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gh

COLLEGE OF HEALTH SCIENCES

SCHOOL OF PUBLIC HEALTH

UNIVERSITY OF GHANA

KNOWLEDGE AND PERCEPTION OF POLYCYSTIC OVARY SYNDROME

AMONG NURSES WORKING AT THE LA GENERAL HOSPITAL ACCRA

BY

LAWRENCIA ADJEI

(10392246)

A DISSERTATION SUBMITTED TO THE SCHOOL OF PUBLIC HEALTH,

UNIVERSITY OF GHANA, LEGON IN PARTIAL FULFILLMENT OF THE
REQUIREMENT FOR THE AWARD OF MASTER OF PUBLIC HEALTH
DEGREE

OCTOBER 2019
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DECLARATION

I, Lawrencia Adjei, do hereby declare that with the exception of reference to the

literature works of other researchers which have been duly cited, this proposal is as a

result of my original work.

LAWRENCIA ADJEI DR. ERNEST MAYA

………………… ………………….

(STUDENT) ( SUPERVISOR)

DATE ………….. DATE……………

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DEDICATION

This work is dedicated primarily to the Almighty God, for seeing me this far and also
to that one person that believed in me and continuely encouraged me when I wanted to
give up.

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ACKNOWLEGDEMENT

I am thankful to the Almighty God for his unending grace for bringing me this far and
to my Academic supervisor Dr Ernest Tei Maya.

To my family thank you for your continous support, I would not have come this far if
not for your endless prayers.

My sincere gratitude also goes to Dr Dwomoh, Dr Guure and Yakubu all of statistics
department and to Felicity Kuwornu, Edith Akosua Damptey, Melvin Katey, Sumaila
and all who has helped to make my MPH programme sucessful

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TABLE OF CONTENTS
DECLARATION........................................................................................................... i

DEDICATION.............................................................................................................. ii

ACKNOWLEGDEMENT .......................................................................................... iii

TABLE OF CONTENTS ........................................................................................... iv

LIST OF TABLES ..................................................................................................... vii

LIST OF ABBREVIATIONS .................................................................................... ix

ABSTRACT .................................................................................................................. x

CHAPTER ONE .......................................................................................................... 2

INTRODUCTION........................................................................................................ 2

1.1 Background .............................................................................................................. 2

1.2 Problem Statement ................................................................................................... 4

1.3 Justification of Study ............................................................................................... 5

1.4 Research Questions .................................................................................................. 6

1.5 Objectives ................................................................................................................ 6

1.6 Definition of Terms.................................................................................................. 6

CHAPTER TWO ......................................................................................................... 9

LITERATURE REVIEW ........................................................................................... 9

2.1. Global Estimates of Prevalence .............................................................................. 9

2.1.1 Phenotypes ............................................................................................................ 9

2.1.2 Signs and symptoms ............................................................................................. 9

2.1.3 Diagnosis............................................................................................................. 10

2.1.4 Risk factors and Causal links .............................................................................. 11

2.1.5 Complications ..................................................................................................... 12

2.1.6 Management and Treatment Options .................................................................. 13

2.2 Awareness and Knowledge of PCOS ................................................................... 13

2.3 Perceptions on PCOS ............................................................................................. 14

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2.4 Influence of Socio demographics on Knowledge and Perception ......................... 16

2.5 Experience with the condition, Knowledge and Perception .................................. 16

2.6 Influence of Education Programme on knowledge and perception ....................... 17

2.7 Sources of Information and Knowledge Level ...................................................... 18

CHAPTER THREE ................................................................................................... 20

METHODOLOGY .................................................................................................... 20

Introduction .................................................................................................................. 20

3.1 Study Design .......................................................................................................... 20

3.2.1 Study Site ............................................................................................................ 20

3.2.3 Sample Size and Sampling Method .................................................................... 21

3.3 Study Tools ............................................................................................................ 22

3.5 Quality Assurance and Data Processing ................................................................ 23

3.6 Data Analysis ......................................................................................................... 23

3.7 Ethical Considerations ........................................................................................... 25

3.7.1 Conflict of Interest .............................................................................................. 25

3.7.2 Funding ............................................................................................................... 25

3.7.3 Consent ............................................................................................................... 25

3.7.4 Data Storage, Usage and Confidentiality ............................................................ 26

3.7.5 Risk and Benefits ................................................................................................ 26

CHAPTER FOUR ...................................................................................................... 28

4.1 Characteristics of study participants ...................................................................... 29

4.1.2 Awareness of Polycystic Ovary Syndrome......................................................... 30

4.1.3 Sources of Information for awareness ................................................................ 30

4.1.4 Nurses Experience with PCOS ........................................................................... 31

4.2 Level of Knowledge of Nurses on PCOS .............................................................. 32

4.3 Association Between Knowledge levels and Sociodemographic Characteristics of

Respondents ................................................................................................................. 34

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4.3.1 Association between Non-demographic Characteristics and Knowledge Level. 35

4.4 Factors associated with Nurses having higher knowledge of PCOS ..................... 37

4.5 Perception of Nurses on Polycystic Ovary Syndrome ........................................... 38

CHAPTER FIVE ....................................................................................................... 39

DISCUSSION ............................................................................................................. 39

5.1 Awareness and Knowledge level of respondents................................................... 39

5.2 Perception of Respondents ..................................................................................... 40

5.3 Factors associated with higher knowledge of Nurses on PCOS ............................ 41

SUMMARY, CONCLUSION AND RECOMMENDATIONS ............................. 43

6.1 Conclusion ............................................................................................................. 43

6.2 Recommendations .................................................................................................. 44

6.2.1 Recommendations to Researchers ...................................................................... 44

6.2.2 Recommendations to Ghana Health Service....................................................... 44

REFERENCES ........................................................................................................... 45

APPENDIX ................................................................................................................... 1

Appendix 1: Questionnaire ............................................................................................ 1

Appendix 2: Participant Information Sheet .................................................................... i

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LIST OF TABLES
Table 1: Diagnostic criteria for PCOS globally ........................................................... 11
Table 4.1Shows the summary of Demographic Information of study Participants (pages
27-28) ........................................................................................................................... 28
Table 4.1.4 The experience with PCOS ....................................................................... 31
Table 4.3 Shows the association between socio-demographic characteristics and
knowledge level. .......................................................................................................... 33
Table 4.3.1 The Association between Knowledge levels, Experience with the condition
and Sources of information among Nurses .................................................................. 35
Table 4.4 Factors associated with Nurses having higher knowledge of PCOS ........... 36
Table 4.5 Shows the Perception of Nurses on Polycystic Ovary Syndrome ............... 38

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LIST OF FIGURES

Figure 1.1 Conceptual framework of factors associated with level of knowledge and
perceptions. (Adapted from Alumran, Hou, & Hurst, 2013) ......................................... 7
Fig 4.1.3 A graph showing the sources of awareness of PCOS ................................... 30
Fig4.2 A Bar chart showing knowledge levels of Nurses ............................................ 32

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LIST OF ABBREVIATIONS
WHO World health Organization

PCOS Polycystic Ovary Syndrome

NIH National Institute of Health

AE-PCOS Androgen Excess and Polycystic Ovary Syndrome Society

IVF in Vitro Fertilization

BMI Body Mass Index

NGO Non-Governmental Organizations

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ABSTRACT

Background: Polycystic Ovary Syndrome is the fourth gynecological disorder

affecting women of reproductive age. The immediate cause of this syndrome is

unknown however, abnormal hormonal levels, lifestyle factors are contributing factors

to Polycystic Ovary Syndrome. It is estimated that over 116 million are affected with

Polycystic Ovary Syndrome in the year 2012 worldwide. The Rotterdam criterion is the

most common criteria used to diagnose the disease. Any patient presenting any two of

these features that is dysfunctional ovulation, hormonal disorder and polycystic ovarian

morphology is diagnosed with Polycystic Ovary Syndrome. Polycystic Ovary

Syndrome increases risk to metabolic disorders which are the leading cause of diabetes

and cardiovascular disease. Long term complications such as pre-eclampsia, gestational

diabetes are found in women with Polycystic Ovary Syndrome. Their unborn children

suffer complications such as fetal macrosomia, small-for –gestational age and perinatal

mortality.

Aim: The aim of this study was to determine the factors associated with the level of

knowledge and perceptions on Polycystic Ovary Syndrome among nurses at the La

General Hospital, Ghana.

Methods: A descriptive cross-sectional study was conducted among nurses working at

the La General Hospital Accra, Ghana. A self-administered questionnaire consisting of

close-ended questions were adopted in this survey. Results was analyzed using stata

version 15 and presented as mean, standard deviations, percentages, chi-square and

ordinal logistic regression. All statistical tests performed were at a significance level of

5%.

Results: 142 nurses participated in the survey out of which 101(71 %) were females.

The mean age was 31.07(0.49). Fifty-one percent thus seventy-three were unaware of

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the condition. The main sources of information to nurses were the internet and school.

Excellent Knowledge level was 25(17.6 %.) Finally, 28(40.6%) of the respondents

agreed to the name being confusing, 43(62.3%) said the condition was hereditary and

53% felt anxious about having the condition.

Conclusion

Nurses’ knowledge as well as their awareness on Polycystic Ovary Syndrome is low,

there is the need to create awareness and intensify knowledge sources to increase

Knowledge about the condition. Nurses had a few misconceptions about the condition

and these were the condition neither manageable nor hereditary.

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CHAPTER ONE

INTRODUCTION

1.1 Background

Women in reproductive age are faced with diverse endocrine disorders one of which is

Polycystic Ovary Syndrome (Gupta et al., 2017).The actual factor contributing to this

condition is not known, however, the condition manifests when abnormal changes in

hormones occurs and usually during adolescence. Research has attributed causes to

genetics, lifestyle or both. The signs that accompany the condition include menstrual

dysfunction, acne, chronic anovulation, hirsutism, hyperandrogenism, infertility and

metabolic disorder syndrome (Ehrmann, 2005).

WHO estimated that 116 million women were affected with Polycystic Ovary

Syndrome (PCOS) in 2012 worldwide (Vos et al., 2012). In the United States of

America, one out of every 15 women reports with the condition. In a systematic review

by Tao et al (2017) on 42 studies conducted in Europe, America, Asian and the Middle

East, the lowest prevalence of 5.6% was recorded amongst Chinese women and the

highest prevalence of 16% was recorded amongst women in the Middle East. The

prevalence recorded in black women in their study was 7.0%, however a study

conducted in south Enugu state in Nigeria at two major infertility centers recorded a

prevalence of 18.1% (Ugwu et al 2013) and this result of 18.1% prevalence is not

surprising as PCOS is a major cause of infertility in women.

