INTRODUCTION
"I can see, and that is why I can be happy, in what you call the dark, but which to me is golden. I can see a God-made world, not a manmade world."
- Helen Keller
Visually challenged is the consequence of a functional loss of vision. This term includes both partial sight and total blindness. In 1996 it was surveyed that nearly 1.20 crore people were blind, nearly 1/4th of the total world population. Among these 14.9 out of 100 only were in developing countries compared to 3 per 1000 in developed countries. Around 3-5 million people are added every year worldwide. In India alone the prevalence of blind people was 0.7% as per WHO regional report, May 2004.
Indian council of medical research (May 2006), stated the reports that nearly 153 million people are affected worldwide with blindness. Around 2 million people are being added every year. WHO (May 2007) report shows globally around 5% of total population nearly 1.5 million blind children were younger than 15 years of age, out of which 1.0 million are in Asia alone in India, It's found that 1.2 per 1000 between age group of 7-15yrs are blind.
Teachers work closely with each individual so they learn how to more around independently dress themselves, feed themselves, socialize, master skill in sensational activities and sound sensation also they develop physical education of art and music abilities. Parents of visually challenged children need special guidance and counseling regarding care of their visually challenged client. Parents should be given reassurance to cope up with the child physical care need and motivate the child to do their work independently. Parents should be shown educational films, brochures and seminars on parenting need for visually challenged children, particularly the mothers should be trained to assess their children's needs and engage to solve their problems.
Visually challenged people learn by tactile perception on pictorial display and raised line pictures rather than instructional method, (Heller, 2002). Hygienic practices highly declines in these visually challenged women. Special studies on improvement of reproductive health knowledge in a group of visually challenged women were conducted, (yatcinkaya, 2006). The visually challenged children are more dependent upon others for their daily basic needs. Various government and non government organization take steps in special training; support and guidance to live independently, special school services meet the unique needs of these visually challenged children. The boys and girls learn basic life skills for independent life in these schools. Braille system of education starting from preschool.
The term adolescent comes from the Latin word which means 'to grow to maturity'. Marlow's classification of adolescent includes early adolescence of 12-13yrs; middle adolescence of 14-16yrs and late adolescence of 17-21yrs and early adulthood of 22-23yrs. Adolescent is an important period in the life span because of their immediate effects on attitudes and behavior. Adolescent is a transition period which means that what has happened before will leave its marks on what happens now and in the future. Same like that early adulthood period is a period of change which means the rate of change in attitude and behavior parallels the rate of physical change.
In India it is estimated that 4-5million marriage take place annually involving girls below19yrs of age and 17% of women are not offered social or economic options, lack education to access the services to experience reproductive health, have weak bargaining powering the areas of sexual relationship, child bearing and child rearing. It even brings her risk of disease and unwanted pregnancy.
(Prof.Ramalingaswami, 2008) stated that: 'I cannot say when the concept of reproductive health was developed'. (Jose Barzeatto, 1987) in his report he stated that "Reproductive health is an embedded goal for development. Poor health of the people is a handle to nation's growth, and other demographic circumstances can be detrimental".
Regarding the education of visually challenged girls specialized women teachers are appointed with a teacher pupil ratio of 1.8. The same teacher also provides counseling services to the parents. The special qualification in Braille methods of teaching and individual counseling for visually challenged children are essential, particularly for visually challenged women, specialized models based on reproductive system, models of pad and cloth material, menstrual hygiene are specially taught during this age group.
However, implementing the concept of reproductive health world-wide needs to change in the thoughts of health personnels. We have achieved by realistic governments of the need for a paradigm shift; we have created a environment favorable to incorporated approach to primary care services in the area of reproduction, but the real conflict will be fought at the level of the abundant communities around the world where these ideas require to become reality.
Significance and Need for the study
"A person is blind to the extend that he must devise substitute techniques to do efficiently those things he would do with sight if he had normal vision"
Kenneth
Blindness is regarded as the most severe and traumatic physical handicap. Visually challenged women are a highly heterogeneous group. The general problems of visually challenged women are need assistance in their day to day activities such as identification in placing menses materials, washing the clothing's, particularly after menarche they feel more worried about their being blind since they need more assistance. Menstrual hygiene practice is a turning point among visually challenged women. These have to be analyzed and assessed to determine what and how could they be trained.
Adolescent period includes mental, emotional, social and physical maturity. Healthy development of adolescent depends on physical, mental, social and emotional factors. The physical influence in girls during adolescence is the significanct changes occurring in their body, both internally and externally. These changes unsettle a number of adolescence leading to imbalance. Adolescence are ignorant of their body and its functions. There is a sudden gain of curiosity and attention in one's own body and the bodies of one's peers. They are interested to know "how things work".
The young woman has to become adaptive to the developmental changes. They need training in hygienic practices during menstruation which includes bathing twice a day, washing their perineum after each urination and defecation, changing the protective menstrual materials frequently, disposing in dustbin. In the aspect of sex education and sexual behavior help to prevent the STD and HIV, Nowadays girls are prone to dangerous sexual behaviors such as premarital sex, homosexual and substance abuse. These problems may affect the psychological aspects such as irritability, impaired concentration, restlessness, feeling of dullness, hopelessness, anxiety, depression also occur mainly during adolescence period.
