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Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 23  |  Issue : 1  |  Page : 86-94

Impact of a capacity-building initiative for first-year student nurses on reproductive and sexual health: A quasi-experimental study in Bangalore city, Karnataka, India


1 Independent Consultant, Counsellor and Special Educator for Pledge Academy, Bengaluru, Karnataka, India
2 Director, Pledge Academy, Bengaluru, Karnataka, India
3 Trainer, Global Health Academy, Bengaluru, Karnataka, India
4 Junior Resident, Division of Biostatistics, St. Johns Research Institute Nursing Faculty of Selected Institutions, Bengaluru, Karnataka, India
5 Head, Div of Epidemiology & Population Health, St. Johns Research Institute, Bengaluru, Karnataka, India
6 Prof (Nursing) – Adjunct, Div of Epidemiology & Population Health, St. Johns Research Institute, Bengaluru, Karnataka, India

Date of Submission30-Dec-2021
Date of Decision02-May-2022
Date of Acceptance03-May-2022
Date of Web Publication05-Jul-2022

Correspondence Address:
Dr. Maryann Washington
Division of Epidemiology and Population Health, St. Johns Research Institute, Bengaluru - 560 034, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijcn.ijcn_126_21

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  Abstract 


There is evidence of gaps in knowledge, perception and self-assessed competence on reproductive and sexual health (RSH) issues of nursing students. A quasi-experimental study was conducted in Bangalore city between January 2017–December 2018 to study the impact of a capacity-building initiative for 1st-year nursing students on their knowledge, perceptions, self-assessed competence and resilience. Eight nursing institutions were selected purposively; initially, four were allocated randomly through lottery method to the intervention group (IG) and four to the comparison group (CG). Since one institution dropped out before the intervention from IG, another institution was recruited to replace this institution. Both, the IG and CG, had seven batches of students (three diploma and four degree) each. A sample size of 120 students for each group was required. An investigator-developed and validated survey was administered to both groups at the start (pre-test) and 18 months after the start (post-test) of the study to assess their knowledge, perceptions and self-assessed competencies. Resilience was measured at the end of the study using a standardised tool, 'The Child Youth Resilience Measure'. A capacity-building initiative (31.5 h) which was participatory, contextualised and integrated life skills, was implemented for the IG over a period of 18 months. A condensed version of the programme (13.75 h) was provided to the CG over the same period. The analysis considered a total sample of 625 students (IG = 294; CG = 331) that participated in both, the pre-test and the post-test. Nursing students within both groups showed statistically significant improvement in their overall knowledge scores from pre-test to post-test (P < 0.01). However, the difference in the overall knowledge scores of IG and CG (between groups) was not statistically significant at the post-test (P = 0.076). There was a statistically significant increase in self-assessed competencies on RSH within both groups from pre-test to post-test (P < 0.001), but no statistically significant difference was seen between the two groups at post-test (P > 0.05). There was no significant difference (P > 0.05) in resilience scores between IG and CG at the post-test. The study is limited in that it could not measure competencies in the real-world setting. The study shows that changes in perceptions would require more time and possibly more practice and experience. Nevertheless, even condensed versions of such capacity-building initiatives could improve the overall knowledge and self-assessed competencies of nursing students.

Keywords: Capacity-building initiative, curriculum intervention, quasi-experimental study, reproductive and sexual health, reproductive and sexual health, student nurses


How to cite this article:
Hartley S, Tavares J, Pushparaj M, Selvam S, Mony P, Washington M. Impact of a capacity-building initiative for first-year student nurses on reproductive and sexual health: A quasi-experimental study in Bangalore city, Karnataka, India. Indian J Cont Nsg Edn 2022;23:86-94

How to cite this URL:
Hartley S, Tavares J, Pushparaj M, Selvam S, Mony P, Washington M. Impact of a capacity-building initiative for first-year student nurses on reproductive and sexual health: A quasi-experimental study in Bangalore city, Karnataka, India. Indian J Cont Nsg Edn [serial online] 2022 [cited 2022 Aug 20];23:86-94. Available from: https://www.ijcne.org/text.asp?2022/23/1/86/349815




