1.

BACKGROUND OF THE STUDY:

Polycystic ovary syndrome (PCOS) is a common endocrine disorder in the progenitive age

group and the leading cause of infertility. The worldwide prevalence of PCOS in women varies

between 2.2% to 26%. Due to limited literature on burden of PCOS among adolescent girls, its

significance is still un-fathomed as a research is few and far between in the present time. We conducted

Systematic review and metanalysis to estimate the pooled prevalence of PCOS among Indian

adolescent girls (14-19 years).

Polycystic ovary syndrome (PCOS) is the most common endocrine condition affecting

between 8 and 13% of women of reproductive age and 6–18% of adolescent girls depending on the

diagnostic criteria used and the population studied. Adolescence, as defined by the World Health

Organization, is the period between 10 and 19 years of age that includes significant and critical

changes in growth, development and puberty.

Diagnosis of PCOS during adolescence is both controversial and challenging due to the

overlap of normal pubertal physiological changes (irregular menstrual cycles, acne and polycystic

ovarian morphology on pelvic ultrasound) with adult PCOS diagnostic criteria. These challenges have

been acknowledged in adult and pediatric consensus statements. Specifically, challenges include the

risk of under-diagnosis, delayed and/or poor diagnosis experiences, and over-diagnosis as well as the

additional risk of the use of inconsistent non-evidence-based approaches in the diagnosis and

management of PCOS among specialists, general practitioners and allied health professionals. These

challenges are exacerbated by the lack of robust evidence. For example, ‘only adolescents’ studies are

limited and suboptimal in quality. Further, adult studies that include adolescents do not specify the

number of adolescents or time post menarche, which is critical information to determine the evolution

of normal pubertal physiological changes. Lastly, relevant consensus statements are often not specific

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to adolescents and/or not based on robust high-level evidence and/or rigorous processes, indicating

the need for high quality, evidence-based guidelines.

The aim of the first International Evidence-based Guideline for the Assessment and

Management of PCOS (‘the Guideline’) was to promote the accurate diagnosis of PCOS, optimal

consistent care, the prevention of complications and improved patient health outcomes from

adolescence to adulthood. The term ‘adolescence’ in the Guideline was defined as the period between

10 and 19 years of age according to the World Health Organization. However, based on evidence,

those who were within a gynecological age of 8 years or less than 8 years post menarche were also

identified in the recommendations.

This paper focuses specifically on the adolescent recommendations from the Guideline and

examines the evidence and rationale supporting these recommendations. We discuss the importance

of avoiding missed diagnosis, of delayed, under- or over-diagnosis, and of evidence-based

management to address PCOS symptoms in adolescents. Additionally, we expand on approaches to

identify girls ‘at risk’ of PCOS but not yet diagnosed, including the need for future follow-up.

2. NEED OF THE STUDY:

Polycystic Ovary Syndrome (PCOS) stands as a prevalent yet often underdiagnosed health

concern among adolescent girls, presenting multifaceted challenges that extend beyond the realms of

physical health. Against the backdrop of Ahmedabad's distinctive cultural and lifestyle dynamics,

there emerges a critical need for a thorough investigation into the prevalence, impact, and management

of PCOS specifically within the adolescent female population attending schools in this vibrant city.

In Ahmedabad, where dietary patterns, social norms, and lifestyle practices diverge from other

regions, it becomes imperative to discern the unique factors contributing to the prevalence of PCOS.

This study aims to unravel the intricate interplay between cultural nuances and the manifestation of

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PCOS symptoms in adolescent girls. Understanding how these factors converge can not only enhance

our comprehension of the condition but also inform tailored interventions that are attuned to the

specific needs of this demographic.

The implications of PCOS extend beyond the realm of health, permeating into the educational

sphere. By conducting this study within Ahmedabad schools, we seek to unravel potential links

between PCOS and academic performance. This nexus between health and education is often

overlooked, and uncovering such associations can pave the way for nuanced policies that integrate

health education into the academic curriculum, fostering a holistic approach to adolescent well-being.

Early detection and intervention are paramount in addressing PCOS effectively. By focusing

on schools in Ahmedabad, this study aims to identify symptoms at an early stage, enabling timely

medical and psychological support. The cultural sensitivity of interventions is paramount, considering

that perceptions of health and wellness are deeply rooted in the local context. Tailoring educational

programs to resonate with Ahmedabad's cultural fabric ensures that health literacy initiatives are not

only effective but also culturally relevant.

Moreover, the emotional well-being of adolescent girls in the context of PCOS is a facet that

requires nuanced exploration. Ahmedabad's socio-cultural landscape influences how these girls

perceive and cope with PCOS. By delving into the psychological impact of PCOS, this study strives

to contribute not only to the medical understanding of the syndrome but also to the development of

comprehensive support systems that encompass both physical and mental health.

In the broader context of educational policies, the findings of this study can play a pivotal role

in shaping future initiatives. Ahmedabad's schools can serve as testing grounds for innovative

approaches to health education that address PCOS and its implications. By integrating health

education into the academic curriculum, schools can empower adolescents with knowledge about their

own health, fostering a proactive and informed approach to well-being.

