relationship between pranayama on selected
menopausal symptoms among menopausal women.
Review of literature revealed studies related to pranayama and outcome of
pranayama on selected menopausal symptoms among menopausal women. The
conceptual frame work adopted for the study was based on modified
Weidenbach’s helping art of clinical nursing theory [1964].The evaluative
approach and a quasi experimental design was used. The study was conducted in
community area of Bhiwani. Menopausal women who fulfilled inclusion criteria
were selected non - probability purposive sampling technique was assigned into
experimental and control group respectively. Pilot study and the main study were
conducted in the Bhiwani Consent was obtained and confidentiality of the
response was assured. Pre-test was done by using structured interview
questionnaire method and by using modified menopausal rating scale.
Menopausal women in experimental group practiced pranayama and then the
level of menopausal symptoms was assessed by using the same scale. But in
control group post-test was assessed without any interventions.
The study findings concluded that the women in experimental group had
reduction in selected menopausal symptoms. when compared with control group
after the intervention; hence pranayama can be incorporated as an effective
therapy in managing selected menopausal symptom among menopausal women.
The investigator has derived the following implication from the study which is vital
concern in the field of nursing practices, administration, education and research.
Nursing Practice
The Nurse should insist pranayama as a routine therapy among menopausal woman to
manage menopausal problems.
The Nurse should advocate the clients regarding yoga and help them to choose
appropriate therapy.
Nursing Administration
The Nurse administrator should organize public awareness program in their
organization on yoga and pranayama and its wide range of benefit to menopausal
women.
Nursing Education
The Nurse Educator should involve the concept of yoga in Nursing practice.
71
Educator can encourage the nurse to bring out innovative and creative ideas pertaining
to management of selected menopausal symptoms.
Yoga is a specialized field that can be integrated with nursing curriculum as a
extracurricular subject.
Nursing Research
Nurse researcher can provide more research in this evolving discipline.
The finding of the study serves as a basic for the student to conduct further studies
regarding management of menopausal symptoms.
RECOMMENDATION
1. A similar study can be conducted with a large sample size with longer
duration.
LIMITATION
The review of literature does not contain Indian studies related to
pranayama on menopausal symptom due to its non availability.
72
Reference
73
REFERENCE
74
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Yoga+Its+Origin+History+and+Development
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331521926_Scientific_benefits_of_Yoga_A_Review
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27. https://www.tandfonline.com/doi/abs/10.3109/09540261.2016.1160878
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9781428905214. Archived from the original on 10 September 2017.
29. Jain, Andrea Selling Yoga : from Counterculture to Pop culture. Oxford
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31. James Mallinson, "The Original Gorakṣaśataka". In White, David Gordon
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32. Joan, Budilovsky,; Adamson, Eve The complete idiot's guide to yoga (2 ed.).
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33. Johannes Bronkhorst, The Two Traditions of Meditation in Ancient India.
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Śaivism and the Tantric Traditions: A Festschrift for Alexis Sanderson.
Leiden: Brill. pp. 1–3 with footnotes.
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40. National Institute on Aging. Retrieved 6 October 2018.
41. Norbu , Chogyal Namkhai,et al Adriano Clemente. Yantra Yoga Snow Lion
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78
Annexures
79
ANNEXURE-I
From Dated-------
Ms. Anshu
M.Sc.Nursing II year Satya College of Nursing,
Rohtak,Haryana
To,
The INCHARGE
Sub:- Requesting letter for the Permission for data collection to conduct pilot study.
I am interested in data collection for conducting pilot study in your organization from
-------to----------, hence request you to kindly grant permission and do the needful.
Bhiwani
80
ANNEXURE-II
FROM:
Ms. Anshu
TO
………………….…….
Through
Sub:-- Requesting letter for the Permission for data collection to conduct main
study.
The population of study are the menopausal women of selected community area of
Bhiwani. I am interested in data collection for conducting pilot study in your
organization from -------to----------, hence request you to kindly grant permission and
do the needful. Herewith I am enclosing a copy of.
ROHTAK, HARYANA
81
ANNEXURE-III
From,
Ms. Anshu
M.Sc. Nursing Final Year (Medical Surgical Nursing)
SATYA COLLEGE OF NURSING, ROHTAK, HARYANA,
To,
………………..…………………
……………………………………
Forwarded through:-
Principal,
Sub: Request expert opinion and suggestion of experts for establishing content
validity of data collection tool.
Respected Sir/Madam,
I am a M.Sc. Nursing Final Year student from SATYA college of nursing Rohtak,
Haryana. As Part of My academic requirement for the partial fulfillment of Masters of
Science in Nursing Degree from Pd. B.D. Sharma, University of Health Sciences
Rohtak, I am undertaking “A comparative study to assess the effectiveness of
pranayam on quality of life and blood pressure among menopausal women of
selected community area of Bhiwani”
With regards to this, I have prepare a data collection tool under the guidance
of my research guide and co guide for the collection of data. I am herewith sending a
copy of tool to you for its content validity.
