VIJAY MARIE COLLEGE OF NURSING BEGUMPET,

HYDERABAD.

STRUCTURED
QUESTIONAIRE

SUBMITTED BY

MS.K.D. Sharon

MSc (N) 2ND Year

VMCON, Begumpet

Hyderabad.
PROBLEM STATEMENT: A Study To Assess The Effectiveness Of Mentha Bar

In Reducing Dysmenorrhea Among Adolescent Girls In A Selected College,

Hyderabad.

AIM: To assess the effectiveness of Mentha bar on reduction of dysmenorrhea

among adolescent girls in selected colleges, Hyderabad

OBJECTIVES OF THE STUDY

1. To assess the level of dysmenorrhericpain among adolescent girls both in

experimental group & control group.

2. To plan and administer Mentha bar among adolescent girls in experimental

group.

3. To assess the effectiveness of Mentha bar on reduction of dysmenorrhea

among adolescent girls in experimental group.

4. To find the association between the Post-test levels of dysmenorrheric pain

among adolescent girls with selected demographic variables both in

experimental group & control group.

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 DATA COLLECTION TOOL

SECTION A - Demographic variables

Demographic variable included in the Performa are Age, Religion, Type of family,

Educational status, family income, residence, family members suffering from

dysmenorrhea, who suffers from dysmenorrhea, diet preferences

SECTION B – Clinical variable Performa

The clinical variables included in this Performa were age at menarche, weight, Body

mass Index, number of days of menstrual flow, duration of pain, quality of pain,

home remedies and medical treatment.

SECTION C – Pain scale (WaLIDD SCALE)

Dysmenorrhea scale is information related to dysmenorrhea which will be rated in a

4-point scale, the responses ranged from none ‘0’ to ‘3’. The maximum score will be

16. A working ability, location, intensity, days of pain, dysmenorrhea

(WaLIDD) score was designed.

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 STRUCTURED QUESTIONNAIRE TO ASSESS THE EFFECTIVENESS
OF MENTHA BAR IN REDUCING DYSMENORRHEA AMONG
ADOLESCENT GIRLS

SECTION-A
DEMOGRAPHIC VARIABLES
1. Age in years [ ]
a. 15years – 16years
b. 17years– 18years

2. Education status [ ]
a. Intermediate First Year.
b. Intermediate Second Year.

3. Religion [ ]
a. Hindu
b. Muslim
c. Christian
d. Others

4. Dietary habits [ ]
a. Vegetarian
b. Non-vegetarian
c. Eggetarian
d. Mixed

5. Socio Economic class [ ]

a. Accessible class
b. Affordable class
c. Compromised class
d. Unaffordable class

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7. Family Income per Month.
a. <5000/month [ ]
b. 5001-10,000/month
c. 10,001-20,000/month.
d. >20,001/month.

8. Type of Family.
a. Single Parent Family.
b. Nuclear Family [ ]
c. Joint Family.
d. Extended Family.

9. Area of living.
a. Urban [ ]
b. Rural
c. Semi-Urban.

10. Family history of Dysmenorrhea

a. Yes [ ]
b. No
c. If Yes to Whom…………………

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 SECTION-B

PART-I Questions Related to Menstruation, Dysmenorrhea & Mentha

PART-II Personal and Menstrual data of the Sample

PART-I Questions Related to Menstruation, Dysmenorrhea & Mentha Bar.

1. What does the word menstruation means?

a. Discharge of blood from vagina [ ]
b. Discharge of white fluid from vagina.
c. Both.
d. Other.

2. What causes menstruation? [ ]

a. Hormones
b. Enzymes.
c. Caused by disease
d. Don’t know

3. What organ does menstrual blood come from?

a. Uterus [ ]
b. Vagina
c. Bladder
d. Stomach
e. Don’t know

4. What is a Pre-menstrual Symptom?

a. Breast tenderness [ ]
b. Constipation
c. Fatigue
d. vomiting

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5. What is Dysmenorrhea?
a. Pain associated with menstruation. [ ]
b. No Pain associated with menstruation

6. What are the symptoms of Dysmenorrhea?

a. Only lower abdominal pain. [ ]
b. Abdominal pain associated with nausea, vomiting,
c. Abdominal pain associated with diarrhoea, headache, & dizziness.
d. Only B & C

