Knowledge and attitude regarding infertility among high school of madi-6, Chitwan.

Table of contents

Contents page

CHAPTER 1…………………………………………………………………………………………………………………1

INTRODUCTION…………………………………………………………………………………………………………..1

1.1Background of the study………………………………………………………………………………

1.2Rational of the study…………………………………………………………………………………….

1.3Statement of the problem…………………………………………………………………………….

1.4Significance of the study………………………………………………………………………………..

1.5Objectives of the study…………………………………………………………………………………...

1.5.1General objectives…………………………………………………………………………………………..

1.5.2 Specific objectives…………………………………………………………………………………………….

1.6 conceptual framework………………………………………………………………………………………….

1.7 Variable of the study……………………………………………………………………………………………….

1.7.1 Dependent variables…………………………………………………………………………

1.7.2 Independent variables……………………………………………………………………………

1.8 Research question…………………………………………………………………………………………

1.9 Operational definitions……………………………………………………………………………………

1.10 delimitation of the study……………………………………………………………………………………

CHAPTER II……………………………………………………………………………………………………………………………….

LITERATURE REVIEW………………………………………………………………………………………………………………..

2.1 Introduction……………………………………………………………………………………………………….

2.2 Review of literature……………………………………………………………………………………………

2.3 Summary of reviewed literature………………………………………………………………………

CHAPTER III…………………………………………………………………………………………………………………………..

RESEARCH METHODOLOGY……………………………………………………………………………………………………

3.1 Research design…………………………………………………………………………………………………...

3.2 Research setting…………………………………………………………………………………………………..

3.3 Population of study………………………………………………………………………………………………

3.3.1 Sampling techniques…………………………………………………………………………………………

3.4 Sample size……………………………………………………………………………………………………………

3.5 Sampling techniques…………………………………………………………………………………………..

3.5.1 Inclusion criteria……………………………………………………………………………………………..

3.5.2 Exclusion criteria……………………………………………………………………………………………..

3.6 Research instrumentation………………………………………………………………………………………

3.6.1 Validity……………………………………………………………………………………………………………..

3.6.2 Reliability…………………………………………………………………………………………………………..

3.7 Plan for data collection……………………………………………………………………………………………

3.8 Data analysis plan…………………………………………………………………………………………………….

3.9 Ethical consideration………………………………………………………………………………………………..

3.10 Plan for disseminating the research findings……………………………………………………

3.11 Work plan……………………………………………………………………………………………………………..

3.12 Budget planning……………………………………………………………………………………………………

REFERENCES…………………………………………………………………………………………………………………………….

APPENDIX A………………………………………………………………………………………………………………………………

APPENDIX B……………………………………………………………………………………………………………………………
 CHAPTER I

INTRODUCTION

1.1Background of the study

Infertility is a disease of the male or female reproductive system defined by the failure to
achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse
(WHO, 2024). Infertility affects millions of people and has an impact on their families
and communities. Estimates suggest that approximately one in every six people of
reproductive age worldwide experience infertility in their lifetime. Infertility can be
primary or secondary. Primary infertility is when a pregnancy has never been achieved by a
person, and secondary infertility is when at least one prior pregnancy has been achieved.
(Infertility, n.d. 2024)

Infertility has become one of the global public health problems, where couple is unable to
bear a child, they are not able to conceive and remain childless. For women under the age
of 35 years infertility is defined as inability to conceive a child after 1year of unprotected
sexual intercourse. For women aged 35 to 40 years it is defined as inability to conceive after
6 months of unprotected sexual intercourse. For women above 40 years of age it is defined
as inability to conceive after 3months of sexual intercourse. Infertility is also an inability to
carry a pregnancy to term, such as in cases of recurrent pregnancy loss(Ezzell, 2016).