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 As we embark on this study in Ahmedabad schools, community and parental involvement will

be integral. Engaging stakeholders ensures that the study is not merely an academic exercise but a

collaborative effort to raise awareness and foster a supportive environment for adolescents grappling

with PCOS. Through collaboration, this study can transcend the boundaries of traditional research and

become a catalyst for positive change within the community.

In conclusion, this prescription outlines the imperative need for a comprehensive study on

PCOS in adolescent girls in Ahmedabad schools. Beyond the academic pursuit of knowledge, this

study holds the promise of tangible contributions to health and education policies, cultural sensitivity

in interventions, and the overall well-being of a demographic navigating the challenges posed by

PCOS within the vibrant tapestry of Ahmedabad's cultural landscape.

3. STATEMENT:

“Effectiveness of Structured Teaching

Program Regarding Polycystic

Ovarian Syndrome (PCOS)

among Adolescent Girl

in Ahmedabad”

4. OBJECTIVES:

1. To Identify Gaps in Training Knowledge of PCOS Diagnostic Criteria and

Management.

2. To Assess the Right Attitude Play an Important Role in the Management of the Disease and in

Prevention of Complications.
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5. ASSUMPTION:

Assuming a broad spectrum, PCOS can be categorized into four main phenotypes. These

categories are useful in clinical practice because health risks have been defined for at least two

subtypes, and this dictates careful evaluation of metabolic disturbances for women with frank or

classic PCOS. However, in research settings, subdividing PCOS into more discrete categories is

imperative if we are to clearly define incidence, degree of symptomology and health risks among all

variants of PCOS. In the most comprehensive study aimed at evaluating the phenotypic spectrum of

PCOS, Diamanti-Kandarakis et al. showed hyperandrogenic and anovulatory phenotypes of PCOS to

be the most insulin resistant—irrespective of BMI or central adiposity. Their approach to

elucidating differences among PCOS phenotypes involved a number of physicians and ultra

sonographers working cooperatively to diagnose and evaluate a large study population. Inclusion of

each study participant rested strictly on agreement between at least two physicians that symptoms and

signs of PCOS were apparent. Cut-off levels for biochemical hyperandrogenism were carefully

established from a large population of non-hirsute, regularly menstruating women with proven

ovulatory cycles. Lastly, an independent ultra sonographer interpreted all transvaginal ultrasound

recordings. While the efforts of these investigators were exemplary, it is likely that future attempts to

substantiate these findings for different ethnic populations will be hampered by the lack of accuracy

and reliability that is apparent in the evaluation of PCOS features.

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6. OPERATIONAL DEFINITIONS:

6.1- effectiveness:

The comparative effectiveness of the intervention relative to an alternative intervention or usual care.

6.2- Structured teaching program:

Structured teaching is a series of interventions . utilized for children and adults with autism spectrum

disorder or other communication disabilities.

6.3- PCOS:

The PCOS is formation of cysts in the ovaries or dysfunction of ovaries along with cardinal features

of LH hyper-secretion, ovarian hyper-androgenism, hyper-insulinemia, reduced fertility.

6.4- Adolescent:

Adolescence is a transitional stage of physical and mental development that occurs between childhood

and adulthood.

-WHO

6
Period of life between 10 and 19 years.

7. DELIMITATION:

The delimitations for your research on PCOS in adolescent girls in Ahmedabad schools could

include specifying the age range of participants, focusing on particular schools or educational levels,

and considering factors like socioeconomic status or cultural background to ensure a more targeted

and manageable sample.

Additionally, you may want to limit the study to a certain time frame or specific diagnostic criteria

for PCOS.

- PCOS among Indian adolescent girls (14-19 years).

8. CONCEPTUAL FRAMEWORK:

In researching the impact of PCOS on adolescent girls, a comprehensive conceptual

framework is essential to provide a structured understanding of the multifaceted factors influencing

their well-being. This framework may begin with the biological aspect, delving into the hormonal

imbalances characteristic of PCOS and their potential effects on physical health and development.

Simultaneously, the psychosocial dimension should be considered, exploring the emotional

and mental well-being of adolescent girls diagnosed with PCOS. Factors such as body image, self-

esteem, and the psychological implications of living with a chronic condition like PCOS may play a

crucial role in their overall health outcomes.

Lifestyle factors, encompassing diet, exercise, and other health-related behaviors, form

another integral component of the conceptual framework. Investigating how these lifestyle choices

7
interact with hormonal and psychosocial factors can provide insights into effective interventions and

support mechanisms for this demographic.

Furthermore, the influence of socio-economic factors and cultural contexts on the experiences

of adolescent girls with PCOS should not be overlooked. Understanding how these external elements

shape access to healthcare, societal perceptions, and coping mechanisms can contribute to a more

holistic framework.

Ultimately, the conceptual framework aims to facilitate a nuanced exploration of the

challenges faced by adolescent girls diagnosed with PCOS, offering a foundation for targeted research,

interventions, and policy considerations to enhance their overall health and well-being.