Different sets of criteria are used in diagnosing PCOS; these include the Rotterdam

criteria, National Institutes of Health Criteria (NIH) and Androgen Excess Society

(AES). The Rotterdam criterion is widely used in diagnosing Polycystic Ovary

Syndrome. An individual who presents two out of the three conditions present in the

Rotterdam criteria is diagnosed with Polycystic Ovary Syndrome. The three conditions

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are menstrual dysfunction, presence of polycystic ovaries on an ultrasound and

hyperandrogenism (Kovacs & Norman, 2007). PCOS has been classified into various

phenotypes and the basis for this classification is dependent on the presence of the three

main symptoms of the syndrome. Polycystic ovarian morphology (PCOM),

hyperandrogenism (HA) and ovulatory dysfunction (OD). Based on these features four

main phenotypes exist that is phenotypes A, B, C and D (Lizneva et al., 2016).

The risk factors associated with the condition can be categorized as genetic and

environmental factors (Shaiban S.Q et al 2016). Obesity is common amongst patients

with PCOS and may increase the risk of the metabolic disorders associated with the

disease (Sam, 2007). Appropriate lifestyle changes such as diet and exercise are an

effective way to managing PCOS. The condition is not only associated with infertility

but also increases the risk of contracting metabolic diseases like type 2 diabetes and

cardiovascular diseases (Palomba, Santagni, Falbo, & La Sala, 2015).

Polycystic Ovary Syndrome is a chronic disease with lots of complication and has been

underestimated over the years. The complications can be fertility based, oncological,

obstetric and even psychological. Obesity and metabolic disorders are the commonest

complications associated with the syndrome (McDonnell & Hart, 2017). Metabolic

syndrome is found to increase risk to pregnancy-related complications in women with

PCOS. These complications include gestational diabetes, pre-eclampsia, and for the

unborn child, small-for- gestational age, fetal macrosomia and perinatal mortality.

There is also an increased risk of cardiovascular diseases and infertility (Boomsma et

al., 2006). Depression and reduced quality of life are associated with women with

PCOS (Palomba et al., 2015).

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1.2 Problem Statement

Polycystic Ovary Syndrome is a disease of hormonal imbalance and of public health

importance because of its link to infertility. There is high level of unawareness among

the populace when it comes this disease. This is because the signs of the disease appear

during adolescent phase (Nidhi, Padmalatha, Nagarathna, & Amritanshu, 2011). At this

age, the girls do not understand symptoms and they need to be educated of the disease.

Due to the low awareness and knowledge on Polycystic Ovary Syndrome, diagnosis is

delayed. Late diagnosis increases the risk to cardiovascular diseases and type 2 diabetes

and may result in infertility amongst women (Daniilidis & Dinas, 2009). A study

conducted amongst Saudi Arabian women revealed minimal knowledge on the signs,

complications and overall management of Polycystic Ovary Syndrome (Alsinan &

Shaman, 2017). Health education is important in helping patients understand their

condition and manage their symptoms (Paterick, Patel, Tajik, & Chandrasekaran,

2017), however, the health professionals are unable to provide them with adequate

information , care and support they require to help them manage their disease. Women

with PCOS have expressed dissatisfaction in the provision of care and support from

healthcare practitioners (Lin et al., 2018). Women with PCOS have expressed certain

distrust and misconception when it comes to the diagnosis of the disease, they have had

more arguments with healthcare professionals (Lin et al., 2018). Lifestyle management

is essential to combating the disease, but the extent to which practitioners are providing

life style management for PCOS is not well described (Blackshaw, Chhour, Stepto, &

Lim, 2019). In assessing the barriers to lifestyle management among women with

PCOS, a key barrier identified was the procedure of consultation and referral of patients

(Ko, Teede, & Moran, 2016). There is a knowledge gap among physicians and other

health workers in terms of the diagnosis criteria for PCOS (Dokras et al., 2017). The

diagnosis of PCOS is lengthy involving a lot of health professionals and this leaves an

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unmet need for information among patients, there is the need to explore evidence based

resources available to health practitioners as well as test their in-depth knowledge of

the condition(Gibson-Helm, Lucas, Boyle, & Teede, 2014) . Although extensive

research have been done in the area of Polycystic Ovary Syndrome globally, in Ghana

there is a gap that needs to be filled in terms of literature in this area (Maya et al, 2018).

1.3 Justification of Study

Prevalence of PCOS is quite high worldwide and it causes a lot of complications during

pregnancy to both fetus and mother. However, there is inadequate knowledge on the

risk factors and self-management measures amongst patients with PCOS (Sunanda &

Nayak, 2016). Patients experience difficulty in sourcing for credible and helpful

information on their condition (Tomlinson et al.,2013). Nurses are generally seen as

role models in health, and are consulted for health education. Nurses are also vital in

providing education to the community on preventive measures to put in place to reduce

the incidence of diseases. The nurse’s knowledge on a disease is vital to provide

adequate and correct information to the patient (Blake & Harrison, 2013). Adequate

and the right information when available to patients speeds up the diagnosis process,

self-care and treatment (Naidoo, Mahomed, Asmall, & Taylor, 2014). Polycystic Ovary

Syndrome when diagnosed early and treatment given improves the quality of life

amongst patients and prevents further health complications such as infertility and

metabolic disorders like type two diabetes and heart diseases. (Upadhye & Shembekar,

2017).

Several benefits can be obtained globally by enhancing patient knowledge of disease

through health education and promotion. The health status of the individuals is

improved, and enhances quality of life of individuals as well (Yu, Guo, & Zhang, 2014).

In a recent study to assess the perceptions of patients on the importance of nurse’s

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knowledge on cancer, Patients said they felt safe and secured which helps alleviates

suffering during chemotherapy (Kvåle & Bondevik, 2010). The gap in level of

knowledge and perception when assessed among nurses will be used as a tool to

improve education of the public on PCOS.

1.4 Research Questions

a) What is the level of knowledge of PCOS among Nurses at La General Hospital?

b) What are the perceptions about the disease among Nurses?

c) What are the factors associated with the level of knowledge?

1.5 Objectives

Main objective

 To determine Knowledge and perception of Polycystic Ovary Syndrome among

Nurses working at La General Hospital.

Specific Objectives

 To determine the knowledge level among Nurses.

 To assess contributing factors to knowledge level.

 To assess the perceptions of nurses about PCOS

1.6 Definition of Terms

I. Anovulation- Failure of the ovaries to release an egg during a menstrual cycle

II. Hirsutism- Unwanted male pattern hair growth in women.

III. Reproductive age- All women between the ages of 15-49years (WHO, 2016)

IV. Hyper-androgenism- high levels of androgen the male hormone

V. Metabolic syndrome- a group of conditions that elevate the risk to

cardiovascular diseases and diabetes. It includes high blood pressure and sugar,

excessive visceral fat and high cholesterol.

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1.7 Conceptual Framework

Socio-demographic
characteristics
Age
Sex
Rank
Department
Highest education level

Awareness of PCOS

Experience with PCOS

Sources of Information
Treated patient with Knowledge levels
PCOS Internet
Books Perception
collegues sufferedfrom
PCOS Media
self or relative suffered Training Program
from PCOS Another Health
Proffesional

Figure 1.1 Conceptual framework of factors associated with level of knowledge and

perceptions.

(Conceptual framework was developed based on a tool used and validated by Alumran,

Hou, & Hurst( 2013) in their study to assess the overuse of antibiotics amongst parents.

From the tool, previous experience, and demographic characteristics affected

knowledge and perception. Knowledge affected awareness and sources of information.

This framework was further developed based on factors that contributed to knowledge

or perception from articles reviewed and the tool from the study)

The knowledge and perception of Polycystic Ovary Syndrome varies among nurses.

This variation results from several factors that may be direct or indirect. The direct

factors that affect knowledge and perception are awareness of PCOS and the sources of

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information available. When credible information on PCOS is available, knowledge

gaps are filled with the right information and doubts will be cleared. This increases the

knowledge and improves perception. Indirect factors include socio demographic

characteristics, education on PCOS and previous experience with PCOS. Education on

a disease will provide accurate information to participants. Education will provide

answers to questions that may arise on the condition. Similarly, when one becomes a

patient of a disease, health professionals at the hospital provide education on the

disease. Education on self -management measures, diagnosis and treatment options are

given to the patient. This will increase the level of knowledge and clear wrong

perceptions on the disease condition. Socio-demographic characteristics such as age

have been found to affect knowledge and perception, in the case of PCOS, the patients

are usually adolescents and do not understand the condition and as such affects their

knowledge and perception. Education level also affects the level of knowledge and

perception, women with tertiary education have higher understanding of PCOS and a

better perception of the disease compared to women without tertiary education (Alessa

et al., 2017).

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CHAPTER TWO

LITERATURE REVIEW
2.1. Global Estimates of Prevalence

The prevalence rates of polycystic ovary syndrome differ across the population under

study as well as the diagnostic criteria used. Globally, prevalence is 6% using NIH

criteria, 10% using the Rotterdam criteria and 10% using the AE-PCOS Society criteria

(Bozdag, Mumusoglu, Zengin, Karabulut, & Yildiz, 2016). The prevalence is lower

when all three criteria is combined in diagnosis compared to when just one criteria is

used (Wolf, Wattick, Kinkade, & Olfert, 2018). Variations have been seen in the

prevalence rates across different ethnicities, rates are higher among black ethnics

compared to Caucasians and Iranians living in the same geographic areas (Ding et al.,

2017). In west Africa, a prevalence of 12.2% exist amongst women attending a

teaching hospital in southern Nigeria (Ogueh, Zini, Williams, & Ighere, 2014)

2.1.1 Phenotypes

Four main phenotypes exist. Phenotype A is characterized by the presence of

hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology, B by

ovulatory function and hyperandrogenism, C by hyperandrogenism and polycystic

ovarian morphology and D ovulatory dysfunction and polycystic ovarian morphology

(Lizneva et al., 2016)

2.1.2 Signs and symptoms

Many clinical features characterize Polycystic Ovary Syndrome. These features

include Hirsutism, Alopecia, weight gain, appearance of polycystic ovaries on an

ultrasound, excess androgen hormones, acne, anovulation or oligo-anovulation

resulting in fertility problems and menstrual dysfunction and the metabolic syndrome

(Gul, Zahid, & Ansari, 2014). Hirsutism is the growth of excess hair usually around

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areas such as chin, chest, abdomen, around the lip. This excess growth results from

excess androgens (Loriaux, 2012). Dysfunction ovulation resulting in menstrual

dysfunction is always present in women with Polycystic Ovary Syndrome.

Anovulation is the absence of ovulation and oligo-anovulation is irregular ovulation.

Long term anovulation results in infertility (Palomba et al., 2015). The link between

PCOS and obesity is complicated as each condition can result in the other. There is a

dysfunction is the production of insulin among women with Polycystic Ovary

Syndrome, and this usually results in excess weight gain leading to obesity and other

metabolic syndromes like diabetes (Sam, 2007).

2.1.3 Diagnosis

Different sets of criteria are used in diagnosing PCOS; they include the Rotterdam,

National Institutes of Health (NIH) and Androgen Excess Society (AES) criteria. The

Rotterdam criterion is widely used for the diagnosis of Polycystic Ovary Syndrome

(Kovacs & Norman, 2007). The conditions for the diagnosis using each criterion are

summarized in the table 1

below.

