الفهرس 
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Abstract
Polycystic ovary syndrome (PCOS) is one of the most female widespread endocrinopathies and metabolic alterations that affects about 5%-10% of women worldwide during their reproductive age of 12–45 years. PCOS is defined by a combination of signs and symptoms of androgen excess and ovarian dysfunction in the absence of other specific diagnoses (Escobar-Morreale, 2018).
However, the exact underlying causes of PCOS are remaining unknown and largely unclear. Nevertheless, strong evidence supports the possibility of the condition, which is probably due to a combination of genetic, epigenetic, and environmental factors, including in utero exposure to androgens in disease development (Speelman, 2019).
Furthermore, POCS is usually characterized by features of anovulation (amenorrhea, oligo-amenorrhea, and irregular cycles), a combination of hyperandrogenism (either clinical or biochemical), and polycystic ovaries. It is frequently associated with insulin resistance and obesity (Kriedt, et al., 2019).
PCOS has a negative effect on women’s health across the lifespan and can lead to serious health problems in women and the community if not treated such as anxiety, depression, poor self-esteem, alters the coping abilities, and decrease quality of life, insulin resistance, obesity, and cardiovascular disease (Sha, et al., 2019).
Therefore, a healthy lifestyle is one of the most important aspects of managing PCOS successfully which includes a healthy diet, regular exercise, and achieving and maintaining a healthy weight. Recent evidence suggests that following a healthy lifestyle reduces body weight, sleep disturbance, mood fluctuation, abdominal fat, reduces testosterone, improves hair growth, and improves insulin resistance (Rawat, et al., 2017).
Aim of the study: The present study aimed to evaluate the effect of educational program on lifestyle for paramedical students with the polycystic ovarian syndrome.
Research hypothesis: Students who attendance the educational program regarding polycystic ovarian syndrome, will be improve their knowledge scores and their lifestyle.
Research design: A quasi-experimental design of one group “pre-test & post-test” was utilized to achieve the aim of the current study.
Study setting: The study was conducted in two government colleges in Jordan, (Rafidah Al-Aslamia College of Nursing / Midwifery and Paramedical and Nusaiba Al-Maznieh College for Nursing / Midwifery and Paramedical). Also, both colleges are under the umbrella of the Ministry of Health in Jordan.
Sample size: (68) students.
Sample type: Purposive sample.
Sample criteria:
All students in all grades with previous diagnosis of polycystic ovarian syndrome.
Age from 18 to 25 years.
Not married.
Had no medical and gynecological problem except PCOS.
Size and technique of sampling:
All students in the all grades of both colleges (745) were included to assess polycystic ovary symptoms.
The students diagnosed with polycystic ovarian syndrome for the intervention study (68).
The total number of participiants from Rufaida college was (n= 48) and (n= 20) participants from Nusaiba college.
Tools for data collection:
A data collection tools were developed by the researcher after reviewing the related literature and written in simple clear Arabic language. It’s included the following:-
1) Identification of Students with PCOS Tool.
2) POCS Structured Interviewing Questionnaire.
3) Assessment of Lifestyle Habits Tool.
4) Follow up Sheet.
5) Psychological Assessment Tool.
Tool (I): Identification of students with PCOS Tools: This tool was designed by the researcher to identify the students with PCOS. It encompassed two main parts including:-
Part (1): Clinical parameters of PCOS, which included hirsutism, acne, and acanthosis nigricans, and it included 5 questions.
Part (2): Biochemical parameters of PCOS, which included 17-Alpha hydroxyprogesterone, serum testosterone, follicular stimulating hormone (FSH), luteinizing hormone (LH), prolactine, and fasting insulin.
Tool (II): PCOS Structured Interviewing Questionnaire : This tool was designed by the researcher in the Arabic language after reviewing related literature to collect data. It encompassed three main parts including;
Part (1): General characteristics and physical characteristics of the students. It involved personal data such as age, residence, marital status, level of father’s and mother’s education, family history of the PCOS , and anthropometric measurements such as height, weight, body mass index and waist circumference (from question no.1 to 14).
Part (2): This part was designed to assess the menstrual history of the students such as the age of menarche, cycle length, duration of menstrual blood flow, and number and rhythm of menstrual cycles through the previous year (from question no.15 to 22).
Part (3): This part was used to assess students’ knowledge regarding polycystic ovarian syndrome such as definition, causes, signs and symptoms, risk factors, complications, and treatment (from question no.23 to 32).
Scoring system: This scoring system was used to assess the student’s knowledge would be checked with a model key answer, the score range was assigned to each answer as follows:-
1- Correct = 2 marks.
2- Incorrect = 1 mark.
*Level of satisfaction:
≥ 60% was considered satisfaction level.
< 60% was considerd unsatisfaction level.
Tool (III): Assessment of Lifestyle Habits Tool: This tool was designed by the researcher in the Arabic language to assess the student’s lifestyle habits. It encompassed four main parts including:
Part (1): This part was designed to assess the student’s food habits such as types of food intake, frequency, components of meal (from question no.1 to 14).
Part (2): This part was designed to assess the student’s physical activity such as type of exercise, times of exercise (from question no.15 to 17).
Part (3): This part was designed to assess the student’s leisure time such as watch TV, frequency, and use of computer (from question no.18 to 20).
Part (4): This part was designed to assess the student’s sleep pattern such as sleep hours daily, naptime, and insomnia (from question no.21 to 25).
