A study to assess effectiveness of QR coded self-Instructional module regarding endometriosis on knowledge among women in selected urban area

Background: Endometriosis is a chronic gynaecological disorder that affects a substantial number of women of reproductive age and often leads to pelvic pain, infertility, and reduced quality of life. Despite its high prevalence, awareness and knowledge regarding endometriosis remain limited among women, contributing to delayed diagnosis and inadequate management. Digital health education strategies such as QR coded self -instructional modules (SIM) offer a convenient and effective method to improve health-related knowledge.

1. To assess the knowledge regarding endometriosis among women in selected urban areas. 2. To assess the effectiveness of a QR coded self -instructional module on knowledge regarding endometriosis among women in selected urban areas. 3. To determine the association between knowledge scores and selected demographic variables. Methodology: A quantitative research approach with a quasi -experimental one-group pretest-post-test design was adopted. The study was conducted in selected urban areas of PCMC, Pune. A total of 100 women were selected using a simple random sampling technique. Data were collected using a structured knowledge questionnaire. Following the pretest, a QR coded self-instructional module on endometriosis was administered. Post -test knowledge was assessed after the intervention. Descriptive and inferential statistics, including paired t-test and Fisher’s exact test, were used for data analysis.

The pretest findings revealed that 78% of women had poor knowledge and 22% had average knowledge regarding endometriosis. After the intervention, 98% of women demonstrated good knowledge, while 2% had average knowledge. The mean knowledge score increased significantly from 4.6 in the pretest to 17.8 in the post-test. The paired t-test value was 37.1 with 99 degrees of freedom (p < 0.05), indicating a statistically significant improvement in knowledge following the QR coded SIM. A significant association was observed between knowledge scores and occupation.

The study concluded that the QR coded self-instructional module was highly effective in improving knowledge regarding endometriosis among women in selected urban areas. The findings support the use of QR code -based digital health education as an accessible, cost -effective strategy to enhance women’s awareness and promote early identification and management of endometriosis

Endometriosis, QR coded self-instructional module , Women’s health, Knowledge assessment, Digital health education, Urban women

Endometriosis is a disease in which tissue similar t o the lining of the uterus grows outside the uterus. It can cause severe pain in the pelvis and make it harder to get pregnant. Endometriosis can start at a person’s first menstrual period and last until menopause. With endometriosis, tissue sim ilar to the lining of the uterus grows outside the uterus. This leads to inflammation and scar tissue forming in the pelvic region and (rarely) elsewhere in the body. The cause of endometriosis is unknown. There is no known way to prevent endometriosis. There is no cure, but its symptoms can be treated with medicines or, in some cases, surgery. [1]. It causes a chronic inflammatory reaction that may result in the formation of scar tissue (adhesions, fibrosis) within the pelvis and other parts of the body. Several lesion types have been described: • Superficial endometriosis found mainly on the pelvic peritoneum cystic ovarian International Journal of Midwifery and Nursing Practice https://www.nursingpractice.net ~ 22 ~ endometriosis (endometrioma) found in the ovaries • Deep endometriosis found in the recto- vaginal septum, bladder, and bowel • In rare cases, endometriosis has also been found outside the pelvis.

of the Study Endometriosis is a chronic and often debilitating gynaecological disorder that affects an estimated 176 million women worldwide, with a prevalence of 6 -10% among women of reproductive age. In India, the prevalence of endometriosis is estimated to be around 4- 22% among women of reproductive age. [2] Despite its high prevalence, endometriosis remains poorly understood, and many women experience delayed diagnosis and inadeq uate treatment (Nnoaham et al ., 2012). Lack of awareness and education about endometriosis among women is a significant barrier to early diagnosis and effective management. [3] The use of technology, such as QR coded SIM, has been shown to be an effective way to disseminate health information and promote health education. QR coded SIM can provide a convenient and accessible way for women to access information about endometriosis, its symptoms, diagnosis, and treatment options . [4] Therefore, this study ai ms to assess the effectiveness of a QR coded SIM regarding endometriosis using QR codes among women residing in selected urban areas of Pune city .[5] Need of the Study Endometriosis is a chronic and often debilitating condition affecting a significant p ercentage of women Worldwide. In India, it is becoming increasingly recognized as a common cause of infertility, chronic pelvic pain, and a reduced quality of life among women. Despite its high prevalence, awareness and knowledge about endometriosis remain s limited, particularly in urban areas. women may not fully understand the symptoms, causes, or treatment options available to them. This gap in awareness can lead to delayed diagnosis, poor management, and worsening of symptoms, often resulting in long-term impartment of QOL. Key reasons for the need of this study: 1. lack of awareness about endometriosis. 2. Delayed diagnosis and its QOL. 3. Ease of access to digital health education 4. Empowering women through knowledge.