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Table 1: Diagnostic criteria for PCOS globally

NIH 1990 Rotterdam 2003 AE-PCOS 2006 NIH/International

PCOS guidelines

2018

Hyperandrogenism Hyperandrogenism Hyperandrogenism Hyperandrogenism

Chronic Ovulation Anovulation/Oligo- Ovulation Oligo-anovulation

anovulation Dysfunction Polycystic ovaries

Polycystic ovaries

Both conditions must be 2/3 condition must be Both conditions 2/3 conditions must be

present present for diagnosis must be present present

Source: (Wolf, Wattick, Kinkade, & Olfert, 2018)

2.1.4 Risk factors and Causal links

The exact cause of the condition is unknown, however multiple mechanisms through

which it occurs has been proposed by researchers. Insulin being a common feature

associated with the condition led to the conclusion that, there is a causal relationship

between metabolic disorders and Polycystic Ovary Syndrome (Setji & Brown, 2007).

Factors that increase the risk to Polycystic Ovary Syndrome have been categorized into

environmental and genetics. Environmental factors such as sedentary lifestyle, lack of

exercise, high intake of fatty food lead to obesity. More than 40% of women with

PCOS are obese (Sam, 2007). Women with insulin resistance are at higher risk of

having PCOS. Insulin resistance results in higher risk to diabetes and gestational

diabetes during pregnancy (Choudhary, Jain, & Chaudhari, 2017) insulin regulates

enzymes involved in fat synthesis and this resistance leads to dyslipidemia observed in

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women with PCOS (Shaw, Sicree, & Zimmet, 2010). Women with hyper-androgenism

are most likely to have PCOS (Hussein & Alalaf, 2013).

2.1.5 Complications

Many complications have been found to be associated with Polycystic Ovary

Syndrome. Complications may be long term or short term, affects the pregnancy

outcomes and can be psychological as well. During pregnancy complications such as

miscarriages, pregnancy induced hypertension, pre-eclampsia. Women with PCOS,

who have been treated for fertility have higher risk to perinatal mortality when they

have multiple pregnancies. Multiple pregnancies are associated with poorer pregnancy

outcomes. Preterm birth, lower gestational age neonates and low birthweight is

associated with children born to mother with PCOS. Later in life children are at higher

risk to endocrine and cardiovascular dysfunction. There is an increased risk of

miscarriage in PCOS patients who conceive (Palomba et al., 2015). Women with PCOS

have two times the risk to cardiovascular diseases and more than four times risk to

developing diabetes compared to women without PCOS. A combination of hyper

insulinemia, hyper-androgenism, and oligo anovulation increases the risk of

endometrial cancer and other endometrial disorders. (Palomba et al., 2015). Case

studies have showed that women with PCOS are anxious, depressed and have eating

and bipolar disorders. The depression is most likely to occur in the teenage because of

the trouble of managing body weight and adult women also suffer from frustration

because of the sub fertility and miscarriage in their reproductive age. A patient with

PCOS also suffers from low self-confidence because of daily struggle with hirsutism.

The psychiatric disorders are most likely to happen due to the insufficient sound sleep

which is a symptom of PCOS (Sirmans & Pate, 2014)

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2.1.6 Management and Treatment Options

Although the exact mechanism and pathogenesis of PCOS is not known, researchers

have brought to light certain lifestyle modifications that can help manage the condition.

Also there are treatment options for the clinical features associated with the condition.

Weight control through exercise and healthy diets improves many aspects of PCOS.

Menstrual cycles, androgen levels, lipid and glucose levels are all regularized.

Hyperandrogenism in PCOS patients contribute to fat deposition around the stomach

and waist region and an increase in Body Mass Index (BMI). Poorer pregnancy

outcomes can also be associated with higher BMI (Badawy & Elnashar, 2011). The use

of metformin in the treatment of diabetes in PCOS patients have proven very effective

in treating the metabolic syndrome in PCOS patients. Women that have infertility issues

because of PCOS and are trying to conceive can be put on oral contraceptives to reduce

hyperandrogenism and correct anovulation. Alternatively, in vitro fertilization (IVF)

can also be used to help women conceive. Use of anti-androgenism medications can be

used to reduce features as a result of hyperandrogenism. Direct hair removal can also

be adopted to reduce hirsutism. A combination of lifestyle modifications and treatment

options can be used to effectively treat and manage PCOS (Pillai, Bang, & Green,

2007).

2.2 Awareness and Knowledge of PCOS

There is generally a low awareness, low level of knowledge and misconception among

women of all age groups on Polycystic Ovary Syndrome. In study conducted amongst

350 students of public and private universities in Dhaka, Bangladesh to assess the

knowledge of students on symptoms, complications, diagnosis methods and sources of

knowledge, treatment and management methods showed the following results: 58% had

minimal knowledge on PCOS and only 6% were aware and informed on the condition.

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Majority (67.7%) of students had knowledge from their doctor. The main sources of

information on PCOS to students were their doctors, internet, media, and

physiotherapist (Jahangir S 2013). In a similar study conducted among 150 students of

Nitte Usha Institute of Nursing Sciences, 76% had average knowledge and 10.7% had

good knowledge regarding Polycystic Ovary Syndrome. The study also revealed that

consumption of junk foods and other dietary patterns of the students were influenced

by their level of knowledge on PCOS (Sabitha & Sunanda, 2016).

Another study among patients of gynecological clinics conducted in Mumbai, India

showed similar results. Twenty one percent of the respondents were well aware and

informed about Polycystic Ovary Syndrome. The study concluded on the need for more

efforts to intensity creation of awareness on the general public about PCOS (Pitchai,

Sreeraj, & Anil, 2016). Amongst 275 women with polycystic ovarian syndrome aged

12-14years in New Delhi. The knowledge of the women with PCOS regarding PCOS

and its management was found to be inadequate with mean score of 12.1 out of 33. The

study concluded on the need for a development of a special health care package for the

women (Dalal, Babu, & Rastogi, n.d.). Conversely, there is high level of awareness

among Saudi Arabian women and this is attributed to higher levels of education and

the fact that internet was the major contributor to their awareness (Alessa et al., 2017)

Many factors such has educational programme, experience with disease, source of

information and availability of the information affects the knowledge level.

2.3 Perceptions on PCOS

Divergent perceptions on the PCOS exist. In a recent study conducted by Teede et al

,(2014) in Australia on the perceptions amongst women with the condition as well as

primary care providers, 48% of the women felt the name was confusing and 51% of the

women suggested the name be changed. In the same study, amongst the primary

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healthcare workers studied, 74% agreed on the name being confusing and 81% agreed

on change of name. A study conducted by Colwell et al (2010), revealed that 63% of

the women felt they had increased knowledge on the syndrome after participation in a

clinical research. Another study conducted in Australia also revealed that the name was

confusing and needed to be changed (Teede, Gibson-Helm, Norman, & Boyle, 2014).

In America, adolescent girls had significant differences between the groups with self-

perception and interpersonal relationships. In terms of self-body image, girls with

PCOS had significantly greater negative feelings about their appearance than the non-

PCOS group. The study concluded that clinical manifestations of PCOS have a strong

negative impact on self-perception and quality of life issues for affected adolescents

(Yoo, Adams, & Chang, 2003). Assessing knowledge and the perception of students

about PCOS in Bangladesh revealed the following results: 36.57% of students felt the

condition was manageable, 10.86% felt it was curable and 14.29% felts the condition

was fatal. In the same study, 44.12% felt anxious on having the disease where as

41.18% were depressed (Jahangir, 2013). In Mumbai, India 100 subjects who were

recruited through purposive sampling visiting gynecological clinics and revealed that

81% of the respondents felt that the condition was manageable (Pitchai et al., 2016).

In the UK, ten women living with PCOS had their experiences and perceptions

documented. This was an exploratory study and themes that were found include change

in their life plans to start a family, difficulty with living with the condition and majority

of the participants said they suffered from depression, self-harm and suicidal ideation.

Participants in the study conveyed their frustration over lack of support for patients with

PCOS (Williams, Sheffield, & Knibb, 2015). Among 30 women living with PCOS

recruited through a national self-help organization, thematic analysis of the interviews

revealed pervasive reports of feeling 'freakish', 'abnormal', and not 'proper' women.

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These perceptions were related to three symptoms commonly experienced by women

with PCOS. These are excess hair growth, irregular or absent periods and infertility

(Kitzinger & Willmott, 2002).

Negative emotions were associated with the disease, the most negative emotion

identified by patients with PCOS were the psychological effects of depression and

anxiety felt by these females as a result of the co morbidities and physical changes

experienced by them (Khalil & Ghaly 2010).

2.4 Influence of Socio demographics on Knowledge and Perception

Socio demographic characteristics such as age was found to be negatively correlated

to higher levels of knowledge on PCOS. In a study conducted in tertiary care facilities

in Pakistan revealed that the patients of polycystic ovarian syndrome are mostly young

and do not have understanding of the disease to the extent they should (Khalil W.K.B,

Ghaly I.S, 2010). A study conducted to assess the level of knowledge of PCOS among

2000 women of age group 18-50 years in Saudi Arabia, revealed that the level of

knowledge of PCOS was significantly related to higher educational level and the

highest knowledge level was recorded among women with health college qualification

(Alessa et al., 2017). Age was found to be associated with perception in a study that

was conducted among patients with PCOS attending tertiary care hospitals in Pakistan.

Most of the PCOS patients were young and did not understand the condition and this

has affected their knowledge as well as their perception (Rizvi et al., 2014).

2.5 Experience with the condition, Knowledge and Perception

Experience with a condition affects knowledge positively but its effect on perception is

dependent on the outcome of the condition (Kitzinger & Willmott, 2002). Experience

with a disease involve a colleague suffering from the disease, treating a patient with the

disease or having a close relative or yourself suffering from the disease. Studies have

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shown that, those that suffer from the disease or have a long family history of a disease

condition have adequate knowledge about the condition with regards to the clinical

manifestation or signs, treatment options or lifestyle changes to manage the disease

(Tian et al., 2011). Despite the adequate knowledge developed , a negative perception

may develop if the disease outcome was fatal and a positive outcome may be developed

if the outcome was not fatal (Blendon et al., 2012). Women living with PCOS when

they had their experiences documented had a negative perception with of the condition

and this was attributed to the negative outcomes of the disease on their features

(Williams et al., 2015).

2.6 Influence of Education Programme on knowledge and perception

Education is associated with a higher level of knowledge on the condition. In a study

conducted among nursing students using the quasi experimental method to assess the

level of knowledge of the condition, post-test scores were significantly higher than

pretest scores (Mohamed, 2016). Among 500 female science students attending public

universities in Pakistan, majority (90.2%) of the respondents had good knowledge of

PCOS after an educational intervention. The study concluded that different educational

programs should be done to provide knowledge about polycystic ovarian syndrome

(Haq et al., 2017). In another clinical based research study in Canada, involving 68

women who were counseled and educated on PCOS. After the education session, an

online survey was used to assess their perceptions as well as level of knowledge, 63%

of participants felt they had increased knowledge after participating in the study.