  Introduction Top


Nurses are essential personnel in the health-care setting of any country. In India, the present curriculum of the undergraduate nursing diploma and degree programmes prescribe units of reproductive and sexual health (RSH) with a focus primarily on the bio-medical model. Curricula and competence gaps have been found to adversely affect a nurse's confidence to respond appropriately to RSH issues in the field,[1],[2] be it within the community, health-care setting or their own families. Students in India are prescribed, 3 years to obtain the diploma and 4 years for the degree in nursing programme.[3],[4] They cover courses in the physical and behavioural sciences that incorporate both theoretical and practical experiences in the field, including the hospital setting, community or schools.[3],[4] They come in direct contact with their clientele within 6 months of being enrolled as nursing students. Thus, they can be in a unique position to demystify health-related information as sensitive as RSH to the public, if trained early in their programme. A cross-sectional survey with 723 young student nurses, from all states in the country, except Haryana, studying in eight institutions in Bangalore city, showed that knowledge was below average (<50%) on key concerns such as 'growing up issues', 'prevention of pregnancy' and 'STIs and HIV prevention'.[2]

The ever-evolving attitude towards sexuality in India is greatly influenced by the versatility of religious, political, moral and sexual values of its inherently diverse demography. Despite conservative views being the present norm, social and health related reform seeks to impact sexual scripts, openness and help-seeking behaviours of the public. Hence, this requires health professionals to be more confident and prepared for such developments.[5] RSH curricula, rolled out in a structured, practical and phased manner, that facilitates introspection, open discussion in an unbiased environment, could probably have a better impact on the views and opinions of individuals. First, since it could make them more comfortable with their own sexuality, and then to dialogue with their peers, adolescents, and young people in the community and with patients or clientele in the hospitals.[5],[6],[7],[8]

The implementation of holistic care for clientele (patients or families) requires nurses to conduct a detailed baseline assessment, which necessarily includes an RSH assessment, although it is often overlooked on several occasions. This inevitably triggers concerns and questions regarding 1st-year nursing students' capacities in the field, considering they are exposed to the real world of illness-health from the 3rd month of enrolment into the programme.

Nurses' have extensive training in the biomedical, social and behavioural sciences, as well in communication, health education and counselling techniques. This places them in a unique position in the health team, to counsel patients in an area as sensitive and highly charged as human RSH.[6] In addition, the multiple areas of practice and their longer contact with clientele than any other health-care professional[7] create the potential for nurses to play a pivotal role in RSH. However, speculations often arise regarding their competence in handling such concerns, professionally as well as personally.[8] Available literature suggests the development of educational programmes to help nurses introspect and reflect on their own perceptions is the need of the hour. This could lead towards overcoming any embarrassment or questioning strongly held attitudes that might act as barriers when responding to their own, as well as clientele concerns.[1],[7],[9],[10],[11],[12]

To prepare nurses to meet the RSH needs of their clientele, especially adolescent RSH,[11],[12] is a challenge requiring planned educational experiences within the nursing and midwifery curriculum.[1] This means that it would need to be integrated into their pre-service curricula. If a contextual and comprehensive training on RSH issues with a foundation on sexuality and life skills development is to be integrated into the nursing curricula,[13] it must first be tested for its effectiveness. This includes its ability to foster understanding of one's own sexuality, introspection of one's attitude towards sexuality, and its integration into key nursing duties, for example, comfort to dialogue with clientele, confidence to provide health education for preventive measures, and promoting RSH.

There are typical examples of nursing practice that necessitate the need for incorporation of appropriate RSH competencies. First, implementation of the presumably non-threatening policy of removal of personal artefacts of the clientele when admitted to the hospital could plausibly be a threat to one's body image or embarrassing to the 1st-year nursing student who mostly is in his or her late adolescence.[2] Second, the performance of simple procedures such as urinary catheterisation,[14],[15] per vaginal examination, helping the patient to void, giving a sponge bath, etc., could reasonably be embarrassing situations to a patient, yet an opportunity to teach for the nurse. Third threats related to the diagnoses of heart diseases,[15] injury or even treatment such as palliative care[16] could trigger fears or anxieties about one's sexual life due to restrictions placed thereof on these clients. In addition, it is acknowledged globally that nurses are best placed to provide RSH education and counselling as well as primary RSH care,[17] especially towards adolescent health,[7],[12] and this demands a certain level of competence. The present didactic methods adopted for teaching these topics to pre-service nurses in the Indian settings,[1],[2],[10] might not lend to competencies required to effectively plan for individual or group health education programmes that have RSH promotion as its key outcome.

