Document Type : Original articles
Authors
1 Assistant lecturer of Women Health and Obstetrics Nursing, Faculty of Nursing – Minia University
2 Professor of Maternity and Gynecological Health Nursing, Faculty of Nursing - Ain shams university
3 Assistant professor of Women Health and Obstetrics Nursing, Faculty of Nursing -Minia University
Abstract
Highlights
Safaa Ali Abdelnaem*, Shadia Hamido Mohasib**, Hoda Abd Elazim Mohamed***
* Assistant lecturer of Women Health and Obstetrics Nursing, Faculty of Nursing – Minia University,
** Professor of Maternity and Gynecological Health Nursing, Faculty of Nursing - Ain shams university
*** Assistant professor of Women Health and Obstetrics Nursing, Faculty of Nursing -Minia University
Keywords
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).
|
Socio-demographic characteristics |
No= 214 |
% |
|
Age/year |
||
|
18 – < 20 |
83 |
38.8 |
|
20 – < 22 |
114 |
53.3 |
|
≥22 |
17 |
7.9 |
|
Mean ± SD |
19.9 ± 1.1 years |
|
|
Academic Level |
||
|
1st |
61 |
28.5 |
|
2nd |
73 |
34.2 |
|
3rd |
57 |
26.6 |
|
4th |
23 |
10.7 |
|
Residence |
||
|
Urban |
37 |
17.3 |
|
Rural |
177 |
82.7 |
|
Marital status |
||
|
Single |
202 |
94.4 |
|
Married |
12 |
5.6 |
|
Mother's education |
||
|
Illiterate |
84 |
39.3 |
|
Read/Write |
45 |
21.0 |
|
Secondary |
51 |
23.8 |
|
University |
34 |
15.9 |
|
Socioeconomic Status |
||
|
Low |
22 |
10.3 |
|
Moderate |
187 |
87.4 |
|
High |
5 |
2.3 |
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).
|
Vaginal infection characteristics |
N=214 |
% |
|
Symptoms from the following you suffer |
|
|
|
Itching, burning, swelling, malodorous, abnormal discharge and leucorrhea (General symptoms) |
37 |
17.3 |
|
Thick white vaginal discharge as small pieces like white cheese (Candida symptoms) |
89 |
41.6 |
|
Thin, white (milky) or gray vaginal discharge, and fishy odor (Bacterial vaginosis) |
8 |
3.7 |
|
Itching, burning, swelling, malodorous, abnormal discharge and leucorrhea + Thick white vaginal discharge like white cheese. |
68 |
31.8 |
|
Itching, burning, swelling, malodorous, abnormal discharge and leucorrhea + Thin, white (milky) or gray vaginal discharge, and fishy odor |
6 |
2.8 |
|
Thick white vaginal discharge as small pieces like white cheese + Thin, white (milky) or gray vaginal discharge, and fishy odor. |
3 |
1.4 |
|
General sympotms, candida sympotms, and bacterial vaginosis sympotms |
3 |
1.4 |
|
Period of vaginal infection symptoms from the beginning at this episode |
|
|
|
Less than one week |
132 |
61.7 |
|
One week |
21 |
9.8 |
|
More than one week |
61 |
28.5 |
|
Number of vaginal infection episodes per year |
|
|
|
Once |
46 |
21.5 |
|
Two times |
33 |
15.4 |
|
Three times or more |
135 |
63.1 |
|
Kind of treatment used |
|
|
|
Medication |
20 |
9.3 |
|
Douching |
16 |
7.5 |
|
Cotton underwear |
56 |
26.2 |
|
Not treated |
122 |
57.0 |
|
Students action taking |
|
|
|
Go to private clinic to seek treatment |
23 |
10.7 |
|
Tell my mother about my complain |
48 |
22.4 |
|
Ask my sister about my complain |
13 |
6.1 |
|
Ask my friends about my complain |
11 |
5.1 |
|
Cannot tell any person |
113 |
52.8 |
|
Others (pharmacist, asked doctor in my work) |
6 |
2.8 |
|
Barriers to seek gynecologist when exposed to vaginal infection |
|
|
|
Shyness |
124 |
58.0 |
|
Tradition |
9 |
4.2 |
|
No special girl's center |
17 |
7.9 |
|
The belief that this is a natural |
61 |
28.5 |
|
Others (laziness, single, economically) |
3 |
1.4 |
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).