Education was also found to be positively associated with enhanced knowledge

(Colwell, Lujan, Lawson, Pierson, & Chizen, 2010). Effective educational intervention

conducted especially for nurses have been found to significantly increase their level of

knowledge on diseases. A study conducted in Hoshangabad, India to test the

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effectiveness of the of education programme on their knowledge on PCOS revealed a

positive correlation between education and level of knowledge (Gupta et al., 2017).

Factors such as age and health education have been found to be associated with

perception. Health education has been found to positively affect the perception as well

as the knowledge level of a disease. Students in China after education on PCOS had

higher levels of knowledge and their perception changed (Wang et al., 2018).

2.7 Sources of Information and Knowledge Level

Sources of information positively or negatively affects the level of knowledge on a

disease condition. There is the need to strengthen the information sources on PCOS to

enhance their credibility (Ali & Ameera, 2010). Knowledge scores on diseases

increases with increasing credible sources of information on the disease. The available

source of information include Television, Radio, internet, pamphlets and books (Wen

et al., 2015). Upadhye &Shembekar, (2017) conducted a study to assess the knowledge

on POCS among 200 medical students. Data were collected from the students using a

structured questionnaire. The study revealed that 33% girls had information from

teacher, 19% got information from friends, 11.5% got information a doctor, 3.5% got

from newspaper, and 5% got information from internet. Seventy-two percent of girls

were aware of PCOS. The study concluded that knowledge of the disorder and

counseling for adolescents should be included in the curriculum. Different levels of

knowledge exist amongst professional health workers and students. In a study among

200 teenage girls, to estimate the level of knowledge on PCOS, majority thus about 123

of the girls had fair knowledge on the condition. The study recommended that

administration of an information booklet on the condition will help teenage girls

understand and have better knowledge on PCOS (Brar, Kaur, & Ramanadin, 2016). The

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internet as a source of information on PCOS has greatly affected knowledge and cleared

a lot of misconception about the disease (Alessa et al., 2017)

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CHAPTER THREE

METHODOLOGY

Introduction

This chapter presents the study design, study area, study population, sample size and

sampling method, inclusion criteria, data collection tools and technique, data

processing and analysis, quality control, ethical consideration and pretesting of data

collection tools.

3.1 Study Design

This study employed a cross-sectional design using quantitative data collection

techniques to collect data among nurses at the La General Hospital in Accra, Ghana.

Data was collected between May and June 2019. Survey was designed to examine

socio-demographic characteristics of participants, perception, level of knowledge and

contributing factors to knowledge level on Polycystic Ovary Syndrome.

3.2.1 Study Site

The study site was the La general hospital, in the La Dadekotopon Municipality, Greater

Accra. The hospital was established in 1963 and become a district hospital in 2004. It

has a bed capacity of 150. The hospital is a primary facility and sees a greater number

of patients compared to other hospitals in the Municipality. The hospital serves

population of La and neighboring communities. The la Dadekotopon municipality has

a population of one hundred and eighty three thousand, five hundred and twenty eight

(183,528). It has a total staff strength of three hundred and forty-seven (347) but has

two hundred and fifty-nine (259) nurses. The hospital has over twenty units that renders

various services to all. The hospital has a dedicated Gynecological department. Other

services provided at the hospital include general medicine, surgery, maternal health,

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dentistry, adolescent counselling and family planning. The hospital serves as a referral

point for other private clinics in and around the La Dadekotopon Municipality (LGH,

2016).

3.2.2 Study population

The study population was all staff nurses at the La General Hospital.

The study population was nurses from the hospital. Nurses from all department in the

hospital especially those from Gynecology and Obstetrics participated in the study.

3.2.3 Sample Size and Sampling Method

The sample size was calculated using Cochran’s (1977) equation for sample size of

proportion.

2
n = 𝑧1−𝛼 P(1 − P)

𝜀2

n = sample size

z = the selected critical value of 1.96 at 95% confidence level,

p = the estimated proportion of good knowledge 10.7% (Sunanda & Sabitha, 2016)

ε = the level of precision of 5%

A minimum sample size of 138 was obtained but after 10% adjustment to account for

non-response rate, a total sample size of 152 was used in data collection. I had initially

planned on obtaining the list of all staff nurses from administration and using simple

random sampling to select participants for the study. However, Most of the selected

nurses refused to consent for the study and others were on leave. Due to the limited

time allocated for data collection, nurses were enrolled consecutively until the

maximum sample size of 152 was obtained. There was 100% response rate.

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3.2.4 Inclusion Criteria

 All staff Nurses of the hospital at the time of data collection were recruited.

 Nurse should have been practicing post training for at least a year.

3.2.5 Exclusion Criteria

 Nurse that were on leave and not present at the time during data collection were

excluded from the study.

 Nurses who did not consent to participate in the study were excluded from the

study.

3.3 Study Tools

A self-administered questionnaire with both open and close-ended questions were used

in this study. Data collected include socio-demographic characteristics such as age,

educational level, marital status, rank and department. Information was also collected

on the perception, knowledge on risk factors associated with PCOS, clinical features,

diagnosis, managements, treatment methods, and complications A questionnaire that

has been validate and used in a similar study by Fannana & Jahangir (2013) was adopted

and modified to suit the objectives of the study.

3.3.2 Method of Data Collection

Nurses from all departments were recruited for this study. The research team stationed

in a private room at the Out patients Departments (OPD) , for the ease of data collection

and nurses were directed to complete the questionnaires there. The principal

investigator approached nurses at their workstations in the hospital, explained study to

them, and those that consented to participate were directed to the OPD to fill out the

questionnaire. Data collection was over a month duration and collected during the day

and night shifts

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3.4 Summary of variables

3.4.1 Dependent variables

 Knowledge Level of Polycystic Ovary Syndrome

 Perceptions about Polycystic Ovary Syndrome.

3.4.2 Independent Variables

 Age (In completed years)

 Educational level (highest level of Education attained)

 Marital status

 Department (Department of work at the hospital)

 Rank (Nurses rank)

 Sources of Information on PCOS

 Experience with Condition (Experience with the condition was defined as either

treated a patient, had a family member, self, or colleague suffer from the

condition)

3.5 Quality Assurance and Data Processing

Research assistants were trained on the ethics of research and questionnaire was pre-

tested at Lekma hospital before data collection began. To prevent participants from

being recruited twice for the study, they were asked if they had already been recruited

for the study, their integrity was counted on. The consent form were cross-checked for

repeated identifiers.

3.6 Data Analysis

Each completed questionnaire was scored on knowledge of risk factors, clinical

features, diagnosis, treatment and complications. There were total of five categories

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under which questions were asked. These categories were clinical features, diagnosis,

risk factors, complications, and management.

Each correct answer attracted a mark of 0.5 and wrong answer attracted no mark.

Clinical features attracted a maximum of 2.5 marks. Respondents were asked to list five

clinical features. For the section on Diagnosis, respondents were required to state the

three main features for diagnosis under Rotterdam criteria or National Institute of

Health criteria for diagnosing PCOS. The maximum scored attained was 1.5. Risk

factors also had three answers which attracted a maximum score of 1.5. For

complications, respondents were expected to provide complications to mother, unborn

child and psychological complications. The maximum score for this section was 2.5

marks. The maximum score for management was 1.0.

The computed scores were further re-categorized as poor, average and good knowledge.

Three levels were used to show a clearer presentation of knowledge. Participants with

less than five overall score were grouped as having poor knowledge; scores from 5 to

7 were grouped under average knowledge and scores greater than 7 were classified as

good knowledge. All respondents that were unaware of the condition were grouped as

having poor knowledge.

Questions on perception were scored on a five point Likert scale ranging from 1-5

depending on the type of answer chosen. Strongly disagree was coded as 1, disagree=

2, neither agree nor disagree =3, agree=4 and strongly agree=5. The scale was further

categorized into a three-point scale having agree, disagree and neither agree nor

disagree.

Statistical analysis were performed using stata version 15. Descriptive statistics were

used to summarize data and chi-square to examine the association between

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demographic data, experience with disease and knowledge as well as perception.

Ordinal Logistic regression was to identify the contributing factors to the knowledge

levels after the proportionality assumption test was performed and it showed no

significance, (P=0.3). Hence, the model was fit for be use.

3.7 Ethical Considerations

Ethical Clearance (GHS-ERC053/02/2019) was sought from the Ghana Health service

Ethics Review committee for approval for this study. Permission was also taken from

the regional health directorate and the administration of the La General Hospital prior

to data collection. The consent of participants was sought by the use of an informed

consent for this study. Participant’s privacy and confidentiality were assured for this

study. This study was voluntary to participant and participation was at his or her own

will. A participant was free to withdraw at from the study at any time during the study.

All soft copy data was kept on a laptop which was password protected. All hardcopy

data and questionnaires were kept under lock and key.

3.7.1 Conflict of Interest

There was no conflict of interest by the researcher.

3.7.2 Funding

This study was self- funded by principal Investigator.

3.7.3 Consent

The details of the study were explained clearly to all participants before they consented

for the study. The fact that they (the participants) were going to be answering a series

of question was explained. In addition, each participant was told that they had the right

to refuse to participate or stop their participation at any point of the data collection

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process. Therefore, participants were free at any point in time during the data collection

process to stop, pause or skip any questions they are not comfortable answering.

Furthermore, each participant received a copy of their consent forms and was be urged

to call the principal investigator or the Ghana Health Service Ethics Review Committee

representative if they feel that their rights have been infringed upon.

3.7.4 Data Storage, Usage and Confidentiality

Participants were assured that their details would be kept completely confidential for

five years and then the questionnaires discarded through burning. Identifiers was

removed in case the work was to be published. Participant personal information was

kept in a locked drawer. No one, apart from the investigator and her supervisor had

access to participant information. Data collected were coded in such a way that none of

the responses could be tied to any one specific participant. There was no way

whatsoever for anyone (except the PI) to be able to identify participants by their

answers to any part of the questionnaire. During data analysis and report writing, log

files and data sets were stored on a laptop protected by password known only to the

principal investigator. If data were to be used again in another study, ethical clearance

will be sort again from the ethical review committee at Ghana Health Service.

3.7.5 Risk and Benefits

This study poses no health risk to the nurses whatsoever, however the time involved in

filling out questionnaire may have pose discomfort to the nurses. There is no direct

benefit to the participants; however, the results of the study would be made available to

the hospital after research.

3.7.6 Reimbursement

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There was no remuneration for this study however; a token of a pen and note pad were

given to nurses for their time.

