Genital Hygiene Training Provided to Turkish Women
Condition: Genital Hygiene; Genital Hygiene Behaviors; Self-care Agency
MeSH terms: Candidiasis; Candidiasis, Vulvovaginal
Study type: Interventional

Summary: 
      Purpose: In the study, it was aimed to determine the effect of genital hygiene training
      provided to women living in rural areas with a vulvovaginal candidiasis history on genital
      hygiene behaviors and self-care agency.

      Material and methods: This study with a randomized controlled design was conducted with the
      participation of women who were registered to Family Health Centers located in two villages
      in the rural areas in the east of Turkey and who had a history of vulvovaginal candidiasis
      within the last year. The study sample consisted of 114 women in total, 57 of whom were in
      the intervention group and 57 were in the control group. The women in the intervention group
      were provided with genital hygiene behaviors training. The study data were collected
      Identifying Information Form, Genital Hygiene Behavior Inventory (GHBI), and Self-Care Agency
      Scale (SCAS).
    

Detailed description: 
      Design The study was designed as a randomized controlled trial in which the subjects were
      randomly assigned to the intervention (receiving genital hygiene training) and the control
      group.

      The study was conducted in the Family Health Centers of two randomly selected villages with a
      distance of 20-30 km to Van province located in the east of Turkey. These villages are in a
      rural area and people make their living mostly through farming. Each village had one family
      health center, and other health institutions were in the provincial center. Family health
      centers are primary care health institutions which provide reproductive health service for
      women (healthy woman follow-up, laboratory tests, family planning, education, counselling,
      etc.). While training is provided within the scope of preventive health services in family
      health centers, there is no training provided specifically on genital health regarding
      vulvovaginal candidiasis. Working hours are between 08.00-17.00 every weekday, and there are
      three family health doctors and three family health professionals (midwife and/or nurse) in
      these centers.

      Sample The study sample consisted of women who tested positive on at least one culture test
      and received and completed treatment for vulvovaginal candidiasis in the last year according
      to the registry of the Family Health Centers. The study inclusion criteria were being within
      the age range of 18-49 years, not having a systemic disease, and not being pregnant or
      puerpera between the dates when the study was conducted. According to the registration system
      of the family health centers, 1,400 women who met these criteria were receiving service from
      these centers.

      In order to predict the most suitable sample size for the study, priori-power analysis was
      performed on a web-based software (https://www.stat.ubc.ca/~rollin/stats/ssize/n2.html).
      Sample size was calculated to be 57 for each group (57 in the intervention group and 57 in
      the control group) with 5% margin of error at two-way significance level, 95% confidence
      interval, 80% power of representing the population and by assuming that the mean score of
      genital hygiene behaviors, which was 84.51 (standard deviation 5.69), would increase by three
      points. According to the records of the family health centers where the study was conducted,
      there were 142 women who received and completed treatment for vulvovaginal candidiasis in the
      last six months. 142 women were assigned to the intervention and control groups through
      randomization. Women were listed by the researchers for randomization. According to the list,
      women with odd numbers were assigned to the intervention group and those with even numbers
      were included in the control group. The sample selection process carried out in line with
      CONSORT criteria is presented in Figure 1.

      Data Collection Tools In the collection of the study data, Identifying Information Form,
      Genital Hygiene Behavior Inventory (GHBI), and Self-Care Agency Scale (SCAS) were used.

      Identifying Information Form: The form developed by reviewing the literature consisted of
      questions inquiring about the sociodemographic characteristics of the women (age, educational
      status, employment status, etc.).

      Genital Hygiene Behavior Inventory (GHBI): The scale was developed in Turkish in order to
      measure genital hygiene behaviors of women, and the validity and reliability study of the
      scale was conducted by Karahan in 2017. The scale consists of three subscales, which are
      "general hygiene" (12 items), "menstrual hygiene" (8 items), and "abnormal finding awareness"
      (3 items). The 23-item and 5-point Likert type scale is scored between 1 and 5. The minimum
      and maximum scores to be obtained from the scale are 23 and 115. As the score obtained from
      the scale increases, the women's levels of displaying proper genital hygiene behaviors
      increase. The Cronbach's alpha internal consistency coefficient of the scale is 0.80.

      Self-Care Agency Scale (SCAS): The scale was developed by Kearney and Fleischer in 1979. The
      Turkish validity and reliability of the scale was conducted by Nahcivan in 1993. It is used
      to measure individuals' self-care agency levels. Each item of the 35-item and 5-point Likert
      type scale is scored between 0 ad 4. The minimum and maximum scores to be obtained from the
      scale are 0 and 140. A high score on the scale shows the individual's high level of self-care
      agency. The Cronbach's alpha internal consistency of the scale is 0.89.

      Procedures The women assigned to the intervention and control groups were called on their
      telephone numbers registered at the family health center by the researchers to inform them
      about the study, and they were invited to the family health centers. The pretest data were
      obtained from the women through the scales used in the study and the questionnaire on their
      sociodemographic characteristics by face-to-face interviews held by the researchers in the
      counselling room in the family health centers. Four weeks later, posttest data were collected
      by following the same procedures.

      Following the pretest, "genital hygiene behaviors training" was provided to the women in the
      intervention group by E.S.B., one the researchers. In addition, a genital hygiene brochure
      prepared by the researchers which included the same content as the training was given to each
      participant. The training program was carried out as oral instruction as well as using the
      demonstration method which is called as "tell-show-do". Individual questions of the women
      were answered at the end of the training. In the first meeting with the women, 2 sessions of
      45 minutes with a 10-minute break were held in the counselling rooms of the relevant family
      health centers. Two weeks after these sessions, a 45-minute session was held in order to
      reinforce the training with the same method. No intervention was made to the women in the
      control group.

      Genital hygiene training program was developed by reviewing the literature, and expert
      opinion was taken for content check before application. In line with the opinions of three
      academics in the field of nursing, necessary corrections were made, and the training program
      was finalized. The training program included introduction of reproductive organs, properties
      of genital discharge, achieving hand and general hygiene, genital infections, hygiene rules
      in sexual contact, ensuring genital hygiene during menstruation, problems related to genital
      organs, and coping with genital problems.
    

Intervention name(s): Genital hygiene training
Intervention type(s): Other
Intervention description(s): In the first meeting with the women, 2 sessions of 45 minutes with a 10-minute break were held in the counselling rooms of the relevant family health centers. Two weeks after these sessions, a 45-minute session was held in order to reinforce the training with the same method.
Allocation: Randomized
Intervention model: Crossover Assignment
Intervention model description: The study was desined as a randomized controlled trial
Masking: Single (Participant)
Primary purpose: Supportive Care
Keywords: genital hygiene; vulvovaginal candidiasis; genital infection; self-care; rural area