Objectives

  • To assess the baseline knowledge, perception and self-assessed competence on RSH of 1st-year nursing students participating in the study by conducting a pre-test using an investigator-developed questionnaire
  • To implement a capacity-building initiative on RSH using the life-skills approach and study its impact on nursing students at the end of 18 months through a two-group, pre-test–post-test comparative analysis
  • To determine the resilience of nursing students at the end of the study.


Hypothesis

  • All nursing students (IG and CG) will score higher in their knowledge on RSH at the post-test as compared to their pre-test scores
  • The perception of nursing students on RSH in both groups (IG and CG) will change from pre-test to post-test
  • The nursing students of both groups (IG and CG) will rate their self-assessed competence on RSH issues higher in the post-test and compared to the pre-test
  • At the post-test, the IG will have higher knowledge scores on RSH as compared to the CG
  • The perception of nursing students on RSH in the IG will change more than the CG from pre-test to post-test
  • The self-assessed competence on RSH issues of nursing students in the IG will be higher than the CG at the post-test.


Methods

A quasi-experimental pre-test-post-test quantitative study was adopted for the study. Eight nursing institutions were selected purposively, representing the three types of managements (government, private and minority) from Bangalore city, Karnataka. These eight nursing institutions were either affiliated with the Rajiv Gandhi University of Health Sciences for their degree nursing programme or the Karnataka Nursing Board for their diploma in nursing programme. The 1st-year nursing students of both degree and diploma nursing programmes were recruited from six institutions. While from two of the selected institutions, only students of the degree nursing programme were recruited.

Sampling

Purposive cluster sampling technique was used in the study. Inclusion criteria sought nursing institutions that were representative of different types of managements (private, government or minority), functional for at least 10 years, and willingness to participate in the study. Full-time 1st-year students studying of the relevant nursing course (Degree/Diploma) in the eight institutes (n = 856) were available for recruitment to the study. These eight institutions were allocated to the intervention (IG) and comparison group (CG) using the lottery method. However, before the pre-test data were collected, one institution dropped out from the IG. Therefore, another institution was purposively selected and grouped in the IG. Thus, in all there were four institutions and seven batches (four Degree and three Diploma) in the IG and CG, respectively.

To compare the impact of the capacity building initiatives, the sample size was computed based on the assumption extrapolated from a previous study[18],[19] that there would be a 65% improvement in knowledge. In essence, the mean score of the IG would presumably improve by 40 while that of the CG would improve by 10 from the pre-test score. Therefore, to observe a difference of 30 in the mean score between IG and CG, with a 5% level of significance and 99% power, the sample size required was 9 per group. Since there would be at least four nursing institutions in the IG and CG as a design effect of three (the intervention making the variability within the cluster even lower) was assumed, a minimum sample size required per group was 30. Furthermore, as both groups had Degree and Diploma students, a total of 60 from each group was calculated, totalling to 120 (60 each in the IG and CG).

Instruments

An investigator-developed and validated survey was used to assess knowledge, perceptions and self-assessed competencies. The survey was adapted from available instruments,[18] based on the experience of the study team, and validated by three experts in the field. The reliability of the tool was not checked due to the tight timeline for completion of the study. The survey was divided into four sections: (i) Baseline information of the students was obtained in the first section.(ii) The second section was used to measure the knowledge of students based on their correct response to items on three themes: 'growing up issues', 'prevention of pregnancy' and 'STIs/HIV'.[2] (iii) The third section was used to understand perceptions of students on RSH, where students responded to statements on a 5-point scale ranging from 'strongly agree' to 'strongly disagree'.[2] This section was not scored since the responses of students indicated their personal views on specific RSH aspects.(iv) The fourth section was used to measure self-assessed competence of students based on their own assessment of their level of confidence in dealing with RSH concerns.[2] The 'Child Youth Resilience Measure[19] that consisted of 26 items to which students had to respond 'Yes', 'No', or 'Sometimes', was added in the post-test after seeking permission for its use.