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CHAPTER FOUR
RESULTS
Table 4.1Shows the summary of Demographic Information of study Participants (pages
27-28)

Characteristics Frequency Percentage (%)

Age(Years)
Mean (SD) 31.07(±0.49)
23-32 96 67.6
33-42 41 28.9
43-52 3 2.1
53-62 2 1.4
Totals 142 100
Sex
Male 41 28.9

Female 101 71.13

Totals 142 100

Marital Status
Single 66 46.5
Married 68 47.9
Divorced 4 2.8
Widowed 4 2.8
Totals 142 100
Highest Qualification
Certificate 20 14.2
Diploma 55 38.7
Higher National Diploma 2 1.4
Degree 65 45.7
Totals 142 100
Department
Out Patient Department 21 14.9
Obstetrics and Gynecology 14 9.9
Emergency 15 10.6

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Characteristics Frequency Percentage (%)

Pediatrics 17 11.9
Surgical 20 14.0
Medical 34 23.9
Reproductive Child Health 21 14.8
Totals 142 100
Rank
Health Assistant Curative 11 7.8
Community Health Nurse 10 7.0
Midwife 8 5.6
Nursing Officer 63 44.4
Senior Midwifery Officer 4 2.8
Senior Nursing Officer 40 28.2
Principal Midwifery Officer 1 0.7
Principal Nursing Officer 5 3.5
Totals 142 100

Source: field data 2018

4.1 Characteristics of study participants

There was 100% response rate for this study; one hundred and fifty-two questionnaires

were sent out and all were received. However, there was ten incomplete questionnaires,

these lacked vital information such as the age and years of experience. Incomplete

questionnaires were excluded from data analysis. One hundred and fifty-two nurses

from all departments at the La General Hospital participated in this study. Thirty-four

(23.9%) of the participants for this study were from the medical department of the

hospital, 14(10.6%) were from the Obstetrics and gynecology, 21(14.8%) were from

RCH departments of the hospital. Amongst the participants recruited 63(44%) were

nursing officers, 8(5.6%) were midwives and 40(28.2%) were senior officers. The mean

age was 31.07(±0.49) years and the age range was between 23-56 years. More than half

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of study participants, 101(71.3%) were females and 68(47.9%) were married. Sixty-

five (45.7%) of the participants had a degree from a university.

4.1.2 Awareness of Polycystic Ovary Syndrome

Majority thus 73(51.4%) of the Nurses were unaware of the condition and 69(49.3%)

were aware of the condition.

4.1.3 Sources of Information for Awareness

25

21(30.4%) 21(30.4%)
20

15 15(21.7%)
Frequency

10

8(11.6%)

5
4(5.8%)

0
Training Internet Another health Media School
program proffessional
Sources of Information

Figure 4.1.3 A graph showing the sources of awareness of PCOS

Source: field data 2018

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Table 4.1.4 The experience with PCOS

Experience with condition N (%)

Colleague had Relative or self-
Variables Treated Patient condition had condition
Experience 9(6.3) 19(13.4) 16(11.3)
No
Experience 56(39.4) 42(29.6) 46(32.4)
Don't Know 77(54.2) 81(57.0) 80(56.3)
Totals 142(100) 142(100) 142(100)
Source: field data 2018

4.1.4 Nurses Experience with PCOS

Overall, those that had experience with the condition were 30(20.98) and 112(79.0) did

not have experience with PCOS.

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4.2 Level of Knowledge of Nurses on PCOS

Out of the 69(49.3%) of the Nurses that were aware of the condition, 90(63.4%) had

poor knowledge on the condition, the rest had average and excellent knowledge on the

condition. The mean knowledge score was 5.89 (SD= ±0.31). Below is a figure showing

the distribution of knowledge levels among nurses of La General Hospital.

100

90(63.4%)
90

80

Knowledge Levels
70

60
Frequency

50

40

30 27(19.1%)
25(17.6%)

20

10

0
Poor knowledge Average Excellent

Figure 4.2 A Bar chart showing knowledge levels of Nurses

Source: field data 2018

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Table 4.3 Shows the association between socio-demographic characteristics and

knowledge level.

Knowledge level
Variables Poor Average Excellent Chi P-value
N (%)
Age (years) 6.34 0.385
23-32 60(42.3) 21(14.8) 15(10.6)
33-42 28(19.7) 5(3.5) 8(5.6)
43-52 2(1.4) 0 1(0.7)
53-62 0 1(0.7) 1(0.7)
Sex 14.95 <0.001
Male 36(25.4) 2(1.4) 3(2.1)
Female 54(38.0) 25(17.6) 22(15.5)
Marital status 7.57 0.27
Single 42(29.6) 16(11.3) 8(5.6)
Married 42(29.6) 10(7.0) 16(11.3)
Divorced 3(2.1) 0 1(0.7)
Widowed 3(2.1) 1(0.7) 0
Education Qualification 7.57 0.27
Certificate 13(9.2) 4(2.8) 3(2.1)
Diploma 39(27.5) 11(7.7) 5(3.5)
Higher National Diploma 1(0.7) 1(0.7) 0
Degree 37(26.1) 11(7.7) 17(12.0)
Rank 25.97 0.06
Community Health Nurse 10(7.0) 0 0
Health Assistant 10(7.0) 1(0.7) 0
Midwife 5(3.5) 1(0.7) 2(1.4)
Nursing Officer 33(23.2) 16(11.3) 14(9.9)
Principal Midwifery Officer 0 1(0.7) 0
Senior Midwifery Officer 1(0.7) 1(0.7) 2(1.4)
Senior Nursing Officer 26(18.3) 8(5.6) 7(4.9)
Department 22.4 0.07
Out Patients Department 9(6.3) 6(4.2) 6(4.2)
Obstetrics &Gynecology 4(2.8) 4(2.8) 6(4.2)

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Knowledge level
Variables Poor Average Excellent Chi P-value
N (%)
Emergency 9(6.3) 3(2.1) 3(2.1)
Pediatrics 14(9.9) 3(2.1) 0
Surgical 17(12.0) 1(0.7) 2(1.4)
Medical 21(14.8) 7(4.9) 6(4.2)
Reproductive and Child Health 16(11.3) 3(2.1) 2(1.4)

* Significance at p< 0.05

4.3 Association Between Knowledge levels and Sociodemographic Characteristics

of Respondents

Chi square was performed to find out the association between independent variables

and the primary outcome variable which is knowledge level. After the analysis, sex and

experience with the condition were found to have an association with knowledge level

of nurses.

The younger the nurse the lower the knowledge level on PCOS. Married nurses

recorded the highest number of excellent knowledge levels. Divorced and widowed

levels showed lower levels of knowledge. Nurses having a university education showed

higher levels of knowledge compared to other education qualifications. Nursing

officers had better knowledge levels compared to other ranks. For midwives, the higher

the rank the lower the number of nurses that had higher knowledge levels. The OPD,

Obstetrics, Gynecology, and Medical departments had six nurses each having excellent

knowledge, however nurses from the emergency department had all respondents having

average and excellent knowledge levels.

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Table 4.3.1 The Association between Knowledge levels, Experience with the condition
and Sources of information among Nurses

Knowledge Levels
Variables Poor Average Excellent Chi P-value
Experience with
condition 30.28 <0.001
No Experience 83(54.5) 18(12.6) 11(7.75)

Experience 7(4.9) 9(6.3) 14(9.9)

Source of Information 5.51 0.70

Training Program 1(0.7) 4(2.8) 3(2.1)

Internet 7(4.9) 6(4.2) 8(5.6)

Another Health

Professional 3(2.1) 7(4.9) 5(3.5)

Media 2(1.4) 2(1.4) 0

School 4(2.8) 8(5.6) 9(6.3)

* Significance at p< 0.05

4.3.1 Association between Non-demographic Characteristics and Knowledge

Level.
Chi square used to test the association between known demographic characteristics

showed no sufficient association except sex however, with regards to non-demographic

characteristics experience with the condition showed sufficient relationship with

knowledge levels (chi=30.28, P<0.001).

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Table 4.4 Factors associated with Nurses having higher knowledge of PCOS

Odds Ratio of
Higher [95% P-
Variables Knowledge Conf. Interval] value
Sex
Male Ref
Female 1.45 0.155 13.571 0.75
Educational Qualification
Certificate Ref
Diploma 0.17 0.027 1.202 0.17
Higher National Diploma 0.33 0.004 2.605 0.07
Degree 1.12 0.180 6.967 1.04
Department
Out Patients Department Ref
Obstetrics and Gynecology 2.81 0.309 23.302 0.34
Emergency 1.33 0.136 13.004 0.80
Pediatrics 0.08 0.008 0.911 0.04
Surgical 0.33 0.211 5.134 0.42
Medical 0.19 0.379 0.978 0.45
Reproductive and Child Health 0.40 0.050 3.181 0.38
Source of Information
Training Program Ref
Internet 0.24 0.316 1.783 0.16
Another health Professional 0.28 0.312 2.577 0.26
Media 0.06 0.005 0.909 0.04
School 0.68 0.885 5.270 0.72
Experience with Condition
Experience 2.47 0.374 16.318 0.35
No Experience Ref
Age
23-32 Ref
33-42 0.64 0.177 2.309 0.50
43-52 796224.5 0 1.00
53-62 0.10 0.002 5.200 0.25

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* Significance at p< 0.05

4.4 Factors associated with Nurses having higher knowledge of PCOS

Ordinal Logistic regression was used to predict the association between knowledge

levels and independent variables. Factors that were associated with knowledge included

Department and sources of information. Pediatric department was significantly

associated with lower knowledge. If a nurse worked in the pediatric department, she

was 92% less likely to possess higher knowledge of PCOS compared to if she worked

in OPD. (OR= 0.08.CI= 0.008-0.911, P<0.05). Media as a source of information was

associated with lower knowledge. If a nurse had media as a source of information, she

was 94% less likely to have higher knowledge about PCOS compared to if she heard

her information from a training program (OR=0.06, CI= 0.005-0.909, P<0.05).

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Table 4.5 Shows the Perception of Nurses on Polycystic Ovary Syndrome

Variable Agree Neutral Disagree

N (%)
Difficulty associating with people 24(34.8) 11(15.9) 34(49.3)
PCOS patients are depressed 43(62.3) 10(14.5) 16(23.2)
PCOS patients require support 48(69.6) 5(7.3) 16(23.2)
PCOS patients are suicidal 11(15.9) 14(20.3) 44(63.8)
PCOS is difficult to live with 29(42.0) 16(23.2) 24(34.7)
PCOS patients are not proper women 7(10.1) 6(8.7) 56(81.2)
PCOS cannot be managed 37(53.6) 14(20.3) 18(26.1)
PCOS patients have low body image 29(42) 16(23.2) 24(34.8)
PCOS cannot be controlled 8(11.6) 3(4.35) 58(84.1)
Anxious about Having PCOS 18(26.1) 4(5.8) 47(68.1)
PCOS is hereditary 17(24.6) 9(13.0) 43(62.3)
PCOS is a permanent condition 17(24.6) 9(13.0) 43(62.3)
The name is confusing 28(40.6) 8(11.6) 33(47.8)

4.5 Perception of Nurses on Polycystic Ovary Syndrome

Likert scale was used to evaluate individual perception of respondents regarding PCOS.