1. To assess the knowledge r egarding endometriosis among women in selected urban areas. 2. To assess the effectiveness of QR coded SIM on knowledge regarding endometriosis among women in selected urban area. 3. To find out the association of knowledge scores with demographic variables of the women. Research Methodology Research Approach The present study adopted a quantitative research approach to systematically assess the effectiveness of a QR coded self-instructional module on knowledge regarding endometriosis among women. This appr oach enabled

measurement and statistical evaluation of knowledge levels before and after the intervention. Research Design A quasi- experimental one -group pretest -post-test research design was used for the study. This design allowed the researcher to measure baseline knowledge regarding endometriosis, administer the QR coded self -instructional module, and subsequently assess the change in knowledge among the same group of participants. Setting of the Study The study was conducted in selected urban areas of PCMC, Pune. The setting was chosen based on accessibility of the population, feasibility of data collection, and availability of women willing to participate in the study. Population and Sample The population of the study consisted of wom en residing in selected urban areas. A sample of 100 women was selected using a simple random sampling technique. Women who were willing to participate and available during the data collection period were included in the study, while women working as healt hcare professionals and those unwilling to participate were excluded. Variables of the Study In the present study, the QR coded self-instructional module regarding endometriosis was considered the independent variable, while the knowledge regarding endometriosis among women was considered the dependent variable. Tool for Data Collection Data were collected using a structured tool developed by the researcher. The tool consisted of a demographic data section and a structured knowledge questionnaire cont aining 20 multiple-choice questions related to endometriosis, including its causes, risk factors, symptoms, diagnostic procedures, complications, and management. The QR coded self-instructional module served as the educational intervention and provided com prehensive information on endometriosis through digital content accessible via smartphones. Scoring Procedure Each correct response in the knowledge questionnaire was awarded one mark, with a maximum possible score of 20. Knowledge scores were used to d etermine the level of knowledge regarding endometriosis among women before and after the intervention. Validity and Reliability Content validity of the structured knowledge questionnaire and the QR coded self -instructional module was established through expert review by obstetrics and gynaecology specialists, nursing educators, and community health professionals. Necessary modifications were made based on expert suggestions. Reliability of the tool was established through a pilot study, which confirmed i ts consistency and suitability for the main study. Pilot Study A pilot study was conducted on a small sample of women residing in an urban area to assess the feasibility of the International Journal of Midwifery and Nursing Practice https://www.nursingpractice.net ~ 23 ~ study, clarity of the tool, and reliability of the questionnaire. The findin gs of the pilot study indicated that the tool was understandable and the study was feasible to conduct on a larger sample.

of Data Collection After obtaining formal permission and informed consent, the pretest was conducted using the structured knowledge questionnaire. The QR coded self -instructional module was then administered to the participants. Posttest assessment was carried out using the same questionnaire after the intervention to evaluate the effectiveness of the QR coded SIM. Plan for Data Analysis The collected data were organized, tabulated, and analysed using descriptive and inferential statistics. Descriptive statistics such as frequency, percentage, mean, and standard deviation were used to describe demographic variables and knowledge levels. Inferential statistics, including paired t - test and Fisher’s exact test, were used to determine the effectiveness of the QR coded self -instructional module and to assess the association between knowledge scores and selected demographic variables.