Ethical approval

Ethical approval for the conduct of the study was obtained from the St John's Medical College and Hospital Institution Ethics Committee (IEC) Ref No 137/2013 on 16th September 2016 for 1 year. Since the study included a sensitive topic, the research team was requested to re-submit the protocol, survey and Participant Information Sheet (PIS) with Consent Form for renewal of IEC approval. These were approved by the IEC on 18th October 2016. The study was supported by the Indian Council of Medical Research from January 2017 to December 2018. The study was registered in the Clinical Trial Registry of India (CTRI) and approved (CTRI/2017/04/008353). Required permissions were obtained from the Director of Medical Education, Karnataka, to include the government-managed nursing institution; and from the administrative heads of the remaining seven nursing institutions. The PIS detailing the aim, objective and timeline of the study, and a Consent Form was provided to all nursing students before the pre-test was administered. Only students above 18 years who consented to participating in the study (signatures obtained) were recruited. All test responses were coded by institution, programme (Degree or Diploma) and study group (IG or CG) to ensure the confidentiality of nursing students and responses. The survey was handled only by core members of the research team. Identifying information such as names of nursing students were not included in the data entry process.

Capacity-building activities in the intervention and comparison group

Four faculties from each of the institutions were sensitised on the capacity-building strategy through a 3-day workshop in Feb 2017. The capacity-building initiative for students began in March 2017, with content primarily from a training guide developed for nursing students.[12] Each batch of students from the IG had a 3-day workshop after they completed the pre-test. While each batch of the CG had a 1-day workshop [Figure 1]. Active teaching–learning methods such as games, role plays, stories, case scenarios, self-reflective exercises and small group discussions were used to facilitate introspection of their awareness, views and competence on RSH issues. For example, to facilitate the topic of 'concepts and components of sexuality', three activities were conducted. The first was the concept of self and perception of one's body. A large group exercise was used to help them identify and discuss the various components of sexuality. They were even given an opportunity to introspect on how they perceived their own bodies through a self-reflective exercise. The second activity explored recognising and managing emotions. Students were shown various pictures as well as presented with a variety of common workplace situations. They were then provided with the opportunity to explore their own emotions and how they would deal with these different situations. The third activity sought to identify their strengths through a self-reflective and large group activity. At the end of all sessions, students from both groups were encouraged to ask questions using the question box that was provided. Hence, the strategy was participatory and incorporated an adapted version of Kolb's experiential learning cycle[20] that ensured the active engagement of the students [Figure 2].
Figure 1: Capacity-building initiative for intervention and comparison group

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Figure 2: Adaptation of the Kolb's experiential learning cycle

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Data collection

Data were collected from both groups (IG and CG) using the survey at the start (pre-test) of the study in their 1st year of study. This was followed by an 18-month intervention programme after which, the same tool was administered again (post-test) to the students. An additional resilience measure was added on for both groups at the post-test.


  Results Top


The analysis only considered the students who completed the pre-test and the post-test [n = 625 (IG = 294; CG = 331)]. There was attrition of 15% (52/346) from the IG and 12% (46/467) from the CG. Reasons for attrition included unavailability of the student on the day of the post-test or discontinuation from the programme. Totally 294 and 333 completed the post-test in the experimental and control group, respectively.

Baseline information of the nursing students from intervention group and comparison group

The mean age of the nursing students was 19.3 (±2.1) years in the IG with a range of 18–25 years, while in the CG, it was 18.8 (±1.4) years with a range of 18–38 years. The IG group had 97.9% (287/293) female students, while the CG had 96.1% (316/331). In the IG, 6.9% (20/292) of students lived only with their mother against 12% (39/326) of the CG. The CG had 70.2% (219/312) who came from South India compared to 47.2% (126/267) of the IG.