The 12-month prevalence rate ranged from 3.5% to 16.7% in more developed nations and
from 6.9% to 9.3% in less-developed nations, with an estimated overall median prevalence of
9%. (Boivin et al., 2007)

A study was conducted in Grenada. The target population was students who attended the
only college located on the island of Grenada. Five hundred and eight college students over
the age of 16 out of the 1,946 students enrolled in the college at the time of the survey
participated in this study with females comprising 65.7% (n = 334). Overall, while there was a
moderate level of knowledge among both males and females with regards to the risk factors
that may cause infertility, over 73% of the students believed that infertility may be caused by
God’s will and approximately 58% believed in the power of prayer to treat infertility.
(Rouchou, 2015)

A descriptive survey conduct in the students of Jami Institute of Technology of IRAN served
as the target population. A total of 170 surveys were returned (111 male and 59 female
students). The average age of female and male students was 26.6 and 25.8, respectively.
According to study, 67.57% of males and 62.71% of females correctly knew the description
of infertility. Only 21.9% of males and 32.14% of female students correctly knew that the
 most fertile time in a woman’s menstrual cycle occurs in the middle of her cycle. 57.29% of
male and 63.16% of female students knew the age at which women are most fertile. Most
students overestimated that female fertility decreases between ages 40-44, while 27.81% of
males and 36.21% of females correctly answered. Most students believed that infertility is a
disease (males: 58.18%; females: 61.02%). (Alaee et al., 2019)

A descriptive survey design was conducted about knowledge scores of teenagers revealed
that 58.33% had average knowledge, 25% had poor knowledge and remaining 16.66% had
good knowledge regarding infertility. The attitude scores of teenagers revealed that 56.66%
had neutral attitude, 25% had positive attitude and remaining 18.33% had negative attitude
regarding infertility. (“Assessment of Knowledge and Attitude Regarding Infertility among
Teenagers with a View to Develop Health Education Pamphlet,” 2018)

A cross-sectional study was conducted through internet chat application to assess the
knowledge, attitude and practice among adults in Indian population. Sample size was of 119
participants within inclusion criteria. The study revealed that 61.3% of participants had
good knowledge, 66.4% had good attitude, 58.8% had adequate practice on infertility. Age
was found to be statistically significant (p-value=0.009) with attitude.(Taneja, 2020)

1.2 Rational of the study

Infertility is one of the major health problems worldwide, including Nepal. The average prevalence
of infertility in developing countries is estimated to be around 6.9-9.3%. An increasing trend of
infertility has been noticed recently in Nepal however, exact prevalence is still unknown.(Gautam &
Risal, 2018)

The fertility is not always controlled by human; there is panoply of factors which influenced
fertility, like sociocultural factors; lifestyle; impact of environment on the human body;
knowledge of people; social attitudes; and practices. Thus, the voluntary childlessness is on
an increase and can become involuntary childlessness due to fertility diseases. The infertility
as a reproductive health disease is defined by the failure to achieve a clinical pregnancy
after at least 12 months of regular unprotected sexual intercourse. (El Adlani et al., 2021)

Generally, 20-35% of infertility cases due to woman etiology, 20-30% of cases due to man
etiology, 25-40% of cases due to both of man and woman etiologies and 10% idiopathic
 etiology. In Morocco, the infertility is estimated to 15% of population. Like in developing
countries, it is associated to the socially taboo; hence, the man infertility is related to virility
and woman infertility is related to dishonor. Consequently, this social perception about
infertility can affect fertility behavior. Thus, it is important to act on knowledge and attitude
of young people in order to have a favorable behavior toward their fertility. (El Adlani et al.,
2021)

A recent American Psychiatric Association (APA) Resource Document notes that the
“psychological impact of being unable to conceive is a profound loss and significant life crisis.”
The feelings around and reactions to infertility may include anger, sadness, shame or grief.
Couples may feel isolated and stigmatized and find it very difficult to be around other couples
with children.(Infertility, n.d.-b)

A cross-sectional and quantitative study, carried out among 420 undergraduate students of 7
selected colleges of Pokhara Metropolitan city from July to September 2019 Study revealed that
51.9% students had good level of knowledge with the female students having greater
knowledge (57%) than male (48%). The study found that students’ knowledge score related
to infertility was significantly associated with gender.(Dhungana & Jnawali, 2019)

The level of knowledge and attitude towards infertility among high school in Madi is not yet
well studied. Therefore, this study aimed to assess knowledge and attitude towards
infertility among high school of Madi.