|
Total knowledge
|
Pretest |
Post 1 Month |
Post 3 Months |
X2 |
P- Value |
|||
|
No |
% |
No |
% |
No |
% |
|||
|
Poor (< 50%) |
129 |
60.3 |
13 |
6.1 |
21 |
9.8 |
256.597 |
.000** |
|
Moderate (50- 75%) |
75 |
35.0 |
71 |
33.2 |
97 |
45.3 |
||
|
Good (75%) |
10 |
4.7 |
130 |
60.7 |
96 |
44.9 |
||
|
Mean ± SD |
14.2 ± 4.6 |
23.0 ± 4.6 |
21.4 ± 4.9 |
F 215.345 |
.000** |
|||
** 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).
|
Total practice |
Pretest |
Post 1 Month |
Post 3 Months |
X2 |
P-Value |
|||
|
No |
% |
No |
% |
No |
% |
|||
|
Unsatisfactory |
97 |
45.3 |
42 |
19.6 |
45 |
21.0 |
43.713 |
.000** |
|
Satisfactory |
117 |
54.7 |
172 |
80.4 |
169 |
79.0 |
||
|
Mean ± SD |
25.4 ± 5.8 |
29.6 ± 4.8 |
29.8 ± 5.3 |
F 44.052 |
.000** |
|||
** 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).
Quality of Life Domains |
Pretest |
Post 1 Month |
Post 3 Months |
F |
P - value |
|
Mean ± SD |
Mean ± SD |
Mean ± SD |
|||
|
Overall QOL & General Health |
6.8±1.8 |
7.4 ± 1.3 |
7.5 ± 1.4 |
12.663 |
.000** |
|
Physical |
22.9 ± 4.4 |
24.3 ± 3.7 |
24.4 ± 3.6 |
9.350 |
.000** |
|
Psychological |
18.3 ± 3.9 |
19.5 ± 3.2 |
19.6 ± 3.6 |
9.223 |
.000** |
|
Social |
7.4 ± 1.6 |
8.0 ± 1.3 |
7.9 ± 1.4 |
6.327 |
.002** |
Environmental |
24.5 ± 5.1 |
26.5 ± 4.5 |
27.3 ± 4.5 |
19.168 |
.000** |
|
Total Qol |
80.0 ± 13.4 |
85.4 ± 11.3 |
86.8 ± 11.7 |
18.484 |
.000** |
** 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).
|
Total Practice Scores |
Total knowledge Scores |
||||||||
|
Pretest |
Post 1 Month |
Post 3 Months |
|||||||
|
Poor |
Average |
Good |
Poor |
Average |
Good |
Poor |
Average |
Good |
|
|
Satisfactory |
62 (48.1%) |
47 (62.7%) |
8 (80.0%) |
5 (38.5%) |
58 (81.7%) |
109 (83.8%) |
12 (57.1%) |
77 (79.4%) |
80 (83.3%) |
|
Unsatisfactory |
67 (51.9%) |
28 (37.3%) |
2 (20.0%) |
8 (61.5%) |
13 (18.3%) |
21 (16.2%) |
9 (42.9%) |
20 (20.6%) |
16 (16.7%) |
|
X 2 (P – value) |
6.797(.03)* |
15.549(.000)** |
7.135 (.03)* |
||||||
* 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).
|
Item |
Total knowledge Scores |
F Test |
P-Value |
||||||||
|
Pretest |
Post 1 Month |
Post 3 Months |
|||||||||
|
Poor |
Average |
Good |
Poor |
Average |
Good |
Poor |
Average |
Good |
|||
|
Total quality of life |
79.5 ± 14.1 |
79.9 ± 12.2 |
88.1 ± 8.8 |
84.0 ± 11.1 |
84.2 ± 13.3 |
86.3 ± 10.1 |
86.4 ± 14.2 |
86.6 ± 11.3 |
87.0 ± 11.7 |
1.545 |
.06 NS |
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).
|
Item |
Total quality of life |
|||||
|
Pretest |
Post 1 Month |
Post 3 Months |
||||
|
R |
P - value |
R |
P - value |
R |
P - value |
|
|
Total knowledge Scores |
.093 |
.174 NS |
.101 |
.143 NS |
.019 |
.786 NS |
|
Total Practice Scores |
.333 |
.000** |
.361 |
.000** |
.310 |
.000** |
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).