There was a significantly higher proportion of students from the CG (70.6% [231/326]) compared to the IG (53.3% [155/292]) who had attended sessions on RSH before being enrolled to the nursing programme (P < 0.001) [Table 1].
Table 1: Socio-demographic variables of intervention and comparison groups

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Impact of the capacity-building initiative on knowledge scores on the reproductive and sexual health of the intervention group and comparison group

Both groups had mean knowledge scores that were less than average (<50%) at the pre-test. The IG had statistically higher knowledge scores compared to the CG in 'growing up issues' (P = 0.03); 'prevention of pregnancy' (P < 0.01) and overall knowledge score (P < 0.01) at the pre-test. The post-test was done 18 months later. Analysis of Covariance was computed to determine if the post-test scores of IG and CG for each theme were significantly different, after adjusting for the difference in pre-test scores. There was a significantly higher mean score for 'prevention of pregnancy' in the IG compared to CG (P = 0.022), but not for other themes such as 'growing up' or 'STI/HIV' (P > 0.05) [Table 3].
Table 2: Changes in perceptions on RSH of both groups from pre to post-test

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Table 3: Comparison of pre and post-test knowledge and self-assessed competence scores of both groups

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Impact of capacity building initiative on perceptions of reproductive and sexual health issues in both groups

Perceptions are not described as a score, but as a number that reflects if students 'strongly agree', 'agree', are 'undecided', 'disagree' or 'strongly disagree' with the statement. Higher numbers[4],[5] indicate that the nursing students 'disagree' or 'strongly disagree' with the statement. These are also colour coded using darker shades. The lower numbers (1, 2) show that the nursing students 'strongly agree' or 'agree' with the statement. These are colour coded using lighter shades. The middle number (3) indicates that the students are undecided about the statement. [Table 2] shows the pre-test and post-test median numbers obtained for the intervention and the CG.

Of the 15 items used to understand the perception of students on RSH, there was a change in their response for 26.6% (4/15) and 33.3% (5/15) of the items in the IG and CG, respectively. A few examples of change in perception over the course of 18 months are recorded below:

  • Both groups moved from 'agree' to 'strongly agree' for the statement 'it is important to talk with your parents or counselors about sexual doubts' (Item 5)
  • The IG moved from 'undecided' to 'agree' for the statement 'I believe a girl can have an abortion if pregnancy was not wanted' (Item 14)
  • The CG moved from 'undecided' to 'disagree' for the statement 'Girls can be safe from being raped if they dress safely' (Item 12).


Examples where students did not change their perceptions and were undecided about a statement at the pre-test and continued to be undecided at the post-test include:

  • 'Masturbating is safe and can prevent HIV' (Item 7)
  • 'I would refuse sex without a condom' (Item 8).


Impact of capacity building initiative on self-assessed competence of both groups on reproductive and sexual health

The self-assessed competence scores were not statistically different between IG and CG (P > 0.05) both at pre-test and post-test. However, there was a significantly higher score within groups (IG and CG independently) from the pre-test to the post-test (P < 0.001) from their increase in scores from pre-test to post-test.

Resilience score of students from two groups

At the post-test, the nursing students from both groups were also given the Child Youth Resilience Measure to explore their resilience. There was no statistically significant difference (P > 0.05) between resilience scores of the intervention (50.22 ± 2.69) and CG (50.06 ± 3.95) at the post-test (t-test = 0.58 df 623 P = 0.55).


  Discussion Top


The capacity-building initiative in this study integrated life skills within topics of growing up, reproduction, contraception, STIs prevention and healthy sexual relationships[13],[17] with the intention of enhancing the abilities of 1st-year nursing students to address these RSH concerns, both personally and professionally. The sessions included activities that were self-reflective or group-reflective and were accessed primarily from the training guide developed for this purpose.[13] Students in their secondary and higher secondary education (9th-12th grade) are likely to have training sessions on topics related to RSH through the Adolescence Education Programme (AEP) that was rolled out in India.[21] The AEP, however, is implemented only in Central Government administered schools in India. Students who enrol for either the degree or diploma nursing programme are expected to take up science subjects, where biology is compulsory in their 11th-12th grade. The reproductive system is one of the units that is prescribed in this curriculum. Yet, the pre-test knowledge scores of both the intervention and CGs at the pre-test were below average (<50%) on all themes 'growing up issues', 'prevention of pregnancy' and 'HIV and STIs'. Hence, the need to strengthen curricula initiatives on RSH at the start of the nursing programme is evident given that students themselves, who are in late adolescence or early adulthood, would possible experience challenges related to RSH in their personal and professional lives.[1]