1.3 Statement of problem

1.4 Significance of problem

The result of this study will be useful source as a baseline data for future references. This
study finding helps to find the level of knowledge and attitude of young adulthood
regarding infertility.
 1.5 Objectives of study

1.5.1General objective

The aim of the study is to identify the knowledge and attitude regarding infertility among
young adulthoods.

1.5.2 Specific objectives

 To assess the level of knowledge regarding infertility among young adulthoods studying
in selected college.

 To assess the attitude regarding infertility among young adulthoods studying in selected
college.

 To find out association between the level of knowledge and selected demographic
variables.

1.6 Conceptual framework

Fig 1: Conceptual framework on knowledge and practice regarding infertility.

Socio-demographic variables
Knowledge and Attitude
Age
regarding infertility among
Sex high school

Marital status

Ethnicity

Religion

Level of education Knowledge

Attitude
High (80%-100%)
Positive
Moderate (60%-79%)
Negative
Low (<60%)

(Bloom’s cutoff
categories, 2021)
1.7 Variables of the study

1.7.1 Dependent variable

Knowledge and attitude regarding infertility among young adulthood.

1.7.2 Independent variables

A. Socio-demographic variables
Age
Sex
Religion
Level of education
Marital status
B. Outcome variables
Good knowledge
Average knowledge
Poor knowledge
Positive attitude
Negative attitude

1.7 Research questions

What is the knowledge of infertility among young adulthood?
What are the attitudes of young adulthood towards infertility?

1.8 Operational definitions

Knowledge
Knowledge regarding infertility: refers to the recall facts regarding definition, types, causes
and treatment by using structured self-administered questions. The level of knowledge will
be measured by calculating the total knowledge score which will further classify into three
categories on the basis of previous literature:
High (80%-100%)
Moderate (60%-79%)
 Low (<60%)

High school
Students who study in class 11 and 12 of Madi Higher Secondary School.

Attitude
Attitude regarding infertility refers to perspectives, beliefs, and emotional response
toward infertility.

1.10 Delimitation of study

The sample of the study is limited to High School. Data collection will be conducted
within two weeks. Comparative study cannot be done between male and female
due to limited time.
 CHAPTER II

LITERATURE REVIEW
2.1 Introduction

Literature review is concerned with the review of related literature that could be both
electronics and manual areas such as journals, articles; abstract from the internet,
programmed computer search etc. the purpose of literature review is to develop a
thorough understanding and insight into the previous research works that relates to the
present study so it helps to gain deeper insight about the subject, to develop instrument
for data collection and to find out certain data that could be applicable in the
interpretation and conclusion of the study.

2.2 Review of literature

A descriptive study conducted in Gerenda. The survey conducted in college with total
of 508 surveys. Very few students believed that infertility is diagnosable as a disease
(male students: 8.1%; female students: 3.9%) and less than 7% of all students knew
that 70 million couples are involuntarily childless (male students: 5.7%; female students:
6.5%). Only 38.8% male and 44.7% female students correctly knew that the most fertile
time in a woman’s menstrual cycle occurs in the middle of her menstrual cycle. Also,
very few students knew that there is a marked decrease in a woman’s fertility between
the ages of 35 and 39 (male students: 6.3%; female students: 5.6%), with most students
grossly overestimating the age range of decreased fertility. The majority of students,
however, knew that both males and females could be responsible for infertility (male
students: 84.9%; female students: 90.2%).(Rouchou, 2015)

A descriptive study is conducted in Marrakesh-Safi region in Morocco. The participants

were selected from by a simple random sampling method. The required sample size
was estimated 355 participants aged between 15 and 25 years old (male n’= 129;
female n=226). Overall, 355 participants were included in this study whose 226 female
(average age M = 20.77 year) and 129 male (average age M = 20.72 years). The
finding of this study affirms that both of female and male had a low level knowledge
about the meaning and causes of infertility (20.8% of female versus 25.6% of male who
had infertility information). Almost, 7.75% of male and none of female had affirmed that
infertility is just a woman problem. The half of participants (41.6% of female versus
51.9% of male) had reported that it is easier to conceive if the couples had their first
baby.(El Adlani et al., 2021)