Discussion
Vaginal infection is an important women’s health problem associated with negative impacts on quality of life. Nurses have the responsibility to educate patients related to various aspects about vaginal infection and keep themselves free from it (16).
Because of the importance of this issue, female students have been selected to be studied as they are the future mothers. 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 was that “self-care guidelines will improve the quality of life, knowledge and practices of students with vaginal infection more than before implementing self-care guidelines”.
As regard socio-demographic characteristics, the present study showed that, the mean age of students was 19.9 ± 1.1 years and more than one third of students at 2nd academic level.
The findings of the current study agree with, Abd El-Salam A. A., et al., (2018)(17), who studied “The efficacy of learning package regarding vaginal infection and associated risk health behaviors among female university students”, illustrated that, (87.9 %) of female students were recruited at age group from (18-20) years old. Moreover, the findings of the current study are in agreement with Youness E.M., et al., (2017),(12) who studied “Effectiveness of planned educational program on vaginitis and its preventive measures on adolescent female nursing student’s knowledge”, showed that, the mean age of studied students was 19.2±0.53 years.
Regarding distribution of the studied students according to their symptoms of vaginal infection, the present study observed that more than one third of students suffer from candidiasis signs and only (3.7%) suffer from bacterial vaginosis. The findings of the present study are in the line with the study conducted by Hamed A.G., (2015)(18), who studied “The impact of genital hygiene practices on the occurrence of vaginal infection and the development of a nursing fact sheet as prevention massage for vulnerable women” revealed that the white cheese like discharge was the most common (candida signs) (45%), and (4.8%) from bacterial vaginosis.
Moreover, the findings of the current study are in agreement with Khedr N. F., et al., (2015)(13), who revealed that, (32.7%) suffer from candidiasis signs and (5.8%) suffer from bacterial vaginosis. The findings of the current study may be due to exposure of young female to risk factors of candidiasis such as wearing tight non-cotton underwear for long time, using antibiotic continuously, frequent using of vaginal deodorants or perfumed soaps (alkaline medium), stress and lack of sleep.
Additionally the period of vaginal infection symptoms from the beginning at this episode around two thirds of students the symptoms last less than one week. On the other hand, around two thirds of students the symptoms occur about three times or more per year, and more than half of students (57.0%) not treated and can’t tell any person. The finding of the current study in partial agreement with study conducted by Masoumeh E., et al., (2015)(2), who studied “Assessment of educational needs among women of reproductive age with common genital tract infections (vaginitis): the first step for developing a self-care educational package”, revealed that, duration of symptoms were with an average of 22.7 ± 24.5 day, and symptoms occurs with an average of 2.8 ± 2.6 times per year, and with an average of 1.7 ± 1.4 time treatment visits during the preceding year.
Moreover, the findings of the current study are in line with findings of the study conducted by Sabarwal, et al., (2012)(19), who studied “Treatment seeking for symptoms of RTIs among young women” found that, the treatment seeking for any RTI infection was poor and 66% of unmarried women had not sought any treatment for their symptoms. Correspondingly, the finding by Prusty and Unisa, (2013)(20), who studied “RTIs and treatment-seeking behavior among married female adolescents in India”, found that, treatment-seeking behavior among female adolescents is poor. The findings of current study interpreted that in spite the recurrence of infection per year many times for female students they didn’t seek treatment due to many barriers.
Meanwhile, there are barriers that prevent female students from seeking gynecologist when exposed to vaginal infection symptoms. It was observed that the shyness was the most pronounced barrier (58.0%). The belief that this is a natural thing comes the second barrier (28.5%), This result is in agreement with Khedr N. F., et al., (2015)(13), who revealed that, shamed from exposure of genital area and thought that vaginal discharge was simple thing and didn’t need going to physician were the most prominent reasons for didn't consult doctor which constituted (57.8% and 48.9%) respectively. Moreover, in partial agreement with Abdelnaem S., et al., (2013)(21), who studied “Perception of late adolescent girls about sexually transmitted diseases and infections in El-Minia University”, observed that, the shyness was the most pronounced barrier (38.2%). As regards to the sources of knowledge about vaginal infection, the finding of the present study notices that more than half (59.8 %) selected the mother as a source of information about infection, followed by friends & relatives, mass media Physician, Nurse. This interpreted the importance of increasing mother's level of knowledge regarding all issues related to sexual health because they play a crucial role in delivering any message related to RTI.