Majority of the respondents disagreed to the fact that PCOS patients had difficulty

associating with people. They are not suicidal although they are depressed. They also

disagreed to the fact that they are not proper women even though they have low body

image. They agreed to the fact that PCOS patients require social support because the

condition is difficult to live with. The respondents did not feel anxious about having

PCOS. Negative perceptions associated with the condition were low body image and

difficulty leaving with the condition. Some misconceptions were spotted from the

responses given. The condition is hereditary and can be managed.

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CHAPTER FIVE

DISCUSSION

5.1 Awareness and Knowledge level of respondents

It is common for people suffering from an ailment to have low level of knowledge and

misconceptions about the condition due to beliefs associated with the condition. It is

natural to assume nurses will have a better knowledge and no misconceptions about

conditions. However, in this study there was a high level of unawareness, poorer

knowledge levels and misconceptions associated with the conditions.

Nurses play a role in patient education during the caregiving process, during the process

they pass on their knowledge about the condition to patients. When nurses are unaware

about a condition and have low knowledge, there is a tendency of transmitting wrong

information to the patients and this will result in misconceptions about the condition.

Polycystic Ovary Syndrome is prevalent among women with fertility issues as this

condition is a major contributor to infertility among women. Various misconceptions

and wrong information have been passed across because of the lack or inadequate

information sources available to them.

Nurses were generally not knowledgeable because they were neither aware nor had

experience with the condition. These results are in contrast with other studies conducted

among nursing students and other health professionals. In a similar study conducted

among nursing students in India, more of the respondents had average knowledge

compared to this study. The study population in the India study were all females in the

same school. This study has revealed that sex is associated with being knowledgeable

about the condition, hence the higher level of average knowledge in their study (Haq,

Khan, Riaz, Nasim, & Tahir, 2017)

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In another study conducted in the United States of America amongst physicians, one

third of the respondents in the study did not know the diagnostic criteria they used in

diagnosing the condition. They were also unaware of the cardio metabolic

comorbidities associated with the condition, however the psychological complications

such as depression, anxiety and low quality of life were mentioned (Dokras et al., 2017).

Gaps in knowledge with regards to diagnostic criteria used and complications of the

condition negatively affects the knowledge of Physicians. In another study, amongst

adolescent girls (Upadhye & Shembekar, 2017) only a third were aware of the condition

and this is similar to the results obtained in this study.

5.2 Perception of Respondents

Various misconceptions are attributed to the condition, however, among nurses these

misconceptions should not exist. It was unexpected when this study found that nurses

had misconceptions about the condition. The misconceptions they had were with the

condition was not manageable; it was not hereditary and was difficult to live with.

These misconceptions exist because nurses have poor knowledge on the condition and

they have not had enough experience with the condition as well. Although majority of

the respondents agreed to depression, being associated with the condition they

disagreed to the fact that the patients had suicidal ideations. Negative perception

associated with the condition were depression and low body image. Although the PCOS

patients were depressed, respondents agreed to the fact that they were not suicidal yet

required social support to cope with living with the condition. Positive perceptions were

condition being temporal, proper women and condition can be controlled. Despite them

agreeing to the name being confusing, they were not anxious about having the

condition. This results is similar with a study conducted by Colwell et al (2010). The

study also concluded on the name being confusing. The results of this study is also

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similar to a study conducted by Yoo et al ( 2003). Respondents from their study agreed

that PCOS patients have low self-image and are depressed. Another study also

confirmed the results of this study as it concluded that the condition was difficult to live

with and patients are depressed (Williams et al., 2015)

5.3 Factors associated with higher knowledge of Nurses on PCOS

From various studies that have been reviewed, knowledge was associated with the

source of information, socio-demographic characteristics such as age, and if

respondents have had any health education on the condition, regardless in this study the

socio-demographic feature associated with knowledge was sex. Source of information

was also associated with knowledge.

In testing the strength of association, Department and source of knowledge were

associated with higher knowledge level. Despite Internet and School being the highest

source of information, training programs were preferred as a source of obtaining

knowledge compared to media. It is therefore expedient to encourage more training

programs for health professionals .

Nurses from pediatric department had higher knowledge levels compared to nurses

from other departments. This may be because nurses from those department probably

had experience with the condition and may have done rotations previously in the

Obstetric and Gynecology department. All the nurses from pediatrics were also females

so they having higher knowledge is not astonishing as females are the ones affected

compared to males. This result is consistent with another study conducted by Alessa et

al. (2017). The study also found the internet as the highest source of information on

PCOS to all especially adolescent girls. In contrast, age was found to be associated with

knowledge. Although age negatively correlated to knowledge in their study. Experience

with the condition was also found to be associated with knowledge by some studies

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however; in this study experience was not associated with knowledge (Alessa et al.,

2017). Sources of information were also found to be associated with knowledge level,

in this study not all the sources of information was associated. Only the media as a

source of information was associated with knowledge. Other sources of information on

PCOS was another health professional, through a training programme, internet and

books.

5.4 Limitation of Study

Despite the use of a large sample size in this study, non-probability sampling method

was used and as such, some limitations should be noted when drawing conclusions from

this study. The study sample is not representative of the entire nurse population at the

La General Hospital. Findings from this study however should not be generalized to the

entire nurse population of Accra.

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CHAPTER SIX

SUMMARY, CONCLUSION AND RECOMMENDATIONS

6.0 Summary of Findings

At the end of the study majority of the respondents were unaware of the condition.

Knowledge level was very low amongst nurses as more than half of the respondents

had poor knowledge. Factors associated with knowledge were from chi square analysis

were sex and experience with the disease, however after the ordinal logistic regression,

media as a source of knowledge and pediatric department were strongly associated with

lower knowledge levels. Various misconceptions associated with the condition were

that the condition was difficult to live with; it was not hereditary and cannot be

managed. The negative perceptions associated with the disease were the fact that

women with the condition had low body image, and are depressed. Although the women

may be depressed, the respondents agreed to the fact that they were not suicidal.

Positive perceptions associated with the condition that majority of the respondents were

not anxious about having the condition, women did not have difficulty associating with

people, are proper women, condition is not permanent and can be controlled. They also

agreed that the name itself was confusing

6.1 Conclusion

The main objective of this research was to determine the level of knowledge, perception

and factors associated with knowledge of Polycystic Ovary Syndrome among nurses at

La General Hospital, Accra Ghana. There is low level of knowledge among nurses at

the La General hospital and this is because of inadequate experience with the condition

as well as the fact that more than half of respondents were unaware of the condition.

Factors contributing to knowledge was sex and experience with the condition. Females

were more knowledgeable compared to the male nurses for this study. This is not

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surprising as PCOS is a condition affects women. Those that had experience with the

condition were more knowledgeable than those without experience with the condition

were. Factors contributing to higher knowledge levels were source of information and

department of work. The media as a source of knowledge and pediatric department

showed correlation to higher levels. From this study, depression and difficulty living

with the condition were associated with the condition. Suicidal ideations, conditions

being permanent and not being proper women were not associated with the condition.

6.2 Recommendations

6.2.1 Recommendations to Researchers

 Similar studies should be conducted across various facilities among Nurses.

6.2.2 Recommendations to Ghana Health Service

• Ghana Health Service should institute a campaign to create awareness on

Polycystic Ovary Syndrome among nurses.

• In service, training unit of the hospital should conduct frequent training session

for staff nurses to educate them and clear all misconceptions they may have on

the condition.

• Ghana Health Service should collaborate with NGOs who are involved on

female reproductive issues to run workshops aimed at creating awareness and

educating nurses on Polycystic Ovary Syndrome.

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REFERENCES

Alessa, A., Aleid, D., Almutairi, S., Alghamdi, R., Huaidi, N., Almansour, E., & Youns,
S. (2017). Awareness of polycystic ovarian syndrome among Saudi females.
International Journal of Medical Science and Public Health, (6).
https://doi.org/10.5455/ijmsph.2017.0202507022017

Ali Minhal Thaver and Ameera kamal. (2010). Impact of information sources on the
knowledge of adolescents about hepatitis B. Journal of Pakistan Medical
Association, 60, 1072–1075. Retrieved from
http://jpma.org.pk/full_article_text.php?article_id=2471

AlSinan, A., & Shaman, A. A. (2017). A Study to Measure the Health Awareness of
Polycystic Ovarian Syndrome in Saudi Arabia. Global Journal of Health Science,
9(8), 130. https://doi.org/10.5539/gjhs.v9n8p130

Alumran, A., Hou, X., & Hurst, C. (2013). Assessing the overuse of antibiotics in
children in Saudi Arabia : validation of the parental perception on antibiotics scale
( PAPA scale ), 1–8.

Badawy, A., & Elnashar, A. (2011). Treatment options for polycystic ovary syndrome.
International Journal of Women’s Health, 3, 25–35.
https://doi.org/10.2147/IJWH.S11304

Blackshaw, L. C. D., Chhour, I., Stepto, N. K., & Lim, S. S. (2019). Barriers and
Facilitators to the Implementation of Evidence-Based Lifestyle Management in
Polycystic Ovary Syndrome: A Narrative Review. Medical Sciences, 7(7), 76.
https://doi.org/10.3390/medsci7070076

Blake, H., & Harrison, C. (2013). Health behaviours and attitudes towards being role
models. British Journal of Nursing. https://doi.org/10.12968/bjon.2013.22.2.86

Blendon, R. J., Benson, J. M., Wikler, E. M., Weldon, K. J., Georges, J., Baumgart, M.,
& Kallmyer, B. A. (2012). The Impact of Experience with a Family Member with
Alzheimer’s Disease on Views about the Disease across Five Countries.
International Journal of Alzheimer’s Disease, 2012, 1–9.
https://doi.org/10.1155/2012/903645

Boomsma CM, Eijkemans MJ, Hughes EG, Visser GH, Fauser BC, M. N. (2006). A
meta-analysis of pregnancy outcomes in women with polycystic ovary syndrome,
12(6), 673–683. https://doi.org/10.1093/humupd/dml036

Bozdag, G., Mumusoglu, S., Zengin, D., Karabulut, E., & Yildiz, B. O. (2016). The
prevalence and phenotypic features of polycystic ovary syndrome: a systematic
review and meta-analysis. Human Reproduction, 31(12), 2841–2855.
https://doi.org/10.1093/humrep/dew218

Brar, K., Kaur, T., & Ramanadin, P. V. (2016). Knowledge regarding Poly Cystic
Ovarian Syndrome (PCOS) among the Teenage Girls. International Journal of
Nursing Education and Research, 4(2), 136. https://doi.org/10.5958/2454-
2660.2016.00031.4