As part of the capacity building initiative in this study, the IG had more sessions than the CG on 'growing up issues' (4.75 vs 3 h), 'prevention of pregnancy' (5 vs 2 h) and 'HIV/STIs' (2.5 vs 1 h). The study showed that the CG's post-test score was not significantly different from the intervention group (IG) in the first and third themes, but there was a significant difference for the theme 'prevention of pregnancy'. Several reasons could have probably resulted in this finding. The sessions planned through the initiative could have triggered the memory of students on these topics; they may have been keen to learn; or short sensitisation sessions on 'growing up issues' and 'HIV/STIs' could be sufficient to stimulate interest and curiosity to learn about these issues and increase their confidence.[6] The IG could have performed better on 'prevention of pregnancy' probably since they received more than double the duration of related sessions compared to the CG (5 vs. 2 h). Such knowledge is crucial to preventing unwanted pregnancies for adolescents who are sexually active[22] and could be useful information for nursing students. Adolescents, in general, have been reported to be lacking in this information, even those who had sexual relations in exchange for money.[22],[23],[24] Hence, this study has shown that the capacity-building initiative had possibly facilitated in increasing knowledge. In fact, a previous study showed that nursing students agreed on the need for RSH capacity-building initiatives. They believed it would benefit them, personally and for their professional role in addressing these issues.[6]

Professional capacity building of health-care workers (HCWs), particularly nurses and midwives, has been deemed essential as they are considered first-line HCWs in the provision of RSH services such as counselling, education and even treatment of STIs.[17] There was no significant difference in knowledge scores on the topic of HIV/AIDS, including STIs, from pre-test to post-test in both groups. This could be the result of the undergraduate nursing curricula that extensively covers these topics in detail. A previous study also showed that participants had sufficient knowledge on HIV/AIDS and obtained their information from radio, teachers, relatives, friends and television.[11],[25] This present study did not follow-up to identify if improvement in knowledge and self-assessed competence on RSH issues of the participant nursing students had an impact on RSH outcomes such as on delaying sexual debut, reducing risky sexual activity and increasing contraceptive use, which has been demonstrated in related literature.[22] However, it could be a consideration for a future follow-up study of this cohort of nursing students. This study integrated life skills into the capacity-building initiative to help students identify their health goals and perceptions that included behavioural and psychosocial risks, along with protective factors for their own RSH, as typically recommended.[26] The improvement in students' knowledge and competence on RSH issues after 18 months indicates the success of the programme in accomplishing its objectives. Counselling, education and management services have been recommended as the domain of nurses working in primary health care, given their understanding of patients, family and systems.[26],[27],[28] Thus, if nursing students are sensitised to these issues in their 1st year through initiatives that are contextualised to their situation, it is likely that they would gain from it, both personally and professionally. They could 'gain the knowledge and hone the skills required to deliver evidence-based counselling and services' to make a positive impact on adolescent and adult RSH outcomes in any setting.[29]

The overall self-assessed competence of nursing students had increased in both intervention and CGs in this study and was not significantly different at the post-test. A study conducted in Turkey on nursing students also showed an increase in sexuality assessment skills after training.[30] The skills of students are known to increase when RSH education is linked and integrated with life skills. Some of the life skills known to be helpful in sexual relationships include being able to communicate, listen, negotiate with others, ask for and identify sources of help and advice, including being able to recognise pressure from other people and resist it.[27] In this study, both intervention and CGs had life skills incorporated into the capacity-building initiatives. However, the skills of assertive communication, empathy, problem-solving, reaching goals and coping with stress were not included for the CG. Yet, the difference in self-assessed competence of nursing students from both groups did not differ significantly. This could have possibly occurred due to maturation or the fact that the students would have already completed the courses on psychology, concepts of nursing and sociology in the period of 18 months, within which these topics are covered briefly. In addition, students from both groups were provided with the facility to ask anonymous questions (personal/professional) through a question box to reduce their inhibition. These were answered at sessions, and although the IG had more hours compared to the CG (90 min versus 60 min), both groups probably were able to clarify their doubts on these topics.