An adolescent vision problem can disrupt the family system. The visually challenged women have limitation due to loss of vision affecting their ability to benefit from observing and performing self care activities. Hence direct instruction, often involving physical manipulation must begin as soon as child is ready. A visually challenged woman either from birth or from early childhood adjusts to the world of seeing, a world that is in its visual aspects not experimentally knows to them. The early intervention of imparting adequate knowledge and training on personal hygiene and reproductive health enable to perform tasks independently.
Tenth five year plan (2002-2007), goal for HIV/AIDS programme recommended 90% coverage of schools and colleges through education programme. ICDS implementation programme focus on adolescent girls of 11 to 18yrs age by meeting the needs of health, education, self - development, nutrition and recreation. Appropriate, intensive awareness and guidance help adolescent girls in safe guarding their reproductive health. Some of the essential aspects used in preparation of these adolescent girls as healthy adults i.e. as future healthy mothers include, establishment of trust, parental action to prevent loneliness, to increase socialization, to increase self esteem of adolescent, to provide them adequate nutrition and to provide sex education.
If we can convince everyone that, by making the new vision implicit in the words "Reproductive health" a reality, we will above all improve the health of visually challenged women. Considering these areas the investigator is motivated to undertake a study to assess the effectiveness of audio teaching programme on reproductive health in terms of improving knowledge and attitude among visually challenged women.
Statement of the problem
A Quasi-experimental study to evaluate the effectiveness of audio teaching programme on reproductive health regarding knowledge and attitude among the visually challenged women in a selected blind institution at Madurai 2010.
Objectives
To assess the pre test level of knowledge and attitude on reproductive health among visually challenged women
To assess the post test level of knowledge and attitude on reproductive health among visually challenged women
To find the difference between the pre test and post test level of knowledge and attitude on reproductive health among visually challenged women
To find the association between the pre test and post test level of knowledge and attitude with selected demographic variables such as age, religion, educational status, area of living, type of blindness, age at attained menarche and source of information
Hypotheses
H1: There will be a significant difference between the pre test and post test level of knowledge on reproductive health among the visually challenged women
H2: There will be a significant difference between the pre test and post test level of attitude on reproductive health among the visually challenged women
H3: There will be a significant association between pre test and post test level of knowledge and attitude with selected demographic variables
Operational definition
Effectiveness
It refers to the output of audio teaching programme on reproductive health, as desired change in level of knowledge and attitude among visually challenged women.
Audio teaching programme on reproductive health
It refers to the systematically developed instruction, organized, designed to provide information through the audio CD (compact disk) with help of CD player, the information includes selected aspects of reproductive health such as anatomy and physiology of female reproductive system, menstrual hygiene, sex education and sexual behavior, sexually transmitted disease / AIDS and contraceptive devices in Tamil to educate the visually challenged women at selected blind institution.
Knowledge
It refers to the correct oral response of visually challenged women regarding reproductive health as measured the knowledge by a structured interview questionnaire.
Attitude
Attitude refers to the expressed values and feelings of respondents regarding reproductive health as assessed by a 3 point likert scale.
Visually challenged women
Visually challenged means "impairment in vision" or "functional loss of vision". This term includes both partial sight and totally blindness. A woman refers to the unmarried, school going girls within 15-17yrs of age and college going women within 18-23yrs.
Selected blind institution
It refers to those girls who have no sight, both partial and totally blind are staying in the blind institutions namely All India association of blind hostel in Sundarajampatti and oliyagam hostel in vilankudi, Madurai.
Assumption
Interview method adopted for the study would be adequate and sufficient for gaining information about reproductive health among visually challenged women
Audio teaching programme on reproductive health will improve the level of knowledge and desire attitude of visually challenged women.
Delimitation
Response depends upon the verbalization of visually challenged women
Projected outcomes
The result of the study would help the investigator to assess the knowledge and attitude of reproductive health among visually challenged women. The finding on demographic variables would help to identify the factors which affect the knowledge and attitude of reproductive health among visually challenged women in selected Blind Institution.
Conceptual framework
The conceptual framework for the study was derived from general system theory developed by Von Ludwig Bertanlaffy (1968) credited with originating the idea of general system theory defined the philosophy of science movement as general science of wholeness with systems of elements in mutual interaction. It serves as a model for viewing people as interacting with the environment. According to this theory a system consist of a set of an interacting component with in a boundary that first the type and rate of exchange in this environment.
Input
Input refers to matter, energy and information received from the environment, In this study input refers to the demographic variables such as age, religion, educational status, area of living, type of blindness, age at attained menarche and source of information and assessing the level of knowledge and attitude of the visually challenged women on reproductive health by using structured interview schedule in selected blind institution.
Throughput
Throughput refers to matters, energy and information that is modified are transformed within the system. In this study throughput refers to the active phase that the intervention has been taken place, are administration and demonstration of audio teaching programme regarding reproductive health among visually challenged women.
Output
Output refers to matters, energy and information that are released from the system in to the environment. In this study refers that adequate knowledge and positive attitude are desired output. Otherwise the output is moderately adequate, inadequate and negative, netrual attitude need to reassessment and teaching to the client.
Feedback
Feedback is the emphasis to strengthen the input and throughput. In this study it is emphasis to find out the effectiveness of input and throughput. Incase of undesired output need reassessment and teaching.