45
 University of Ghana http://ugspace.ug.edu.gh

Choudhary, A., Jain, S., & Chaudhari, P. (2017). Prevalence and symptomatology of
polycystic ovarian syndrome in Indian women: is there a rising incidence?
International Journal of Reproduction, Contraception, Obstetrics and
Gynecology; Vol 6, No 11 (2017): November 2017DO - 10.18203/2320-
1770.Ijrcog20175010 , 6(11), 4971–4975. Retrieved from
http://www.ijrcog.org/index.php/ijrcog/article/view/3590

Colwell, K., Lujan, M. E., Lawson, K. L., Pierson, R. A., & Chizen, D. R. (2010).
Women’s Perceptions of Polycystic Ovary Syndrome Following Participation in a
Clinical Research Study: Implications for Knowledge, Feelings, and Daily Health
Practices. Journal of Obstetrics and Gynaecology Canada, 32(5), 453–459.
https://doi.org/10.1016/S1701-2163(16)34499-1

Dalal, M., Babu, M., & Rastogi, M. S. (n.d.). An Exploratory Survey To Assess The
Knowledge, Practice And Prevalence Of Polycystic Ovarian Syndrome Among
Women Attending Gyne OPD Of Selected Hospital Of Delhi With A View To
Develop A Health Care Package On Polycystic Ovarian Syndrome And Its
Manageme (Vol. 3). Retrieved from www.iosrjournals.orgwww.iosrjournals.org

Daniilidis, A., & Dinas, K. (2009). Long term health consequences of polycystic
ovarian syndrome: a review analysis. Hippokratia, 13(2), 90–92. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/19561777

Ding, T., Hardiman, P. J., Petersen, I., Wang, F.-F., Qu, F., & Baio, G. (2017). The
prevalence of polycystic ovary syndrome in reproductive- aged women of
different ethnicity: a systematic review and meta-analysis. Oncotarget, 8(56),
96351–96358. Retrieved from
www.impactjournals.com/oncotarget%0Awww.impactjournals.com/oncotarget/

Dokras, A., Saini, S., Gibson-Helm, M., Schulkin, J., Cooney, L., & Teede, H. (2017).
Gaps in knowledge among physicians regarding diagnostic criteria and
management of polycystic ovary syndrome. Fertility and Sterility, 107(6).
https://doi.org/10.1016/j.fertnstert.2017.04.011

Ehrmann, D. A. (2005). Polycystic ovary syndrome. N Engl J Med, 352(12), 1223–

1236. https://doi.org/10.1016/S0140-6736(07)61345-2

Gibson-Helm, M. E., Lucas, I. M., Boyle, J. A., & Teede, H. J. (2014). Women’s
experiences of polycystic ovary syndrome diagnosis. Family Practice, 31(5), 545–
549. https://doi.org/10.1093/fampra/cmu028

Gul, S., Zahid, S. A., & Ansari, A. (2014). Original Article PCOS : Symptoms and
Awareness in Urban Pakistani Women. International Journal of Pharma Research
and Health Sciences, 2(5), 356–360.

Gupta, M., Singh, D., Toppo, M., Priya, A., Sethia, S., & Gupta, P. (2017). A cross
sectional study of polycystic ovarian syndrome among young women in Bhopal,
Central India. International Journal Of Community Medicine And Public Health,
5(1), 95. https://doi.org/10.18203/2394-6040.ijcmph20175603

Haq, N., Khan, Z., Riaz, S., Nasim, A., & Tahir, M. (2017). Prevalence and Knowledge
of Polycystic Ovary Syndrome ( PCOS ) Among Female Science Students of

46
 University of Ghana http://ugspace.ug.edu.gh

Different Public ... Prevalence and Knowledge of Polycystic Ovary Syndrome (

PCOS ) Among Female Science Students of Different Public Universities of
Quetta ,. Imperial Journal of Interdisciplinary Research, 35(June), 385–392.

Hussein, B., & Alalaf, S. (2013). Prevalence and characteristics of polycystic ovarian
syndrome in a sample of infertile Kurdish women attending IVF infertility center
in maternity teaching hospital of Erbil City. Open Journal of Obstetrics and
Gynecology, 03(07), 577–585. https://doi.org/10.4236/ojog.2013.37104

Jahangir, S. (2013). A STUDY ON KNOWLEDGE & AWARENESS OF

POLYCYSTIC OVARIAN SYNDROME AMONG FEMALE NON MEDICAL
Submitted To Tilka Fannana Submitted By Safa Jahangir ID : 2013-3-70-001
Department of Pharmacy East West University.

Khalil W.K.B, Ghaly I.S, D. K. A. . (2010). International Journal of Pharmacy Practice.

Conference: 5, 4(3), 68–82. https://doi.org/10.1016/j.ijpharm.2010.06.045

Kitzinger, C., & Willmott, J. (2002). “The thief of womanhood”: women’s experience
of polycystic ovarian syndrome. Social Science & Medicine (1982), 54(3), 349–
361. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11824912

Ko, H., Teede, H., & Moran, L. (2016). Analysis of the barriers and enablers to
implementing lifestyle management practices for women with PCOS in Singapore.
BMC Research Notes, 9(1), 311. https://doi.org/10.1186/s13104-016-2107-2

Kovacs, G., & Norman, R. (2007). Polycystic Ovary Syndrome, 1–363.

https://doi.org/10.1056/NEJM199509283331307

Kvåle, K., & Bondevik, M. (2010). Patients’ Perceptions of the Importance of Nurses’
Knowledge About Cancer and Its Treatment for Quality Nursing Care. Oncology
Nursing Forum, 37(4), 436–442. https://doi.org/10.1188/10.ONF.436-442

Lin, A. W., Bergomi, E. J., Dollahite, J. S., Sobal, J., Hoeger, K. M., & Lujan, M. E.
(2018). Trust in Physicians and Medical Experience Beliefs Differ Between
Women With and Without Polycystic Ovary Syndrome. Journal of the Endocrine
Society, 2(9), 1001–1009. https://doi.org/10.1210/js.2018-00181

Lizneva, D., Suturina, L., Walker, W., Brakta, S., Gavrilova-Jordan, L., & Azziz, R.
(2016). Criteria, prevalence, and phenotypes of polycystic ovary syndrome.
Fertility and Sterility, 106(1), 6–15.
https://doi.org/10.1016/j.fertnstert.2016.05.003

Loriaux, D. L. (2012). An approach to the patient with hirsutism. Journal of Clinical

Endocrinology and Metabolism, 97(9), 2957–2968.
https://doi.org/10.1210/jc.2011-2744

McDonnell, R., & Hart, R. J. (2017). Pregnancy-related outcomes for women with
polycystic ovary syndrome. Women’s Health, 13(3), 89–97.
https://doi.org/10.1177/1745505717731971

Mohamed, H. A. A. (2016). Effect of educational program on the level of knowledge

regarding polycystic ovarian syndrome among adolescent girls. Journal of

47
 University of Ghana http://ugspace.ug.edu.gh

Nursing Education and Practice, 6(10), 80–87.

https://doi.org/10.5430/jnep.v6n10p80

Naidoo, S., Mahomed, O. H., Asmall, S., & Taylor, M. (2014). Nurses’ knowledge of
chronic disease management. Health SA Gesondheid.
https://doi.org/10.4102/hsag.v19i1.809

Nidhi, R., Padmalatha, V., Nagarathna, R., & Amritanshu, R. (2011). Prevalence of
Polycystic Ovarian Syndrome in Indian Adolescents. Journal of Pediatric and
Adolescent Gynecology, 24(4), 223–227.
https://doi.org/10.1016/j.jpag.2011.03.002

Ogueh, O., Zini, M., Williams, S., & Ighere, J. (2014). The Prevalence of Polycystic
Ovary Morphology Among Women Attending a New Teaching Hospital in
Southern Nigeria. Afr J Reprod Health, 18(1), 161–164. Retrieved from
https://pdfs.semanticscholar.org/6ef4/521e18c6cb9091b9ac778610969fcc2b4c47
.pdf

Palomba, S., Santagni, S., Falbo, A., & La Sala, G. B. (2015). Complications and
challenges associated with polycystic ovary syndrome: Current perspectives.
International Journal of Women’s Health, 7, 745–763.
https://doi.org/10.2147/IJWH.S70314

Paterick, T. E., Patel, N., Tajik, A. J., & Chandrasekaran, K. (2017). Improving health
outcomes through patient education and partnerships with patients. Proceedings
(Baylor University. Medical Center), 30(1), 112–113.
https://doi.org/10.1080/08998280.2017.11929552

Pillai, A., Bang, H., & Green, C. (2007). Metformin & glitazones: do they really help
PCOS patients? (Provisional abstract), 56(6), 444–453. Retrieved from
http://onlinelibrary.wiley.com/o/cochrane/cldare/articles/DARE-
12007006049/frame.html

Pitchai, P., Sreeraj, S., & Anil, P. (2016). Awareness of lifestyle modification in
females diagnosed with polycystic ovarian syndrome in India: explorative study.
International Journal of Reproduction, Contraception, Obstetrics and
Gynecology, 5(2), 470–476. https://doi.org/10.18203/2320-1770.ijrcog20160393

Qureshi S.S, G. J. . & S. K. (2016). Prevalence and risk factor of polycystic ovarian
syndrome. Asian Journal of Pharmaceutical and Clinical Research, 9(2), 23–25.
Retrieved from
http://innovareacademics.in/journals/index.php/ajpcr/article/download/10202/40
20%5Cnhttp://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed
13&NEWS=N&AN=20160197866

Rizvi, M., Abbas, A., Tanwir, S., Sabah, A., Ali, Z. M., Sundrani, M., … Mir, H. A.
(2014). IJPT PERCEPTION AND ATTITUDE OF PATIENTS REGARDING
POLYCYSTIC OVARIAN SYNDROME (PCOS) IN TERTIARY CARE
HOSPITALS OF PAKISTAN-A SURVEY BASED STUDY. International
Journal of Pharmacy & Therapeutics, 5(3), 147. Retrieved from
www.ijptjournal.com

48
 University of Ghana http://ugspace.ug.edu.gh

Sam, S. (2007). Obesity and Polycystic Ovarian Syndrome. Obesity Management, 3(2),
69–73. https://doi.org/10.1089/obe.2007.0019.Obesity

Setji, T. L., & Brown, A. J. (2007). Polycystic Ovary Syndrome: Diagnosis and
Treatment. The American Journal of Medicine, 120(2), 128–132.
https://doi.org/10.1016/j.amjmed.2006.06.029

Shaw, J. E., Sicree, R. A., & Zimmet, P. Z. (2010). Global estimates of the prevalence
of diabetes for 2010 and 2030. Diabetes Research and Clinical Practice, 87(1), 4–
14. https://doi.org/10.1016/j.diabres.2009.10.007

Sirmans, S. M., & Pate, K. A. (2014). Epidemiology-diagnosis-and-management-of-

polycystic-ovary-s, 1–13. https://doi.org/10.2147/CLEP.S37559

Sunanda, B., & Nayak, S. (2016). A Study to Assess the Knowledge Regarding PCOS
( Polycystic Ovarian Syndrome ) among Nursing Students at NUINS ., 24–26.