7. What are the types of Dysmenorrhea? [ ]

a. Primary Dysmenorrhea
b. Secondary Dysmenorrhea
c. Tertiary Dysmenorrhea
c. Only a & b

8. What is Primary Dysmenorrhea? [ ]

a. Recurrent pain occurring before menstruation
b. Severe pain occurring during menstruation
c. Cramping pain occurs just before or during menstruation, absence of other
disease
d. Menstruation associated with no pain

9. What is secondary dysmenorrhea? [ ]

a. Caused by disorder in the hormones of menstrual cycle
b. Caused by disorder in the stomach, pain is intermittent
c. Caused by disorder in the reproductive organs, pain last longer
d. All the above

10. What is Mentha? [ ]

a. It’s a Herb known as mint

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b. It is a wild flower
c. It’s a green seed.
d. It is an oil.

11. What is the common name of Mentha in India? [ ]

a. Cilantro
b. Curry leaves
c. Pudina
d. Spinach

12. What are uses of Mentha? [ ]

a. Help’s to treat infection
b. Reduces level of menstrual pain.
c. Used in cooking for taste for pleasant smell.
d. All the above.

13. Which form of Mentha you used as home remedy to relieve dysmenorrhea? [ ]
a. Mint paste
b. Mint Tea
c. only leaves
d. Some Other form.

14. Have you ever used Mentha in relieving dysmenorrhea pain? [ ]

a. Yes, it is very effective
b. No, I never used.

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 PART-II Personal and Menstrual data of the Sample

1. Weight in kilograms. [ ]
a. Below 40 kg.
b. 41-50 kg.
c. Above 50 kg

2. BMI (body mass index)

a. Under weight (< 18.5) [ ]
b. Average (18.5 – 24.9)
c. Over weight (> 25.00)
d. Obesity (≥ 40)

3. Age at Menarche (in years) [ ]

a. > 11years
b. 12years
c. 13years
d. 14years and above

4. The average cycle of menstruation is [ ]

a. 26 days
b. 28 days
c. 30 days
d. > 35 days.

5. The number of sanitary pads changed per day?

a.1 pad per day [ ]
b. 2 pads per day
c. 3 pads per day
d. > 3 pads per day

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6. Duration of bleeding in days
a. 1-2 days [ ]
b. 3-4 days
c. 5-6 days
d. > 7 days

7. Nature of Bleeding?
a. Scanty [ ]
b. Low
c. Moderate
d. Heavy

8. Characteristics of Bleeding?
a. Only Blood [ ]
b. Blood with Clots

9. Type of Sanitary napkin is being used?

a. Home-made (cloth) sanitary napkin. [ ]
b. Market available sanitary napkin.
c. Both.

10. Do you experience regular menstrual cycle? [ ]

a. Yes often monthly.
b. alternative months
c. quarterly
b. irregular four or six times a year.

11. Pain during menstruation was stared at? [ ]

a. from the first cycle
b. After a half year of menstrual cycle.
c. After a year of menstrual cycle.
d. recently .

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12. Common Site of menstrual pain? [ ]
a. Lower abdomen& back pain
b. Left side of abdomen
c. Right side of abdomen
d. Pelvic pain and Groin Pain (Inguinal)

13. Type of Pain is commonly felt [ ]

a. Radiating pain
b. Colicky pain
c. Spasmodic pain.
d. Recurrent pain.

14. Pain characteristics [ ]

a. Twisting
b. Stinging
c. Sharp.
d. Combination of above any two or more characteristics.

15. Duration of Pain [ ]

a. One day before Menstruation to end
b. Onset of Menstruation i.e. 1st day
c. 12 hours to 72 hours
d. Throughout menstruation.

16. Nature of pain/ Intensity of pain. [ ]

a. Mild
b. Moderate
c. Severe Cramping
d. Incapacitating pain.

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17. Type of Dysmenorrhea is experienced? [ ]
a. Primary Dysmenorrhea
b. Secondary Dysmenorrhea.

18. Is your daily activity hindered due to dysmenorrhea? [ ]

a. No, my daily activities is not hindered, I can manage without assistance
b. yes, I can’t do my daily activities, I need assistance.

