Essay: Menstrual Hygiene In Rural Nepal - Factors And Strategies.

Needs analysis (including background literature, an analysis of the health problem, and consideration of the context in which you are proposing the intervention); setting intervention goals/objectives; planning strategies for achieving these goals; and identifying the means of e- valuating objectives.

You may choose any topic area and geographic context you wish, as long as you can justify the public health importance of the health outcome as part of your proposal. You may choose to continue working on the same (or similar) topic area that you addressed in Assignment 1, but this is not imperative. In order to keep the scope and scale of the proposal realistic, you need to ensure that your budget does not exceed $200K per year and can be completed within 3 years.

• Aims
• Research questions/ Objectives
• Study methods
• Sampling methods
• Sample size and power
• Intervention
• Data collection method
• Ethical statement
• Data analyses
• Anticipated outcomes and significance
• Proposed timeline
• Budget and justification of budget

Background, brief literature and rationale

Nepal is a land locked nation present in southern Asia that is surrounded by the majestic Himalayas and a part of the country also forms a part of the Indo-Gangetic plain. The nation hosts a meagre population of about 26.4 million (World Health Organization, & Council for International Organizations of Medical Sciences, 2016). The nation has been identified as a developing nation with the total GDP to be approximately equivalent to $ 84 billion according to statistical data collected in the year 2018 (World Health Organization, & Council for International Organizations of Medical Sciences, 2016). It should also be noted here that the nation tremendously lags behind in terms of progress and development in the sector of health and hygiene. As a matter of fact, it should be significantly mentioned here that the remote and rural areas of Nepal are over loaded with health related issues such as malnutrition, development of infectious disorders and improper menstrual hygiene (Sommer et al.,2016). Nepal has been predominantly classified as a conservative nation where the menstrual cycle is considered as a taboo and is associated with a number of superstitious beliefs (Sommer et al., 2013). This accounts for the main reason why there is a major gap in the proper maintenance of menstrual hygiene across the rural areas of Nepal. In this regard, it should be stated that, more than 47.60% of the adolescent female population based at Nepal do not have adequate access to sanitary napkins and other commodities that could be used during the cycle. It should be also be noted that the 33% of the female population entering the phase of adolescence have no knowledge about the menstrual cycle (Dahal et al., 2017); (Sapkota et al., 2013). Also, studies have further revealed that, more than 52% of the adolescent female population had witnessed some or the other form of exclusion during their cycle (Department of Health, 2014); (Krishnan & Twigg, 2016). This majorly reflects the lag in the progressive health care outcomes prevalent in the nation.

Hence, this research intends to evaluate the major social determinants that are responsible for the poor maintenance level of menstrual hygiene. In accordance with the data collected from the research studies, it has been witnessed that poor menstrual hygiene accounts for more than 52% of medical cost expenditure associated with poor sexual health and infectious disorders (Palinkas et al., 2015). Therefore, the rationale for conducting this research intends to spread awareness among the adolescent and adult women in the rural areas of Nepal and provide assistance in terms of providing medical aid and facilities so as to ensure a safe menstrual hygiene.

The aims of the research study can be enlisted as under:

• To investigate the social determinants responsible for the poor prevalence of menstrual hygiene among the female population within the rural areas of Nepal
• To critically analyse and determine the existing barriers in terms of access to health care facilities
• To critically investigate the gaps in terms of policies aimed at developing menstrual hygiene
• To organize awareness campaigns in order to facilitate positive promotion of menstrual hygiene and provide effective family planning strategies

Hence, it can be expected that the designed aims would effectively help in designing strong health promotion strategies in order to promote positive health and hygiene among the adolescent and young female population of rural Nepal.

A research question has been defined as the central theme around which the entire project is based on. It typically comprises of the key elements of the research objectives and determined the methodology that would be undertaken for the successful completion of the study (Szolnoki & Hoffmann, 2013). It should also be noted here that the research question broadly considers the stages of investigation, data analysis and documentation of the findings to formulate an effective research question. In this case, the research questions on the basis of the designed research objectives comprise of the following three important questions:

Aims

RQ1: What are the factors that serve as barriers for women in accessing health care facilities within the rural areas of Nepal?

RQ2: What are major gaps within the existing medical policies?

RQ3: Which are the major areas where there is a scope of introducing improvement to enhance the standard of medical health facilities?

An appropriate study method has been identified as a major contributor in enhancing the effectiveness of the study. It should be noted here that a study-design helps in determining the approach that would be undertaken in order to analyse the finding of the research study. In close association with the designed research objectives and the research questions framed, it can be commented that the research study would be qualitative in nature (Barathalakshmi et al., 2014). This is primarily because the objectives of the research are mainly connected with subjective data analysis. Therefore, the study design adapted for this research study would be qualitative that would involve conducting surveys and semi-structured interviews with open-ended questions. In addition to this, the research study would also involve conducting an intensive systematic review on the retrieved literatures that deal with the maintenance of menstrual hygiene among the women population based at Nepal. Therefore, the study method for this research study would widely comprise of adapting a qualitative study design to evaluate and analyse the primary research findings. On the other hand the secondary data that would be retrieved from the literature review would be analysed on the basis of meta- analysis study design.