The findings of the current study are supported by Mohamed H. A., et al., (2012)(15), who showed that, (43%) of the studied students seek advice from their mothers, while (29.0%) of them mentioned physician as a source of their health advice, (26.0%) of them mentioned friend or sister and only (2%) of students mentioned nurse as a source of their health advice. Moreover, Youness E. M., et al., (2017)(12), showed that the most common source of knowledge was their friends and their family members in 80.0% and 66.6%, respectively.
However the finding of the current study is in contrast with the study conducted by Sevil S., et al., (2013)(7), who studied “An evaluation of the relationship between genital hygiene practices, genital infection”, revealed that, nearly half of the students described that healthcare professionals were their preferred source of information. This may be interpreted due to cultural difference. Additionally, in contrast with Sarah R., et al., (2010)(22), who studied “Attitudes and experience of women to common vaginal infections”, showed that, women prefer to seek advice from physician/nurse to correct diagnosis and trust in their expert opinion. Also, in contrast with Renju, (2010)(23), revealed that the most common source mass media, health personnel and family member 11.3 %, 7.5% and 6.3% respectively. These findings may be interpreted due to culture difference.
Regarding distribution of the students according to their total knowledge score about vaginal infection. There was a significant improvement in total knowledge about vaginal infection among students in posttest as compared to pretest assessment (p<0.001). Hence, the finding of present study interpreted that implementing self-care guidelines regarding vaginitis and its preventive strategies was effective in increasing the level of students’ knowledge.
The finding of the current study is in agreement with Youness E. M., et al., (2017)(12), who revealed that as regards the total knowledge score level, There was a statistically significant difference (P<0.001) as regards the pretest and post-test total knowledge score level among the studied students.
Moreover, the finding of the current study is supported by Alka., et al., (2014)(24), who studied “Effectiveness of a “planned teaching programme” (ptp) on knowledge related to reproductive tract infections among rural women”, They found that, the mean of post-test knowledge score was higher compared with pretest knowledge score.
Likewise, the findings reported by Yarmohammadi, et al., (2015)(25), who studied “The effect of education on knowledge, attitude, and practices of patients with vaginitis”, revealed that, the mean of post-test knowledge score (1.8 ± 0.35) was higher compared with the mean of pretest knowledge score (1.1± 0.23) and indicated a significant increase in the mean score of knowledge, attitude, and practice of patients in the intervention group.
Regarding distribution of students related to their total practice regarding vaginal infection, the finding of the current study noticed that there was a significant improvement in total practice regarding vaginal infection among students in post-test as compared to pretest assessment (p<0.001). The finding of the current study interpreted that after the implementation of educational program, there was a positive effect on their practices. Most of the students with vaginal infection symptoms have been significantly relieved or somewhat improved after healthy self-care measures have been instructed, followed and used (p<0.001). The finding of the current study is in agreement with Youness E. M., et al., (2017)(12), who illustrated that, the mean of post-test score (8.3±0.8) of the studied students was higher than that of the mean pretest score (3.5±2.6) in relation to general hygienic measures that prevent vaginitis. The scores predicted that there was a significant difference between the mean of pretest and post-test at P less than 0.001 levels.
Moreover, the finding of the current study agree with Abd El-Salam A. A., et al., (2018)(17), revealed that, there were statistical significant deference among the female students regarding the preventive measures of genital infection in pre and post intervention (p value <0.001). In addition, the findings of the current study agree with Soudabeh Y., (2015)(26), who studied “The effect of education on knowledge, attitude and practice of patients with vaginitis” showed a significant difference in the mean of performance score before and after intervention (p value = 0.002).
Regarding distribution of the students according to their total quality of life, the current study revealed that the mean score of total quality of life at post-test was higher than the mean score at pretest. There was a significant improvement in total QOL among students in post-test as compared to pretest assessment (p<0.001). Hence, the finding of the current study is interpreted that self-care guideline regarding vaginitis was effective in improving the QOL of students.