32. Incidence of circumstances with dysmenorrhoea

a. College absenteeism [ ]
b. Escapism.

33. What are the measures taken to relieve pain? [ ]

a. Home measures like hot milk, ginger tea, etc.
b. Hot applications & Massages
c. No measures, only bed rest.
d. Drug intervention.

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 SECTION C
Dysmenorrhea is a frequent and misdiagnosed symptom affecting the quality of life
in young women. A working ability, location, intensity, days of pain, dysmenorrhea
(WaLIDD) score was designed to diagnose dysmenorrhea and to predict medical
leave.

NOTE: Wong-Baker scale was reclassified to adjust a four-level scale.

GRADES OF DYSMENORRHEA.
 GRADE 0- Score 0 No dysmenorrhea.
 GRADE I–Score 1-4 Mild Dysmenorrhea.
 GRADE II–Score 5-7 Moderate Dysmenorrhea.
 GRADE III–Score 8-12 Severe Dysmenorrhea.

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 PREPARATION OF MENTHA BAR
INTRODUCTION:
Mentha is a herb known as Mint, it is a popular green leafy vegetation used in
cooking for given pleasant taste & also used as aromatic properties. Mentha has
been used in medicine since last 2000 years. Now it has been used in the treatment
of various diseases.

PURPOSE:
1. To relieve muscle spasm.
2. To reduce the menstrual pain.
INGREDIENTS:
1. 5 grams of dried mint leaves powder
2. 5 -10 grams of peanuts
3. 5 grams of jaggery
4. 5 grams of coconut powder.
MECHANISM OF ACTION
Anti-spasmodic & Analgesic

 Menstrual cramps are brought to you by prostaglandins which are hormone

like chemical, which force uterine muscle to contract & cause pain.
 Mentha Bar helps in balancing the muscle relaxation during menstrual
cramps.
PREPARATION OF MENTHA BAR
It refers to the mint leaves are taken from the plant, dried under shadow &
powdered. Take 5 grams of mint powder along with jaggery, peanuts, coconut
powder same amount i.e. 5 grams each ingredient which all mixed together in
shape of small ball/cubes & have to be administered twice a day for 7 days (4
days prior to menstrual period & continued till 3 days during menstruation).
INTERVENTION:

 Identify the adolescent girls with Dysmenorrhoea.

 Explain the benefits of Mentha/Mint on Dysmenorrhoea.
 With confidence and co-operation.
 Prepare the Mentha bar with all the ingredients.
 Administer Mentha bar 4 days before & during menstruation, two times a day
that is morning and evening
 Record the completion of procedure.

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  Evaluate the effectiveness of Mentha bar by assessing the level/ Grade of
Dysmenorrhoea.
LETTER REQUESTING OPINION AND SUGGESTIONS OF EXPERTS TO
VALIDATE THE TOOL
From
Ms Kalla.Daniel.Sharon.
Vijay Marie College of Nursing
Begumpet, Hyderabad, Telangana
Through the proper channel
Rev. Sr. Anne Ponnattil
Principal
Begumpet – 16,
Hyderabad, Telangana.
To

SUB: Request for expert opinion and suggestions to establish content validity
for the
research tool.

Respected Sir/Madam

As a partial fulfilment of masters of science in nursing under KNR university of

health sciences I, Ms Kalla.Daniel.Sharon. of MSc [Obstetrical & Gynaecological
Nursing] Nursing 2nd year student of Vijay Marie College of Nursing, Begumpet,
Hyderabad., Telangana, has registered the following topic for my dissertation.
TOPIC: A STUDY TO ASSESS THE EFFECTIVENESS OF MENTHA BAR IN REDUCING
DYSMENORRHEA AMONG ADOLESCENT GIRLS IN A SELECTED COLLEGE,
HYDERABAD.

Here with I have enclosed

 Objectives of the study
 Demographic variables
 Brief methodology
 Tool

Therefore, I request you to kindly go through my research tool and give your
valuable suggestions and opinions to develop the content validity of the tool.
Thanking You
Yours sincerely, Date:
Kalla.Daniel.Sharon. Place:

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Signature of the Principal

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