Teede, H., Gibson-Helm, M., Norman, R. J., & Boyle, J. (2014a). Polycystic ovary
syndrome: Perceptions and attitudes of women and primary health care physicians
on features of pcos and renaming the syndrome. Journal of Clinical Endocrinology
and Metabolism, 99(1), 107–111. https://doi.org/10.1210/jc.2013-2978

Teede, H., Gibson-Helm, M., Norman, R. J., & Boyle, J. (2014b). Polycystic Ovary
Syndrome: Perceptions and Attitudes of Women and Primary Health Care
Physicians on Features of PCOS and Renaming the Syndrome. The Journal of
Clinical Endocrinology & Metabolism, 99(1), E107–E111.
https://doi.org/10.1210/jc.2013-2978

Tian, M., Chen, Y., Zhao, R., Chen, L., Chen, X., Feng, D., & Feng, Z. (2011). Chronic
disease knowledge and its determinants among chronically ill adults in rural areas
of Shanxi Province in China: a cross-sectional study. Retrieved from
http://www.biomedcentral.com/1471-2458/11/948

Tomlinson, J., Letherby, G., Pinkney, J., Millward, A., & Stenhouse, E. (2013). Raising
awareness of polycystic ovary syndrome. Nursing Standard (Royal College of
Nursing (Great Britain) : 1987), 27(40), 35–39. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/23909179

Upadhye, J. J., & Shembekar, C. A. (2017). Awareness of PCOS (polycystic ovarian

syndrome) in adolescent and young girls. International Journal of Reproduction
Contraception, Obstetrics and Gynecology Int J Reprod Contracept Obstet
Gynecol, 66(66), 2297–2301. https://doi.org/10.18203/2320-
1770.ijrcog20172119

Vos, T., Flaxman, A. D., Naghavi, M., Lozano, R., Michaud, C., Ezzati, M., … Murray,
C. J. L. (2012). Years lived with disability (YLDs) for 1160 sequelae of 289
diseases and injuries 1990&#x2013;2010: a systematic analysis for the Global
Burden of Disease Study 2010. The Lancet, 380(9859), 2163–2196.
https://doi.org/10.1016/S0140-6736(12)61729-2

Wang, M., Han, X., Fang, H., Xu, C., Lin, X., Xia, S., … Tao, H. (2018). Impact of
Health Education on Knowledge and Behaviors toward Infectious Diseases among

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 University of Ghana http://ugspace.ug.edu.gh

Students in Gansu Province, China. BioMed Research International, 2018, 1–12.

https://doi.org/10.1155/2018/6397340

Wen, Y., Wang, H., Chen, B., Chen, Y., Zhang, T., Xu, T., & Sun, W. (2015).
Association of Information Sources and Knowledge on HIV/AIDS in Rural China.
International Journal of Collaborative Research on Internal Medicine & Public
Health, 7(2), 13–23. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/25834646

WHO | Infertility definitions and terminology. (2016). WHO. Retrieved from

https://www.who.int/reproductivehealth/topics/infertility/definitions/en/

Williams, S., Sheffield, D., & Knibb, R. C. (2015). “Everything’s from the inside out
with PCOS”: Exploring women’s experiences of living with polycystic ovary
syndrome and co-morbidities through SkypeTM interviews. Health Psychology
Open, 2(2), 2055102915603051. https://doi.org/10.1177/2055102915603051

Wolf, W. M., Wattick, R. A., Kinkade, O. N., & Olfert, M. D. (2018a). Geographical
Prevalence of Polycystic Ovary Syndrome as Determined by Region and
Race/Ethnicity. International Journal of Environmental Research and Public
Health, 15(11). https://doi.org/10.3390/ijerph15112589

Wolf, W. M., Wattick, R. A., Kinkade, O. N., & Olfert, M. D. (2018b). Geographical
prevalence of polycystic ovary syndrome as determined by region and
race/ethnicity. International Journal of Environmental Research and Public
Health. https://doi.org/10.3390/ijerph15112589

Yoo, R. Y., Adams, J., & Chang, R. J. (2003). Questionnaire on self-perception and
behavior of adolescent girls with polycystic ovary syndrome (PCOS). Fertility and
Sterility, 80, 3. https://doi.org/10.1016/S0015-0282(03)01808-9

Yu, S.-H., Guo, A.-M., & Zhang, X.-J. (2014). Effects of self-management education
on quality of life of patients with chronic obstructive pulmonary disease.
International Journal of Nursing Sciences, 1(1), 53–57.
https://doi.org/10.1016/J.IJNSS.2014.02.014

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APPENDIX

Appendix 1: Questionnaire

Date …………….

Questionnaire code…………..

KNOWLEDGE AND PERCEPTION OF POLY CYSTIC OVARY SYNDROME

AMONG NURSES IN ACCRA

(All the questions asked are for research purpose only and all the information will be

kept confidential) Place circle your choice of answer

A. Demographic Information

1. Date of birth: …………….

2. Sex: 1. Male 2. Female

3. Marital status: 1. Single 2. Married 3. Divorced 4. Widowed

4. Education (qualification): 1. Certificate 2. Diploma 3. HND 4. Degree

5. Rank ………………………………………………………….

6. Which department do you work in? 1. OPD 2. Obstetrics’ and Gynecology 3.

Emergency 4. Pediatrics 5. Surgical 6. Medicals 7.RCH

7. How long have you been working as a Nurse? Years……….

B. Awareness and Sources of Information Polycystic Ovary Syndrome

(PCOS)

8. Have you heard of Polycystic Ovary Syndrome is? 1. Yes 2. No

(Discontinue interview if answer is no)

9. Where did you hear of PCOS? 1. Through a training program 2. Internet 3.

Another health professional 4. Media 5. Print media 6. In school

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10. Have you had any form of health education on PCOS? 1. Yes 2. No 3. I don’t

know

11. If yes, where did you get the health education? ……………………..........

12. Have you treated any patients with PCOS? 1. Yes 2. No 3. I don’t remember

13. Has any close relative or have you suffered from PCOS before? 1. Yes 2. No

3. I don’t remember

14. Have any of your colleagues suffered from PCOS before? 1. Yes 2. No 3. I

don’t remember

C. Knowledge On Polycystic Ovary Syndrome

CLINICAL 16.List 5 clinical features of PCOS

FEATURES ………………………………………………………………………

………………………………………………………………………

…………………………………………………………………

………………………………………………………………………

DIAGNOSIS 17. How is PCOS diagnosed?

………………………………………………………………………

……

………………………………………………………………………

………………………………………………………………………

18. List three risk factors associated with PCOS?

RISK FACTORS ………………………………………………………………………

………………………………………………………………………

………………………………………………………………………

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COMPLICATIONS 19.What are three long term complications of PCOS to the woman?

…………………………………………………………………….

……………………………………………………………………..

…………………………………………………………………….

20. What are two complications of PCOS to the unborn child?

………………………………………………………………….

……………………………………………………………………

……………………………………………………………………

21. List two psychological complications associated with PCOS?

………………………………………………………………………

………………………………………………………………………

MANAGEMENT 22.List two ways PCOS be managed?

………………………………………………………………………..

……………………………………………………………………….

………………………………………………………………………

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D. Perception on Polycystic Ovary Syndrome

For each of the following questions choose from the following alternatives

Strongly Disagree Neither Agree Strongly

disagree agree nor agree

disagree

23.The name PCOS is

confusing and gives no

clue about the disease

24.PCOS is hereditary

and can be transferred

from mother to

daughter

25.PCOS is a

permanent condition

and cannot be cured

26.PCOS cannot be

managed through diet

and exercising

27.PCOS patients have

no control over the

disease

28.PCOS patients have

low body image

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29.I feel anxious about

having PCOS

30.PCOS is a difficult

condition to live with

31.Women with PCOS

are not proper women

32.Women with PCOS

are suicidal

33.Depression is

associated with women

with PCOS

34.PCOS patients have

trouble associating with

other people

35.PCOS patients

require support social

support

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Appendix 2: Participant Information Sheet

University of Ghana
School of Public Health
Consent Form
Title of project: Knowledge and Perception of Polycystic Ovarian Syndrome

among Nurses in Accra

Principal Investigator: This project is being carried out by Lawrencia Adjei as part of her

fulfillment for a Master’s in Public Health. Information collected is mainly for research

purposes.

Introduction

My name is Lawrencia Adjei and I am from the University of Ghana. I am conducting a

study among Nurses to assess their knowledge and perception on Polycystic Ovarian

syndrome.

This study will last for 3 months.152 nurses who work at La general hospital in Accra will

be involved in the study. There is only one interview which will be done today.

If you grant permission to participate in this study, I will ask you some questions on

Polycystic Ovarian Syndrome. Everything will take no more than 15 minutes.

Background.

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Polycystic Ovarian Syndrome (PCOS) is common endocrine disorder that affects women.

Symptoms usually appear during adolescence and if not treated can result in infertility and

other metabolic disorders. This study aims to assess your knowledge and perception

associated with Polycystic Ovary Syndrome

Nature of study

This is a cross-sectional quantitative study

Risk/Benefits

There are no risks involved in participating in this study and the information received will

not affect your work performance in anyway. The time involved in the study may pose

discomfort to you. However, you will be compensated with a note pad and a pen for your

time. There is no direct benefit to you in this research, findings from this study will allow

the researcher to understand your perception and knowledge, and some factors associated

with it.

Voluntary Participation and Right to Leave the Research

It is entirely your decision to grant permission to participate in the study.

If you are not comfortable with participation, you can deny permission and you will not be

asked any questions.

Compensation

There is no payment and there are no costs to you for participating in the study. However,

a small token of a pen and a note pad will be given to you at the completion of the study

for your time.

Confidentiality

No one will be able to know how you responded to the questions. The information will

only have a study or ID number and not your name. All information will be kept safe and

seen only by the researchers. The information will be kept for five years and after that

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discarded through burning, in case this information will be needed in another study, ethical

clearance will be sort again.

Contacts for Additional Information

You may ask me any questions about this study now or the next time you see me.

You may also call or e-mail:

Lawrencia Adjei

0265600518

E-mail: [email protected] or

Hannah Frimpong, GHS-ERC Administrator.

Office: +233 302 681109

Mobile: 233 (0) 243235225 or 0507041223.

Email: [email protected]

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PARTICIPANTS’ STATEMENT

I acknowledge that I have read the purpose and contents of the Participants’ Information

Sheet read and has satisfactorily been explained to me in a language I understand

(English). I fully understand the contents and any potential implications as well as my

right to change my mind (i.e. withdraw from the research) even after I have signed this

form.

I voluntarily agree to be part of this research.

Participant Initials: _____________________________ Code:

_________________

Participant Signature: _________________________________

Date: _________________

I certify that the participant has been given ample time to read and learn about the study.

All questions and clarifications raised by the participant have been addressed.

Researcher’s Name: _________________________

Signature: _________________

Date: _________________

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