A study to assess the knowledge and attitude regarding infertility among teenagers
studying in selected college of Ahmednagar, with a view to develop health education
pamphlet. The knowledge scores of teenagers revealed that 58.33% had average
knowledge, 25% had poor knowledge and remaining 16.66% had good knowledge
regarding infertility. The attitude scores of teenagers revealed that 56.66% had neutral
attitude, 25% had positive attitude and remaining 18.33% had negative attitude
regarding infertility. The study concluded that the knowledge and attitude in the
respective field was inadequate among the teenagers. So it is important to initiate
actions to enhance the knowledge and attitude of the students in the college so that
they can take necessary measures to prevent infertility.(“Assessment of Knowledge and
Attitude Regarding Infertility among Teenagers with a View to Develop Health Education
Pamphlet,” 2018)

A cross-sectional study was conducted through internet chat application to assess the
knowledge, attitude and practice among adults in Indian population. Sample size was of
119 participants within inclusion criteria. In the study to know about the level of
knowledge of participants regarding infertility it was noticed that out of 119 participants,
majority of participants 76(63.9%) considered problem with eggs and tubal factors both
as the cause of infertility, only 7(5.9%) participants didn’t know the cause of infertility.
When participants were asked about infertility, 21(17.6%) participants felt that infertility
is inability to conceive after one year of sexual intercourse without contraception. When
the participant’s knowledge was checked on fertilization, majority 49(41.2%) of
participants knew correctly that fertilization of egg takes place in tube while only 6(5%)
participants didn’t know where fertilization of egg takes place. 75(63%) of participants
had correct knowledge that only one egg is released in ovulation. 55(46.2%) strongly
agreed, 51(42.9%) participants agreed that smoking and alcohol consumption can
decrease the sperm count.52(43.7) agreed with it and 40(33.6%) participants strongly
agreed that polycystic ovary syndrome and obesity are the main reasons for global rise
in infertility in India.(Taneja, 2020)
A cross-sectional survey was carried out by interviewing a sample of 447 adults who
were accompanying the patients at two tertiary care hospitals in Karachi, Pakistan. The
correct knowledge of infertility was found to be limited amongst the participants. Only
25% correctly identified when infertility is pathological and only 46% knew about the
fertile period in women's cycle. People are misinformed that use of IUCD (53%) and
OCPs (61%) may cause infertility. Beliefs in evil forces and supernatural powers as a
cause of infertility are still prevalent especially amongst people with lower level of
education. Seeking alternative treatment for infertility remains a popular option for 28%
of the participant as a primary preference and 75% as a secondary preference. IVF
remains an unfamiliar (78%) and an unacceptable option (55%).(Ali et al., 2011)

A field tested semi-structured questionnaire was administered to 100 rural women in

Kaiwara village, Karnataka, India to study their knowledge, attitude and practice
regarding infertility. Majority (84%) did not know the reason for infertility. 7% felt that
the cause of infertility was due to problems with eggs, 6% felt it to be tubal factors and
only 3% felt it to be due to male factor.(U et al., 2017)

Cross sectional was done to “Assess the knowledge regarding infertility among the
people of reproductive age group "at Gynae OPD of Shree Birendra Hospital. The Non-
probability purposive sampling technique was used. The study population was 110. No
significant relationship was established between the knowledge about infertility and
age. There was approximately equal number of respondents who had knowledge of
infertility in the variation of age group. The proportion of knowledge in male
respondents (93.8%) is comparatively more than the female (84.6%). The proportion of
knowledge of infertility according to the variation of ethnicity was similar to each other.
Likewise the proportion of knowledge of infertility by occupation and marital status
were also not significantly different. (Sharma & Bhandari, 2014)

2.3 Summary of literature review

 CHAPTER III

RESEARCH METHODOLOGY

3.1 Research design

A cross sectional descriptive study research design will be used to assess the
knowledge and attitude regarding infertility among young adulthood.

3.2 Research setting

The study will be conducted in Madi Higher Secondary School.
 3.3 Population of study
Study population will be High School of Madi, Chitwan.

3.3.1 Sampling technique

Non probability purposive sampling techniques will be used for young adulthood.