Description of samples (women) based on their personal characteristics Table 1: Description of samples (women) based on their personal characteristics in terms of frequency and percentage. N=100 Demographic variable Freq % Age 18 - 22 years 26 26% 23 -27 years 24 24% 28-32 years 6 6% Above 32 years 44 44% Education Primary 24 24% Secondary 21 21% Higher secondary 20 20% Graduate and above 35 35% Type of family Nuclear 53 53% Joint 46 46% Single parent 1 1% Religion Hindu 96 96% Muslim 2 2% Christian 1 1% Other 1 1% Occupation Housewife 56 56% Service 37 37% Business 4 4% Labourer 3 3% Age of puberty 9 years 16 16% 10 years 18 18% 11 years 19 19% Above 11 years 47 47% Table 1 deals with the description of the study participants based on their personal characteristics. The demographic profile of the 100 women included variables such as age, educational status, type of family, religion, occupation, and age at puberty. With regard to age, 26% of the women belonged to the age group of 18- 22 years, 24% were in the age group of 23 -27 years, 6% were between 28 -32 years, and the largest proportion, 44%, were above 32 years of age. This indicates that a majority of the participants were above 32 years. In terms of educational status, 24% of the women had primary education, 21% had secondary education, 20% had higher secondary education, and 35% had complet ed graduation or higher education. This shows that more than one-third of the participants were graduates or had higher educational qualifications. Regarding the type of family, 53% of the women belonged to nuclear families, 46% were from joint families, and 1% belonged to single -parent families. This indicates that nuclear family structure was more prevalent among the participants. With respect to religion, the majority of the women (96%) were Hindu, while 2% were Muslim, and 1% each were Christian and belonged to other religions. Occupational distribution revealed that 56% of the women were housewives, 37% were employed in service sectors, 4% were engaged in business, and 3% worked as labourers. This shows that more than half of the participants were homemakers. Concerning the age at puberty, 16% of the women attained puberty at 9 years, 18% at 10 years, 19% at 11 years, and 47% attained puberty after 11 years of age. The findings indicate that nearly half of the participants experienced puberty after the age of 11 years. Overall, the demographic data indicate that the study included women from diverse age groups, educational backgrounds, family structures, and occupational statuses, providing a representative sample for assessing knowledge regarding endometriosis. Section II Analysis of data related to the knowledge regarding endometriosis among women in selected urban areas Table 2: Knowledge regarding endometriosis among women in selected urban areas N=100 Knowledge Pretest Freq % Poor 78 78% Average 22 22% Good 0 0% Table 2 78% of them women had poor knowledge and 22% of them had average knowledge regarding endometriosis. Section III Analysis of data related to the effectiveness of QR coded SIM on knowledge regarding en dometriosis among women in selected urban area International Journal of Midwifery and Nursing Practice https://www.nursingpractice.net ~ 24 ~ Table 3: Effectiveness of QR coded SIM on knowledge regarding endometriosis among women in selected urban area N=100 Knowledge Pretest Post-test Freq % Freq % Poor 78 78% 0 0% Average 22 22% 2 2% Good 0 0% 98 98% Table III depicts, In pretest, 78% of them women had poor knowledge and 22% of them had average knowledge regarding endometriosis. In posttest, 98% them had good knowledge and 2% of them had average knowledge regarding endometriosis. This indicates that there is remarkable improvement in the knowledge among women regarding endometriosis after QR coded SIM. Fig 1: Knowledge regarding endometriosis among women in selcetd urban areas in pre-test & Post-test. Fig, 1 illustrate the comparison of knowledge levels regarding endometriosis among women in selected urban areas during the pre-test and post-test phases. In the pre-test, the majority of women (78%) demonstrated poor knowledge regarding endometriosis, while 22% had an average level of knowledge. None of the participants exhibited good knowledge prior to the intervention, indicating a considerable gap in awareness and understanding of endometriosis among the study population. In contrast, the post -test resul ts show a marked improvement in knowledge levels following the administration of the QR coded self-instructional module. A substantial majority of women (98%) achieved good knowledge scores, while only 2% remained in the average knowledge category. Notably, no participants were found to have poor knowledge in the post-test. The comparison between pre -test and post- test findings clearly demonstrates a significant improvement in knowledge regarding endometriosis among women after the educational intervention. This indicates that the QR coded self-instructional module was highly effective in enhancing awareness and understanding of endometriosis among women residing in selected urban