82
Hence I am request to you kindly examine the tool for its appropriateness and
relevancy of against the given criteria and give your expert opinion and valuable
suggestions for its improvement.
Thanking you
Date:
Place: Bhiwani
Enclosed:
83
ANNEXURE –IV
1. Mr.
2.
3.
84
ANNEXURE V
This is to certify that I have validate the tool of Ms. Anshu,M. Sc. Nursing
(Second) Year student of SATYA COLLEGE OF NURSING, Rohtak affiliated to
B.D. Sharma University of Health Science Rohtak who is undergoing “A
comparative study to assess the effectiveness of pranayam on quality of life and
blood pressure among menopausal women of selected community area of
Bhiwani”
Date:-
Signature
Place:-
Name & Designation of Expert
85
ANNEXURE-VI
Dear Respondents,
You are requested to participate in this study by giving the responses to the
statements, which will take about 40-50 minutes to complete. Information about your
age, religion, education, etc. will help me in the analysis process.
Your kind co-operation and honest responses are valuable. I assure you that
information given by you will be kept strictly confidential and used only for the study
purpose.
Thanking you.
86
ANNEXURE VII
Dear respondent,
87
CONSENT FORM
Code No:
Address -------------------------------------------------
Date -------------------------------------------------
Address -------------------------------------------------
Date -------------------------------------------------
Project Title:
Investigators:
Anshu
88
The subject ----------------has been fully informed about the nature and purpose of the
study. The subject has been assed, if any question have arises regarding study and
these question have been answered to the best of the investigator ability. A signed
copy of this from will be made available to the subject. The subject ensure that
whatever information. She/ He have provided during the study and also their identity
will be kept confidential and will be utilized for the study purpose.
I have been fully informed of the above noticed study is understand that there is
no risk associated with the study. I hereby agree to participant in the study. It further
more recognize the fact that I am free to withdraw this consent and to discontinue
participation in this at any time without prentice to care.
Address -------------------------------------------------
Date -------------------------------------------------
89
ANNEXURE-VIII
Background: Menopause means the natural and permanent stopping of the monthly
female reproductive cycles, which is usually a manifest of a permanent absence of
monthly periods and menstruation. Likes menarche, menopause is an important
development event in a women’s life having physical, psychological and facial
implication for the women. Menopausal women suffers from many problems such as
hot flushes, headache, profuse night sweating, fatigue, hair loss, insomnia, weight
gain, joint pain, muscle pain, dry skin, vaginal dryness and mood disorders and it is
well understood that menopausal women has been suffering from hot flushes,
insomnia, headache, fatigue and profuse night sweating there is a need to overcome
this unsatisfied life event.
STUDY:
If you consent a few question will be asked to you. You are required to give correct
90
opinion or no response to the questions asked.
RISK OF STUDY:
The finding of the study may assist in making health personnel aware about the actual
knowledge quality of life and blood pressure among menopausal women.
ALTERNATIVES OF PARTICIPATION:
Alternative of participation or to withdrawn from the study at any time. If you have
any further question please contact Ms. Anshu. It will guide the health personnel to
take different action to improve the knowledge regarding deep breathing Exercise on
level of blood pressure among hypertensive senior citizen.
CONFIDENTIALITY:
Iassure you that your identity and the information given by you will be kept
confidential and will be utilized only for the purpose of the study.
Financial consideration:
Neither you will be charged nor awarded prize for the inclusion in the study.
QUESTION:
I will try to answer your entire question regarding study up to your satisfaction before
you give your consent for participation in the study.
Yours Faithfully,
Anshu
M Sc. Nursing final year student,
Satya College of Nursing
Rohtak, Haryana.