3.4 Sample size

Required sample for this study was calculated by this formula:

The standard formula for sample size (Cochran’s formula) is given by,

Where,
P= Proportion of acceptable level of practice
q= 1-p
Level of significance 5%= 0.05
Marginal error 5%= 0.5%
Z is value (no of SD from mean corresponding to the desired confidence level)

3.5 Sampling technique

Non probability purposive sampling techniques will be used for High School.

3.5.1 Inclusive criteria

All the students studying in class 11 and 12 of Madi Higher secondary School. Students who
provide informed consent and are willing to participate.
3.5.2 Exclusion criteria
Not willing to participate.
Not available while collecting data.
Students other than class 11 and 12.

3.6 Research instrumentation

A structured self-administered questionnaire will be developed as a tool for the study of
knowledge and likert scale will be used to identify attitude regarding infertility to collect
data. The study consists of 3 parts according to study variables:

Part 1: questionnaire related to socio-demographic information.

Part 2: questionnaire related to knowledge regarding infertility.

Part 3: questionnaire related to attitude regarding infertility.

3..6.1 Validity
Review of literature and consultation with research advisor and experts might be done to
maintain the content validity. Simple and understandable language will be used in the
questionnaire for obtaining clearer and accurate response from respondents. Questionnaire
will be developing in Nepali.

3.6.2 Reliability
The research instrument will be tasted for reliability among 10% total sample size form
Narayani Madhamik Bidhyalaya. The study tool will be revised and finalized on the basis of
results obtained from pre-test if necessary.

3.7 Plan for data collection

At first approval will be taken from the research committee of National Academy of medical
sciences, Bir Hospital Nursing Campus. Formal administrative approval will be obtained from
concerned authority of Madi. Only the researcher will be involved in data collection process.
Objectives of the study will be explained and written informed assent will be taken from
respondents. The data will be collected for a period of 2 week. After that respondent those who
meet the inclusion criteria will be identified. Data will be collected by filling self-administered
questionnaire. After inform written assent is obtained, researcher will gave the questionnaire for fill
up. The researcher will collect data from 10:00 am to 2:00 pm for 14 days. The time period to fill the
data will be 20-30 minutes.

3.8 Data analysis plan

Collected data will be reviewed and checked daily for its completeness, consistency and accuracy.
Data will be analyzed through available software such as SPSS and R. Chi square test and fisher exact
test will be uses to see the association between categorical variables. Data will be presented in
frequency and percentage.
3.9 Ethical consideration
Approval will be taken from the research committee of National Academy of Medical Sciences, Bir
Hospital Nursing Campus. Permission will be taken from the concerned authority of Madi Higher
Secondary school. An informed written consent will be taken from each respondent. Respondents
will not be forced to participate in study and are free to answer and will have full authority for the
exclusion during any period of data collection. Privacy, confidentiality of information of all the
respondents will be maintained.

3.10 Plan of disseminating the research findings

After completing the research study, the copies of the research report will be disseminated
to the library of Bharatpur Hospital of Nursing College and research advisor.

3.11 Work Plan

Content weeks 1st 2nd 3rd 4th 5th 6th 7th 8th
Topic Presentation

Literature review

Proposal writing + Tool development

Proposal presentation with tool and

Finalization

Data Collection and Data Entry

Data Analysis and Draw Findings

Finding presentation

Report writing and Submission of Final

report.

3.12 Budget Planning

S.N Items Expenditure

1. Stationary RS. 6000

2. Transportation RS. 500

3. Communication RS. 500

Total RS. 7000

REFERENCES
 APPENDIX A
INFORMED CONSENT FORM
Research Topic: Knowledge and Attitude regarding Infertility among high school.

Investigator: Umisha Adhikari

Objective: To identify the level of knowledge and attitude towards infertility.