The perception of students did change from pre-test to post-test on certain RSH issues such as, for example, from where they could obtain information on RSH, risk of rape based on the dress of a girl. A previous study showed that religion and formal practice of religion was a factor associated with lower levels of knowledge and more conservative attitudes on RSH issues.[28] Knowledge on growing up issues, and prevention of pregnancy was found to be associated with the religion of nursing students.[2] This study did not determine the association of their perceptions on RSH with religion due to the lack of scoring system allocated to the measurement of perceptions.[2] Another study that evaluated the sexual attitudes of nursing students in Turkey, showed that the most conservative attitudes were held among second-year students, while the third-year students held the most liberal attitudes.[31] Given this scenario, it is important to design curricula with embedded strategies that will facilitate the examination of one's own attitude and beliefs towards RSH. Nursing students could be mentored to develop comfort in communicating about RSH issues with clients of all ages.[32],[33] Such initiatives would probably be best situated at the beginning of their nursing programme since they will be exposed to the acute care and community health settings in the 1st year itself.

Nursing degree and diploma programmes would need to include competency-based curricula that include essential competencies on the prevention of unintended pregnancy and care with focus on adolescents. The greatest advantage of building capacities of nursing students on RSH issues would be that adolescents and young adults would easily identify with them and they would probably be more preferred as sources of information than the adolescents' own parents.[29],[32] RSH education, counselling and non-invasive contraceptive provision are strategies known to effectively increase knowledge and contraceptive use and decrease adolescent pregnancies.[33] 1st-year nursing students have requirements of providing group health education to complete, while being posted in the community settings and in schools. They thus could be more accepted by their peer groups in these settings to address RSH issues. Further, research would be required to study the impact of capacity-building initiatives for nursing students on these long-term outcomes of contraceptive use, counselling of adolescents on the prevention of pregnancy. Incredibly just 13.75 h of sessions for 1st-year nursing students that were provided to the CG had improved their knowledge and self-assessed competence to address RSH issues. Yet, the study is limited in that it depended on self-reports to assess the competencies of students to deal with RSH issues. Nursing faculty could thus take a cue from this study to seek ways to engage students actively to facilitate introspection, discussion and clarification of their doubts on RSH issues, to enable them to gain confidence to address these issues. Such an initiative could probably build the capacity of students and provide them the opportunity to disseminate information about RSH confidently to adolescents and their parents in communities, schools, public health clinics and acute care settings.[29] It is essential that future efforts to identify implementation components linked to the impact on knowledge and self-assessed competence would be needed to expand the evidence base on programmes that impact RSH, of adults in general and adolescents particularly.[26],[33]


  Conclusion Top


This study clearly demonstrated that even a condensed version of a capacity-building initiative for 1st-year nursing students could impact knowledge and self-assessed competence on RSH issues. Perceptions on RSH would take a longer time to change since they are dependent on factors such as religion and beliefs of nursing students. Nursing students can probably collectively use their unique combination of knowledge and skills to make a positive impact on RSH outcomes, especially of adolescents.

Acknowledgements

We would like to thank the Indian Council of Medical Research (ICMR) for supporting this project entitled “Capacity Building of Nursing Students on Reproductive and Sexual Health using Life Skills Approach: A Quasi-experimental Study” (Ref No 2013-0521) for a two-year period (2017–2018). We are indebted to the managements of each of the institutions for granting permission for the conduct of the project within the regular curricula activities of the students. We would like to thank the following faculty members of the selected nursing institutions whose capacities were built on RSH through this project and who assisted in coordinating sessions and facilitating in meeting with the students to complete the project as per plan: B.M Prema, Jayalakshmi S. Jagadeeswari, Remya Cyriac, Bilcy P.B, Sharon Joseph, Poorkodi M, Neelmraj Singh, Lisa Santosh, Shine Susan Jacob, Divya Varghese, Maria Florence, G.B. Vimala Mary, Susan Kumar, Mahalakshmi B, Prakruthi, Shalini, Sushma J.B, Kavya Gowda M, Nadini, S.B, Leeba, Saranya.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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2.
Washington M, Hartley S, Tavares J, Pushparaj M, Selvam S, Mony PK. Is what is known enough? Knowledge, perception and competencies on reproductive and sexual health issues of nursing students from a Metropolitan City, Karnataka. Indian J Contin Nurs Educ 2020;21:50.  Back to cited text no. 2
    
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