areas. Table 4: Paired t-test for the effectiveness of QR coded SIM on knowledge regarding endometriosis among women in selected urban area, N=100 Mean SD T Df p-value Pretest 4.6 2.6 37.1 99 0.000 Post- test 17.8 1.8 Table 4 depicts the paired t-test analysis conducted to evaluate the effectiveness of the QR coded selfinstructional module on knowledge regarding endometriosis among women in selected urban areas. The mean pre- test knowledge score was 4.6 with a standard deviation of 2.6, indicating a low level of baseline knowledge among the participants. Following the intervention, the mean post -test knowledge score increased substantially to 17.8 with a standard deviation of 1.8, reflecting a marked improvement in knowledge. The calculated t value was 37.1 with 99 degrees of freedom, and the correspo nding p value was less than 0.05. This indicates that the difference between the pre- test and post- test mean knowledge scores was statistically significant. Therefore, the null hypothesis was rejected, and it can be concluded that the QR coded selfinstruct ional module was significantly effective in improving knowledge regarding endometriosis among women in selected urban areas. International Journal of Midwifery and Nursing Practice https://www.nursingpractice.net ~ 25 ~ Table 5: Knowledge item analysis, N=100 Knowledge Pretest Post-test Freq % Freq % What is meant by endometriosis? 28 28% 99 99% What are the causes of endometriosis? 10 10% 95 95% Which of the following is a risk factor for endometriosis? 25 25% 95 95% What are symptoms of endometriosis? 13 13% 96 96% Most Common symptom of endometriosis? 13 13% 89 89% What investigations are done in endometriosis? 15 15% 92 92% Physical examination in people with suspected endometriosis should include examination of? 10 10% 86 86% Which test is accurate to diagnose urinary tract involvement in women with suspected pelvic endometriosis? 19 19% 84 84% What is the name of the surgical procedure used to diagnose endometriosis? 20 20% 88 88% Prevalence among women with endometriosis in India? 50 50% 90 90% Prevalence of women with infertility 39 39% 94 94% What is the most common location of endometrial implants? 18 18% 85 85% Which of the following is a common complication of endometriosis? 28 28% 91 91% Which of the following is a surgical option for treating endometriosis? 29 29% 82 82% What is the treatment of infertility in endometriosis? 26 26% 92 92% Which hormone plays a crucial role in the development and growth of endometrial implants? 23 23% 82 82% What is the name of the condition characterized by the growth of endometrial tissue into the uterine wall? 39 39% 90 90% Painkillers used to reduce pain during endometriosis is? 17 17% 86 86% Size of ovarian endometriosis beyond which cystectomy is indicated? 20 20% 82 82% What is the purpose of medical management in endometriosis? 22 22% 86 86% Table 5 presents the frequency and percentage of correct responses by women to each knowledge item in pretest and posttest. It indicates that correct responses by women to each knowledge item improved remarkably after QR coded SIM. Knowledge regarding endometriosis among women improved remarkably after QR coded SIM. Section IV Analysis of data related to the association of knowledge scores with demographic variables of the women Table 6: Fisher’s exact test for the association of knowledge scores with demographic variables of the women N=100 Demographic variable Knowledge p-value Poor Average Age 18 - 22 years 13 3 0.915 23 -27 years 15 3 28-32 years 15 4 Above 32 years 35 12 Education Primary 19 5 0.208 Secondary 18 3 Higher secondary 12 8 Graduate and above 29 6 Type of family Nuclear 42 11 0.290 Joint 36 10 Single parent 0 1 Religion Hindu 75 21 0.423 Muslim 2 0 Christian 1 0 Other 0 1 Occupation Housewife 44 12 0.006 Service 32 5 Business 2 2 Labourer 0 3 Age puberty of 9 years 13 3 0.915 10 years 15 3 11 years 15 4 Above 11 years 35 12 Table VI presents the results of Fisher’s exact test used to determine the association between knowledge scores regarding endometriosis and selected demographic variables of the women. The demographic variables analyzed included age, educational status, type of family, religion, occupation, and age at puberty. The findings reveal that there was no statistically significant association between knowledge scores and age, educational status, type of family, religion, or age at puberty, as the corresponding p values for these variables were greater than 0.05. This indicates that differences in knowled ge regarding endometriosis among the women were not influenced by these demographic characteristics. However, occupation showed a statistically significant association with knowledge scores, as the p value was less than 0.05 ( p = 0.006). This suggests tha t the level of knowledge regarding endometriosis varied significantly according to the occupational status of the women. Overall, the results indicate that among the selected demographic variables, occupation was the only factor significantly associated w ith knowledge regarding endometriosis among women in the selected urban areas.