PSYCHOSOCIAL FACTORS:

Examining the psychosocial dimensions involves investigating the emotional and social

aspects of adolescence with PCOS. Factors such as body image perception, self-esteem, and the

psychological impact of PCOS symptoms are crucial elements in understanding the holistic

experience of affected adolescent girls.

HORMONAL INFLUENCES:

PCOS is fundamentally characterized by hormonal irregularities. Within the conceptual

framework, delve into the dynamic relationships between hormones, focusing on how hormonal

imbalances contribute to the manifestation and progression of PCOS in adolescent girls. This includes

exploring the role of androgens, insulin resistance, and their impact on reproductive health.

8
LIFESTYLE CHOICES:

Adolescence is a pivotal period for forming lifestyle habits. Investigate how lifestyle choices,

including diet, exercise, and sleep patterns, intersect with PCOS in this demographic. Understanding

the role of lifestyle in PCOS progression can inform targeted interventions and preventive strategies.

HEALTH OUTCOMES:

The ultimate goal of the conceptual framework is to elucidate the impact of psychosocial

factors, hormonal influences, and lifestyle choices on health outcomes. This section should analyze

the potential repercussions of PCOS in adolescence, encompassing both short-term and long-term

health implications, including fertility, metabolic health, and mental well-being.

INTERVENTIONS:

Propose targeted interventions based on the findings from the previous components. Consider

how psychosocial support, hormonal management, and lifestyle modifications can be tailored to

address the unique needs of adolescent girls with PCOS. This section should bridge the gap between

research and practical applications, offering insights for healthcare professionals, educators, and

policymakers.

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9. RESEARCH METHODOLOGY:

9.1 Research Approach:

- Mixed-Methods Approach: Combine quantitative surveys and qualitative interviews for a

comprehensive understanding of PCOS in adolescent girls.

9.2 Research Design:

- Convergent Parallel Design: Simultaneously collect quantitative and qualitative data, allowing for

a comprehensive analysis.

9.3 Variables Under Study:

- Dependent Variable: Presence of PCOS.

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 - Independent Variables: Age, lifestyle factors, menstrual patterns, symptoms, emotional well-being.

9.4 Research Setting:

- Secondary Schools in Ahmedabad: Focus on schools within the city for a localized study.

9.5 Target Population:

- Adolescent Girls in Secondary Schools in Ahmedabad: Aged 13 to 19, attending secondary

education.

9.6 Sample Population:

- Stratified Random Sampling: Stratify schools based on factors such as location, size, and type

(public/private) to ensure diverse representation.

9.7 Sample Size:

- Calculation: Determine sample size using prevalence rates specific to Ahmedabad, considering a

confidence level and desired margin of error.

9.8 Sample Technique:

- Stratified Random Sampling with Proportional Allocation: Ensure proportional representation

from each stratum, considering the unique characteristics of schools in Ahmedabad.

9.9 Criteria for Sampling Technique:

- Inclusion Criteria: Adolescent girls aged 13-19 attending secondary schools in Ahmedabad.
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 - Exclusion Criteria: Exclude girls with pre-existing medical conditions that may affect PCOS

indicators.

9.10 Selection and Rationale of Tool for Data Collection:

- Quantitative: Utilize a standardized questionnaire with culturally adapted questions on PCOS

symptoms and lifestyle factors relevant to Ahmedabad.

- Qualitative: Employ semi-structured interviews to explore culturally specific aspects of emotional

well-being and the impact of PCOS.

9.11 Validity:

- Content Validity: Ensure survey questions and interview guide are culturally relevant and cover

all pertinent aspects of PCOS in adolescents in Ahmedabad.

- Face Validity: Have local experts review and confirm the relevance of the research tools.

9.12 Reliability:

- Test-Retest Reliability: Administer the survey to a subset of participants twice, with a time gap,

to assess consistency.

- Inter-rater Reliability: Ensure consistency in coding and analysis of qualitative data by involving

multiple researchers.

9.13 Pilot Study:

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 - Small-Scale Pilot in Ahmedabad: Conduct a preliminary study with a limited number of

participants to refine research instruments, assess cultural nuances, and identify any logistical

challenges specific to Ahmedabad.

10. DATA COLLECTION AND DATA ANALYSIS:

10.1 Data Collection:

- Quantitative Data:

- Tool: Structured questionnaire adapted for the cultural context of Ahmedabad, covering PCOS

symptoms, lifestyle, and health information.

- Sampling: Stratified random sampling from selected schools.

- Data Collection Process: Administer surveys during school hours, ensuring privacy and participant

comfort.

10.2 Data Analysis:

- Quantitative Analysis:

- Descriptive Analysis: Summarize demographic data, prevalence rates, and lifestyle factors.

- Inferential Analysis: Use statistical tests (e.g., chi-square, t-tests) to identify associations.

- Statistical Software: Utilize tools like SPSS for analysis.

10.3 Integration and Interpretation:

- Triangulation:

- Integrate quantitative and qualitative findings to enhance the overall understanding.

- Identify convergence or divergence of results from different data sources.

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- Contextualization:

- Interpret findings in the context of Ahmedabad's cultural, social, and economic factors.

- Consider implications for healthcare, education, and policy.

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11. WORK PLAN:

15
12. BUDGET:

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