Sampling method plays an integral part in a research study (Thompson, 2013). It should be noted here that the sampling technique help in determining the key findings and analyse the obtained results. Sampling methods have been categorically into two basic categories. The first category comprises of probability sampling and the second category comprises of non-probability sampling. The sampling technique widely depends upon the sample size. The sampling method adapted for this research study would comprise of random sampling and it would lay emphasis on the female population based in the rural regions of Nepal between the age group of 14-38 years of age. Based on the sampling method a maximum of 10 participants would be chosen to conduct the primary research study comprising of face to face interview session with open-ended questions.

The sample size of the research study would essentially determine that how many participants would be participating in the research study. Research studies predict that in order to conduct a valid research, it is advisable to study a specific section of the population rather than the entire population (Szolnoki & Hoffmann, 2013). After the successful selection of the participants in the research study, these participants are effectively used in the determination of facts about the entire population set. However, it should be critically noted here that there might be instances when the participant population would exhibit different characteristics that cannot be aligned to the population in general. These criterion form a part of limitations of the research study. Also, it should be noted here that applying correct exclusion and inclusion criterion is essentially important in determining the sample size and according gathering participants of the research study so as to obtain results that can be generalized.

Research questions/ Objectives

Power can also be considered as an important aspect that helps in determining the appropriateness of the research study undertaken (Thompson, 2013). Power is basically the estimation that encompasses of the consideration that how many participants would be required to substantially gain a standard response to validate and support the research findings. In most of the research studies, it is common that researchers proceed with the consideration of two important hypothesis that include, null hypothesis and alternative hypothesis. The null hypothesis proceeds with the positive implication of the research study and the alternate hypothesis considers any alternate form that might be present in support of the research idea.  A number of factors play a key role in determining the power calculations that affect the sampling size. The factors can be enlisted as the accuracy and precision by virtue of which a sample size can be critically measured and analysed. Also, the magnitude of the clinical difference, the type of data analysis that would be used to analyse the findings and consideration of the parameters that would be required for the data analysis.

In this case, the research study would be conducted within the rural areas of Nepal preferably around the four rural areas and the sample size that would be considered for the primary research h would include 10 participants.

The interventions that would be proposed for offering better health facilities to the women residing within the rural communities of Nepal would include educating them and spreading awareness about the importance of maintaining menstrual health. To facilitate proper education among the rural women would include, the organization of health care campaigns across four rural regions in Nepal. The education strategies would include spreading awareness about the physiological cause that governs the menstrual cycle and the manner in which menstrual hygiene must be maintained during the cycle. Further, government funded support programs such as distribution of sanitary napkins and menstrual cups can help in maintaining positive menstrual hygiene. Further, to identify the existing gaps between the existing health care facilities and the non-availability of proper medical facilities within the rural setting of Nepal, the relevant literatures would be thoroughly scrutinised and reformed so as to establish stronger policies to promote positive health.

The data collection method forms an integral part of the research and varies across different research design. Generally for a qualitative research, the data collected method is through either survey responses or interview responses. It should be noted here that after the collection of the interview and data responses, the responses are critically evaluated on the basis of thematic discussion by grouping segregating the responses under different focus groups. On the other hand, it should also be noted that for quantitative study a variety of data collection methods are used depending upon the study design. The most common form of the data collection method is a randomized control trial or an experimental data analysis. It should be noted here that in order to evaluate the data gathered from quantitative research study, the data is analysed on the basis of software analysis using various statistical software tools. For this research study, the primary data collection would be based upon collecting interview responses and segregating the responses among focus groups so as to conduct thematic analysis (Szolnoki & Hoffmann, 2013). On the other hand the secondary data collection would be broadly dependent upon conducting a systematic analysis of the relevant literatures and accordingly assemble data on the basis of thematic discussions.

Study methods

In order to conduct a research, it is essential to critically observe the ethical guidelines and proceed with the research study (Palinkas et al.,2015). Ethical guidelines incorporate a number of factors such as obtaining a formal permission from the health department in order to proceed with the research idea and formally obtain the sanctioning of the budget for the research project. Further, the ethical consideration would involve convincing the partnering health care organization that would offer assistance and community nursing professionals for the launch of community programmes across the four rural regions of Nepal. In addition to this, it should be noted that in order to seek support from the partnering health care organizations, it is important to convince the administrative body which would be done by presenting informative posters, bulletin and a power point presentation presenting a detailed over view about the research program. Further, on obtaining the consent from the administrative body, a review committee would be set up which would comprise of the researcher along with a project coordinator and an administrative post holder of the healthcare organization. The body would recruit the support professionals for the community program and obtain a consent prior to recruiting them from the project. Further, the rural participants who would be short-listed for the interview process would be selected on the basis of the set inclusion criteria. A formal consent would be obtained from the participants and the researcher would elaborate the details of the research study and the purpose of conducting the research in a one-on-one session. Finally, the interview procedure would be conducted and the names of the participants would be kept anonymous so as to respect the privacy of the participants