The finding of the current study is supported by Sameer V., et al., (2014)(27), who studied “Impairment of quality of life in symptomatic reproductive tract infection and sexually transmitted infection” showed that, there was a significant differences between the domains as well as the total QOL score before and after intervention. So, QOL measures give more direct measure of the impact of the disease on daily life and this is more relevant in RTI/STIs where the condition is distressing physically, psychologically and treatment seeking is hindered by numerous factors which are predominantly social.
Moreover, the present study is supported with Roxana P., et al., (2016)(28), who studied “Impact of health-promoting educational intervention on lifestyle (nutrition behaviors, physical activity and mental health) related to vaginal health among reproductive-aged women with vaginitis”, showed that, the mean of total health-promoting lifestyle scores at pre-intervention and post-intervention were statistically significant difference (P < 0.001). Therefore, the educational intervention focused on health promoting lifestyle behaviors are a valuable way to reduce the incidence and impact of health problems, reduce health care costs, and improve quality of life.
Also, the finding of the current study is in agreement with a study conducted by Mirghafour V., et al., (2015)(29), who studied women of reproductive age in Tehran. Their studies have reported a relationship between self-efficacy and the sub-domains of health related lifestyles such as nutrition, physical activity, health responsibility, and other sub-domains of QOL. Moreover, the finding of the current study is supported by Jade E., et al., (2013)(30), “The burden of bacterial vaginosis: women’s experience of the physical, emotional, sexual and social impact of living with recurrent bacterial vaginosis” mentioned that, recurrent bacterial vaginosis had impact on physical, emotional, sexual, social life and total QOL.
Regarding the relation between total knowledge of the students with their total practices, the finding of the current study showed that there were highly statistical significant relation between total knowledge of the students with their practices (P value < 0.01). So, implementation of self-care guideline regarding vaginal infection was effective as a method to improve the knowledge, practices of adolescent nursing students as regards vaginitis. The finding of the present study is in agreement with Abd El-Salam A. A., et al, (2018)(17), who revealed that, there were highly statistical significant deference among the female students total post-practice and total post-knowledge score level regarding post intervention (p value <0.001).
Furthermore, the finding of the present study is in agreement with Mohamed H. A., et al., (2013)(15), who studied “The health practices among female students at Benha University as regards prevention of RTIs” showed that, there was positively correlation between having satisfactory/unsatisfactory knowledge and healthy/unhealthy practices, Thus, when knowledge improves, practice tend to be more healthy (hygienic).
In addition, the finding of the present study is in agreement with Bobhate and Shrivastava, (2011)(31), who studied “Across sectional study of knowledge and practices about reproductive health among female adolescents in urban mumbai” mentioned that, there was significant association between having good knowledge and good practice regarding reproductive tract infection. Moreover, the finding of the current study in the same line with the finding by Soudabeh Y., (2015)(26), who studied “The effect of education on knowledge, attitude and practice of patients with vaginitis”, showed that, the mean scores of knowledge and performance of the study group after the program was increased, indicating a significant effect on the level of awareness in women's behavior and practice. So, teaching programs about health can increase the level of knowledge and attitude changing into better practice.
Regarding the relation between total quality of life; total knowledge total QOL of the students. The finding of the present study observed that there was no statistical significant relation between total knowledge of the students with their total quality of life. However, there was positive correlation between their quality of life and their practices. The finding of the present study is in partial agreement with Emam W. M., et al., (2015)(14), who studied “Effect of vaginal discharge on nurses student’s quality of life” There was a statistical significant difference between nursing students’ knowledge regarding vaginal discharge and their quality of life. There was highly statistical significant difference between nursing students’ quality of life and self-care practices regarding vaginal discharge.
Conclusion
The current study concluded that there were highly statistical significant difference between knowledge, practices and quality of life (P<0.001) pre and post educational program. Also there were positive correlation between total knowledge of the students and their practices (P<0.001). Moreover, there was statistical significant correlation between practices of the students and their quality of life (P<0.001). So, implementation of self-care guideline about vaginal infection was effective in improving the knowledge, practices and the quality of life for nursing students with vaginal infection.
Recommendations
Applying educational programs for adolescent females and their mothers to increase awareness about vaginal infection.
Develop a special health center for adolescent females that motivate them to seek prevention, early diagnosis and treatment of vaginal infection that may have positive impact on their future health and their QOL.
Evaluate and develop strategies to improve factors facing adolescent students to use reproductive health services.
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