Namaskar! I am a student of Bachelor in nursing science (BNS) 3rd year from National academy of
medical science, Bharatpur Hospital Nursing College, Bharatpur -10, Chitwan. I am here for a study
on “Knowledge and Attitude regarding infertility among high school” as a partial fulfillment of the
requirement of Bachelor in nursing science. The study has been approved by the Institute of Review
Committee (IRC) of Bharatpur Hospital. The study involves no foreseeable risks or harm to you. You
will be asked to fill up the questionnaire which will take around 15-20 minutes. Your valuable
answers will help to assess the knowledge and attitude regarding infertility. I would also like to
inform you that your participation in this study is voluntary and you have the full right to withdraw
from the study at any time you want without fear and clarification. All the information given by you
will be kept confidential and will be used only for study purpose. Your personal identity will not be
disclosed to anyone. I hope, you will participate in this study by providing your authentic response
to the questions. Your response will contribute to the successful completion of this research study
and will be highly appreciate

Participant’s agreement: I understand the information in the consent form and I am willing to
participate in your research voluntarily.
…………………….. ………………………
Participant’s Signature Researcher’s Signature

Date:

APPENDIX B
 INSTRUMENT IN ENGLISH

Self-administered questionnaire for Data Collection

Research topic: K knowledge and attitude regarding infertility among high school

Objectives: To find out the utilization status of adolescent friendly sexual and reproductive
health services.

Introduction: The researcher is the student of BNS 3rd year of Bharatpur Hospital Nursing
College, Bharatpur, Chitwan. This research study is conducted as the partial fulfillment of
Bachelor in nursing science curriculum.

Note: This research is only for study purpose. The information will be kept confidential you
are requested to provide factual information.
All the respondents are requested to not to share their information with each other's.

Direction: Please tick (√) the correct statements for your appropriate answer.

Date of data collection:

Code number:

PART I: Demographic data

1. Complete age (years/ Month/ Date)

2. Sex

a. Male

b. Female

c. Others (specify)
3. Marital status

a. Married

b. Unmarried

4. Ethnicity

a. Bramin/ Chhetri

b. Janajati

c. Madhesi

d. Dalit

e. Others (specify)

5. Religion

a. Hindu

b. Buddhist

c. Christian

d. Muslim

PART II: Knowledge regarding infertility

6. What is infertility?

a. Inability to conceive after 6 months of unprotected intercourse.

b. Inability to conceive after 1 year of unprotected intercourse.

c. Inability to conceive after 2 years of unprotected intercourse.

d. Inability to conceive after 5 years of unprotected intercourse.

7. Which of the following can be the cause of infertility in women:

a. polycystic ovary syndrome (PCOs)

b. Smoking

c. Age

d. All of the above

8. what can be the cause of infertility.

a. Eggs

b. Tubal factor

c. Both

d. Don’t know

9. At what phase of menstrual cycle women are most likely to become pregnant.

a. Just after the period

b. Half way between the two period

c. The moment doesn’t matter

d. Don’t know

10. Is infertility is treatable.

a. Yes

b. No

c. Don’t know
11. When one should seek help for infertility problem.

a. After one year of unprotected sexual intercourse without contraception.

b. After 3 months of unprotected sexual intercourse without contraception.

c. After six months of unprotected sexual intercourse without contraception.

d. Don’t know

12. In what age range is there marked decrease in a women’s ability to become pregnant?

a. 25-44

b. 35-39

c. 40-44

d. 45-60

13. If a couple gets pregnant once, could they have a problem trying to get pregnant again?

a. Yes

b. No

c. I don’t know

14. Which of the following statement about infertility is true?

a. Infertility only affects women

b. Lifestyle factors, such as diet and exercise, do not impact infertility.

c. Infertility can be caused by issues in either the male or female reproductive systems.

d. Infertility is always permanent and cannot be treated.

15. Which of the following can negatively affect male fertility?

a. Regular exercise

b. A balanced diet

c. Smoking

d. Staying hydrated

PART III: Attitude towards infertility

Strongly Agree Neutral Disagree Strongly

S.N Questions agree disagree

1. Infertility can be treated.

2. Infertility is a serious medical

condition.

3. I care about being able to have

children.

4. Being capable of having children

is important to my overall health.

5. Smoking and alcohol

consumption can decrease the
sperm count.

6. I am concerned about infertility.

7. I like to have more information
about how to protect infertility.

8. I think that if couple conceives

once, they might have problems
in conceiving again.

9. Infertility is a problem in both

men and women.

10. Sedentary lifestyle contributes in

infertility.