Talk about the goal of the current study was to evaluate how well women in particular urban regions understood endometriosis after completing a self -instructional module using a QR code. The majority of participants had insufficient knowledge regarding endometriosis, its risk factors, symptoms, consequences, and management techniques before the intervention, according to the findings. This suggests a substantial kno wledge gap that could be caused by a lack of awareness campaigns, a lack of focus on women's reproductive health, and the continued stigma associated with gynaecological disorders. The participants' post -test knowledge scores significantly improved follow ing the administration of the selfinstructional module with a QR code. This demonstrates how well educational resources based on QR codes can raise women's awareness of endometriosis. The findings are in line with other research showing that technologydriven and digital educational interventions enhance knowledge retention, make health information more accessible, and enable people to make educated health decisions. International Journal of Midwifery and Nursing Practice https://www.nursingpractice.net ~ 26 ~ Because participants could access the content using their cell phones at any time and from any location, the use of QR codes offered a creative and economical method of information dissemination. Compared to traditional teaching techniques, this flexibility might have improved learning

and increased engagement. Additionally, the self - paced structure of the module encouraged self -directed learning by enabling women to review the material as needed. The results also emphasize how important it is to put technology-assisted health education programs into place in urban areas with high smartphone adoption rates. Because endometriosis is persistent and sometimes misunderstood, lowering the disease burden and enhancing quality of life can be achieved through early awareness and prompt medical consultation.

The analysis of pre -test responses shows that participants had insufficient baseline knowledge regarding Endometriosis. This underscores the necessity for educational programs or awareness materials to bridge the knowledge gap among women of reproductive age. Average knowledge sc ore in pretest was 5.1 which increased to 17.2 in the post -test. T-value for this test was 14.46 with 9 degrees of freedom. Corresponding p- value was small (less than 0.05), the null hypothesis is rejected. Average knowledge score in post -test was signific antly more than that in pretest. It is evident that the information booklet is significantly effective in improving the knowledge among individuals regarding Endometriosis. Implications of the Study The findings of the present study have important implications for nursing practice, education, administration, and research, contributing to the advancement and expansion of the nursing profession. The study highlights the need for nurses to be adequately prepared and trained to implement effective health edu cation interventions that promote awareness, knowledge, and self -care among individuals and communities. In nursing practice, the results emphasize the role of nurses as educators and advocates who can utilize innovative educational strategies to improve health outcomes. From an educational perspective, the study underscores the importance of equipping nurses with appropriate knowledge and skills so they can empower clients and communities to recognize health issues early and take informed decisions regardi ng their care. In terms of nursing administration, the findings support the role of nurse administrators in planning, organizing, and facilitating educational programs that are responsive to community needs and promote holistic, humanistic care. Furthermor e, the study reinforces the significance of nursing research in identifying effective educational strategies and generating evidence to improve prevention, early detection, and management of health conditions. Continuous research and active participation o f nurses in research activities are essential to strengthen evidence -based practice and enhance the quality of nursing care.

of the Study The present study had certain limitations. The study was confined to women only and included a sample s ize of 100 participants, which may limit the generalizability of the findings. Additionally, the study was conducted among women above 18 years of age, and therefore the results cannot be generalized to adolescent populations. Recommendations of the Study Based on the findings of the study, it is recommended that women’s health awareness programs incorporate QR code- based teaching modules as an effective educational strategy. Community health nurses can utilize QR codes during urban health education sess ions to provide quick and reliable access to information. Additionally, hospitals and clinics should display QR codes related to women’s reproductive health in waiting areas to enhance accessibility and promote awareness among women. Conflict of Interest The authors declare that they have no conflict of interest associated with this study.

1. Albee B Jr. Introduction to endometriosis. Centre for Endometriosis Care. Wikipedia. Endometriosis. http://centreforendo.com/introduction- toendometriosis/#introduction-to-EMERITUS. https://en.wikipedia.org/wiki/endometriosis 2. Kumar P, Kumar V, Gupta S. Prevalence of endometriosis in Indian women: a systematic review and meta- analysis. Journal of Clinical and Diagnostic Research. 2018;12:OC01-OC06. 3. Kumar S, Kumar N, Gupta S. Use of QR code in health education: a systematic review. Journal of Education and Health Promotion. 2019;8:145-151. 4. Monahan KE, Hummelshoj L, Webster P. Is early age at menarche a risk factor for developing endometriosis? A systematic revi ew and meta- analysis of case- control studies. Fertility and Sterility. 2012;98(3):696-706. 5. Serial S, Tempest N, Hapangama DK. Theories on the pathogenesis of endometriosis. How to Cite This Article Sawant S, Jaypurkar J, Bankar S, Badhan R, Bairagi D, Adsul D, Malge P. A study to assess effectiveness of QR coded self - Instructional module regarding endometriosis on knowledge among women in selected urban area. International Journal of Midwifery and Nursing Practice. 2026;9(1):21-26 Creative Commons (CC) License This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution -NonCommercial- ShareAlike 4.0 International (CC BY- NC-SA 4.0) License, which allows others to remix, tweak, and build upon the work non- commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.