The data analysis process, which will be used in this research to interpret the primary and secondary data collected from the field work and literature review of previous research works will base of the thematic process (Braun, Clarke & Terry, 2014, King, 2012). Thematic data analysis is the process in which, data collected from extensive research process are identified, analyzed and interpreted depending on several patterns or themes depending on which the qualitative data obtained from the research study is analyzed (O’reilly & Parker, 2013, Clarke & Braun, 2013). There are research evidences that indicated to the fact that thematic analysis procedure is one of the widely used data analysis process which is used to formalize or systematize different analytical procedures. Further the researchers Alhojailan (2012) also indicated to the fact that the thematic analysis is a flexible and due to the fact that qualitative data requires extensive explanation about the data and need to be explained depending on different themes, thematic analysis procedure is applied. This analysis process provides distinction to the each explanations and hence, the analysis continuous properly (Braun, Clarke & Terry, 2014). Further, researches also mentioned that to properly identify and analyze the raw data collected from the experiment, it is important to conduct a thematic analysis because using it, it is easier to determine the validity and reliability of the research findings as the results are divided in several themes and explanations are provided depending on the themes (Gale et al., 2013, Vaismoradi et al., 2016). Besides, thematic analysis is the process that helps the researchers by providing a systematic element in the analysis procedure that ultimately explains both implicit and explicit ideas depending on the raw data obtained from the research. Therefore, the data analysis process for this research aspect will follow the thematic analysis methodology for both primary and secondary set of data (Vaismoradi, Turunen & Bondas, 2013, Bazeley, 2013).

Sampling methods

This public health awareness is about menstrual hygiene among rural women of Nepal and it has been seen that the rate of menstrual hygiene related infections and complications is higher in rural women that in urban areas. Therefore, the research project bears major significance in this context as it helps to provide a clear overview about the presence of menstrual hygiene within the women of Nepal and provide them with interventions so that they can improve their menstrual hygiene related condition and prevent several infectious diseases that could be deleterious for their health. As per the first objective, the anticipated outcome will be associated with the identification of the social and communal issues due to which the women are not aware of the hygienic alternatives for their menstrual cycle and uses unhygienic counterparts during their cycle. This is an important step as after the identification of the reasons for the less usage of sanitary pads in the rural areas of the country, setting objectives for spreading awareness about the menstrual hygiene could be achieved. This awareness will be spread by arranging public awareness campaigns, medical campaigns and providing them with the information about the diseases and infections they could develop by using the unhygienic means of the menstrual cycle. These anticipated outcomes will completely depend on the degree of success of the health promotion campaigns arranged in the rural regions around the country and hence, the significance of it depend on the availability of the data and conduction of the research.

This is the time line decided for the health promotional campaign for sanitary and menstrual health of women in rural region of Nepal. The health promotional campaign and the research related to their menstrual health will continue for three years and within that period all the important steps for conduction of health promotional campaign will be carried out such as recruiting volunteers for the promotional campaign, preparing educational and awareness related materials for the rural regions in Nepal, providing educational intervention to the women who are unaware of the degree of deleterious effect of their unhygienic menstrual practices and then providing them with hygienic menstrual cycle pads so that they can protect their health from different infections. The time line is widespread in half-yearly manner and the processes have been divided in a manner so that it could be conducted smoothly and the benefit could be provided to the women in the rural areas who suffer from infections due to unhygienic menstrual practices.

The budget, which has been allotted for this health promotional campaign is $200,000 which will be divided for different sections of the promotional campaign as per the requirement and need of the campaign. This amount of budget is important as there are several sections in the health promotional campaign and due to this, the recruitment process, organization of health promotional campaign, distribution of sanitary napkins and providing the women with educational sessions so that they can understand the importance of sanitary napkins and use them for hygienic practice of health promotional campaign is an important step which will be conducted, if they have the support of monetary strength. Further, monetary strength is important for the recruitment of volunteers, healthcare professionals, arrangement of community halls and places where the health promotional campaigns will be arranged. Furthermore, it should be understood that this research project has a timeline of three years and to successfully conduct the process, it need to be arranged properly with volunteers, ample amount of helathcare interventional materials and medications, and sanitary napkins so that a smooth conduction of the helathcare promotional campaign, and educational interventions could be carried out. Hence, this specific amount of budget and distribution will be attempt and will be achieved with specific goals and objectives so that research goals and aims could be achieved.

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