Tool (IV): Follow up sheet: This sheet was constructed by the researcher to assess PCOS improvement and outcome measures and was filled by the students, it consisted of three parts:-
Part (1): It included students’ compliance and reasons for non-compliance with the recommended diet and exercise regimen. In addition, students’ opinion about the instructional instructions was useful or not, and it included 3 questions.
Part (2): It is including changing in the menstrual cycle, changing in clinical parameters such as (acne, hirsutism, acanthosis), changing in physical characteristics like weight, BMI, and waist circumference, and it included 11 questions.
Part (3): Follow up card: This card was designed by the researcher to collect general contact information to follow cases through it; student name, college name, specialization, telephone number, and WhatsApp number.
Tool (V): Psychological Assessment Tool: This tool was developed by the researcher to assess psychological health such as, anxiety, depression, and mood fluctuation for students related to lifestyle before and after the intervention. It consists of 10 statements every student had three responses for each statement.
Scoring system: The score range between 3, 2, or 1 was assigned to each answer representing no problem, medium degree problems, large degree problems respectively.Then, the total score was calculated by summation of the scores of its items (30). Students with a total score from 1≤10 were specified as leaving poor psychological lifestyle, students with a total score from 10 ≤ 20 were specified as leaving average psychological lifestyle and students with a total score from 20≤ 30 were specified as leaving good psychological lifestyle.
Supported material (Educational program):
The program was designed by the researcher and written in simple Arabic language using illustrated pictures to facilitate the students’ understanding the information about PCOS it was included; introduction, definition, causes, signs and symptoms, diagnosis, complications, healthy nutrition, physical activity, problems, and their impact of the disease on the reproductive health and management of each problem by pharmacological and non-pharmacological.
Pilot study:
Seventy-five students (10%) who met the criteria for inclusion were recruited for the pilot study based on the total number of the sample. All students who participated in the pilot research were excluded from the research sample.
Results:
Results of the present study revealed that:
• Regarding the distribution of the total studied sample, the finding of the current study revealed that, the prevalence of PCOS was found to be 9.12% among the total study sample.
• The age of the majority of the students (73.5%) ranged between 18-20 years compared to the age of the minority (4.4%) of them ranged between 24-25 years, respectively. with mean age 19.89 years.
• Concerning the area of residence, the majority (51.5%) of the students’ live in city areas while 48.5% of them live in village areas. In addition, the majority (80.9%) of the students live in the nucleolus family, while 19.10% of them live in an extended family. Also, half of the studied sample (50.0%) had educated mothers at the secondary level, while 44.1% of them had educated fathers at the university level.
• The majority (89.7%) of them had monthly income, which met the needs of the family.The study indicated that the majority of the sample was from midwifery specialization.
• Regarding diet pattern, there was a highly significant difference in all items related to the studied students’ lifestyle about diet pattern as compared pre, post, and follow-up intervention (P≤0.001).
• Regarding exercise pattern, there was a highly significant difference in the studied students’ lifestyle regarding their exercise pattern about exercise practiced and kind of sport practiced as compared pre, post, and follow-up applying the educational program (P≤0.001).
• Regarding daily sleep pattern, there was a highly significant difference in studied students’ lifestyle regarding their daily sleep pattern as compared to pre, post, and follow-up applying the educational program (P≤0.001).
• Regarding daily leisure, there was a highly significant difference in the studied students’ lifestyle regarding their daily leisure time about knowing dangerous use of electronic devices such as laptops or smartphones to the health of ovaries in the sitting position as compared pre, post, and follow-up applying the educational program (P≤0.001).
• Concering knowledge about PCOS, there was a highly significant difference as compared to pre, post, and follow-up applying the educational program (P≤0.001).
• Concering psychological status, there was a highly significant difference in all items related to the studied students’ psychological state as compared to pre, post, and follow-up applying the educational program (P≤0.001).
• Regarding the results of the follow-up of the diagnosed studied sample, there was a highly significant difference in all items clinical features of PCOS related to the studied students’ as compared pre, post, and follow-up intervention (P≤0.001).
• Also, regarding physical characteristics, there was a highly significant difference in weight, body mass index, and waist circumference as compared before and after the educational program.
• The main findings of this study generally revealed the following:
• Students with polycystic ovarian syndrome had a major deficiency and lack of knowledge of main items regarding PCOS before applying educational program and there was a significant improvement in students’ knowledge after applying program.
• There was a significant improvement in the student’s lifestyles after applying educational program compared with that before intervention.
• In addition, the educational program significantly improved the student’s psychological status after applying the educational program.
• There was a significant improvement in the student’s clinical features of PCOS and their physical characteristics after applying the educational program compared with that before the intervention.
Based on results of the present study, the following can be recommendations:
Applying screening program for PCOS in young students is a very important to reduce the long-term health complications associated with PCOS.
Providing educational program about main items of PCOS and hazards effects on the reproductive health to paramedical and non-paramedical students in Jordan.
Integrating health education and counseling to support the students suffering from PCOS and their families for decreasing obesity, which affects students’ lifestyles.
The optimal dietary strategies and exercise regimens for PCOS treatment and the relative efficacy and appropriate use of lifestyle management versus anti-obesity pharmacologic agents and surgery.
Further researches:-
There are further researches, which are required to evaluate the impact of this study on a large sample size in another setting about students suffering from PCOS to improve their knowledge and lifestyle through continuous counseling, support, and encouragement.