91
ANNEXURE-IX
DEMOGRAPHICVARIABLES
1. Age in years
a) 45–46years
b) 47–48years
c) 49–50years
2. Education
a) Illiterate
b) Primary
c) Higher secondary
d) Graduate
3. Occupation
a) Government Employee
b) Private Employee
c) Housewife
4. Type of work
a) Sedentary work
b) Moderate work
c) Heavy work
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5. Type of food
a) Vegetarian
b) Non-vegetarian
6. Mode of delivery
a) Normal delivery
b) LSCS
7. Number of delivery
a) 1
b) 2
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MODIFIED MENOPAUSAL SYMPTOMS RATING SCALE
1.HOT FLASHES:
0 1 2 3
0 1 2 3
3. FATIGUE:
0 1 2 3
4.HEADACHE:
0 1 2 3
5. INSOMNIA:
0 1 2 3
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95
SCORING
0- Not experiencing
1- Once in a week
3- Daily experiencing
SCORING GRADES:
0-5- MILD
6-10– MODERATE
11-15- SEVERE
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MASTER DATA SHEET OF PRE-TEST
1 2 3 4 5 6 7
1 0 1 0 0 0 0 0
2 0 0 1 1 1 0 0
3 0 0 1 0 0 0 0
4 0 1 0 0 1 0 1
5 0 1 0 0 0 1 0
6 0 0 0 1 1 0 0
7 0 0 0 1 1 0 0
8 1 0 1 1 1 1 0
9 0 0 0 1 0 0 0
10 0 1 0 0 0 0 0
11 1 1 0 0 0 0 0
12 0 1 0 0 0 1 1
13 0 0 1 1 1 0 0
14 1 1 0 0 0 0 0
15 1 0 1 0 1 0 1
16 0 0 0 1 0 0 0
17 0 1 1 1 0 0 0
97
18 1 1 1 0 0 0 1
19 1 1 0 0 0 0 0
20 0 0 1 1 0 1 0
21 1 1 1 0 0 0 0
22 0 1 0 0 1 0 0
23 0 0 1 1 0 1 1
24 1 0 1 0 0 0 0
25 0 0 0 0 0 0 0
26 1 1 0 0 1 1 0
27 1 1 0 1 0 0 1
28 1 0 0 0 0 0 0
29 1 1 0 0 0 0 0
30 1 0 0 0 1 0 0
31 0 1 0 0 0 0 0
32 0 0 1 1 1 0 0
33 0 0 1 0 0 0 0
34 0 1 0 0 1 0 1
35 0 1 0 0 0 1 0
36 0 0 0 1 1 0 0
37 0 0 0 1 1 0 0
98
38 1 0 1 1 1 1 0
39 0 0 0 1 0 0 0
40 0 1 0 0 0 0 0
41 1 1 0 0 0 0 0
42 0 1 0 0 0 1 1
43 0 0 1 1 1 0 0
44 1 1 0 0 0 0 0
45 1 0 1 0 1 0 1
46 0 0 0 1 0 0 0
47 0 1 1 1 0 0 0
48 1 1 1 0 0 0 1
49 1 1 0 0 0 0 0
50 0 0 1 1 0 1 0
51 1 1 1 0 0 0 0
52 0 1 0 0 1 0 0
53 0 0 1 1 0 1 1
54 1 0 1 0 0 0 0
55 0 0 0 0 0 0 0
56 1 1 0 0 1 1 0
57 1 1 0 1 0 0 1
99
58 1 0 0 0 0 0 0
59 1 1 0 0 0 0 0
60 1 0 0 0 1 0 0
100
MASTER DATA-SHEET OF POST-TEST
1 2 3 4 5 6 7
1 1 1 0 0 1 1 0
2 1 0 1 1 1 0 1
3 1 0 1 0 0 0 1
4 0 1 1 0 1 0 0
5 0 1 1 1 0 0 1
6 0 1 1 0 1 1 1
7 0 1 1 0 1 0 0
8 1 1 1 0 1 1 0
9 0 1 0 0 0 1 0
10 0 1 1 0 1 1 0
11 1 0 1 1 0 1 0
12 1 1 0 1 1 0 1
13 0 0 1 1 0 1 1
14 1 0 1 1 0 1 0
15 1 1 0 1 1 0 1
16 1 0 0 1 1 0 1
17 1 1 0 1 1 0 1
101
18 1 1 0 1 1 0 0
19 1 0 1 1 0 1 0
20 0 1 1 1 0 1 1
21 1 0 1 0 1 1 0
22 0 1 0 1 0 1 1
23 0 0 0 0 1 0 0
24 0 0 0 0 1 0 1
25 1 1 1 1 1 0 1
26 1 0 1 0 0 1 0
27 0 1 0 1 1 0 1
28 1 1 1 0 1 0 1
29 1 1 0 1 1 0 1
30 1 0 1 1 1 0 1
31 1 1 0 0 1 1 0
32 1 0 1 1 1 0 1
33 1 0 1 0 0 0 1
34 0 1 1 0 1 0 0
35 0 1 1 1 0 0 1
36 0 1 1 0 1 1 1
37 0 1 1 0 1 0 0
102
38 1 1 1 0 1 1 0
39 0 1 0 0 0 1 0
40 0 1 1 0 1 1 0
41 1 0 1 1 0 1 0
42 1 1 0 1 1 0 1
43 0 0 1 1 0 1 1
44 1 0 1 1 0 1 0
45 1 1 0 1 1 0 1
46 1 0 0 1 1 0 1
47 1 1 0 1 1 0 1
48 1 1 0 1 1 0 0
49 1 0 1 1 0 1 0
50 0 1 1 1 0 1 1
51 1 0 1 0 1 1 0
52 0 1 0 1 0 1 1
53 0 0 0 0 1 0 0
54 0 0 0 0 1 0 1
55 1 1 1 1 1 0 1
56 1 0 1 0 0 1 0
57 0 1 0 1 1 0 1
103
58 1 1 1 0 1 0 1
59 1 1 0 1 1 0 1
60 1 0 1 1 1 0 1
104