Health Promotion Project: Advancing Menstrual Hygiene in Rural Nepal

This report examines the critical issue of menstrual hygiene in rural Nepal, highlighting the significant challenges faced by women due to social determinants, lack of access to healthcare, and inadequate knowledge. It explores the context of Nepal as a developing nation with a high prevalence of menstrual hygiene-related issues, including malnutrition and infectious disorders, and the influence of cultural taboos. The report outlines the aims to investigate the social factors, analyze healthcare barriers, assess policy gaps, and organize awareness campaigns. It presents research questions focused on barriers to healthcare access, policy gaps, and areas for improvement in health facilities. The study employs a qualitative research design, including surveys and interviews, alongside a systematic literature review. Sampling methods involve random sampling of women aged 14-38 in rural Nepal. The proposed interventions include educational campaigns, government support programs, and policy reforms to improve menstrual health. The data collection methods involve interviews and thematic analysis, with ethical considerations including obtaining permissions and involving healthcare organizations. The report concludes by emphasizing the importance of these interventions to promote positive health and hygiene among adolescent and young women in rural Nepal. The report also provides a detailed background, literature review, rationale, aims, research questions, study methods, sampling methods, sample size and power, intervention, data collection method, and ethical statement.

Running head: HEALTH ADVANCEMENT AND PROMOTION
HEALTH ADVANCEMENT AND PROMOTION
Name of the Student:
Name of the University:
Author Note:

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Background, brief literature and rationale:
Nepal is a land locked nation present in southern Asia that is surrounded by the
majestic Himalayas and a part of the country also forms a part of the Indo-Gangetic plain.
The nation hosts a meagre population of about 26.4 million (World Health Organization, &
Council for International Organizations of Medical Sciences, 2016). The nation has been
identified as a developing nation with the total GDP to be approximately equivalent to $ 84
billion according to statistical data collected in the year 2018 (World Health Organization, &
Council for International Organizations of Medical Sciences, 2016). It should also be noted
here that the nation tremendously lags behind in terms of progress and development in the
sector of health and hygiene. As a matter of fact, it should be significantly mentioned here
that the remote and rural areas of Nepal are over loaded with health related issues such as
malnutrition, development of infectious disorders and improper menstrual hygiene (Sommer
et al.,2016). Nepal has been predominantly classified as a conservative nation where the
menstrual cycle is considered as a taboo and is associated with a number of superstitious
beliefs (Sommer et al., 2013). This accounts for the main reason why there is a major gap in
the proper maintenance of menstrual hygiene across the rural areas of Nepal. In this regard, it
should be stated that, more than 47.60% of the adolescent female population based at Nepal
do not have adequate access to sanitary napkins and other commodities that could be used
during the cycle. It should be also be noted that the 33% of the female population entering the
phase of adolescence have no knowledge about the menstrual cycle (Dahal et al., 2017);
(Sapkota et al., 2013). Also, studies have further revealed that, more than 52% of the
adolescent female population had witnessed some or the other form of exclusion during their
cycle (Department of Health, 2014); (Krishnan & Twigg, 2016). This majorly reflects the lag
in the progressive health care outcomes prevalent in the nation.

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Hence, this research intends to evaluate the major social determinants that are
responsible for the poor maintenance level of menstrual hygiene. In accordance with the data
collected from the research studies, it has been witnessed that poor menstrual hygiene
accounts for more than 52% of medical cost expenditure associated with poor sexual health
and infectious disorders (Palinkas et al., 2015). Therefore, the rationale for conducting this
research intends to spread awareness among the adolescent and adult women in the rural
areas of Nepal and provide assistance in terms of providing medical aid and facilities so as to
ensure a safe menstrual hygiene.
Aims:
The aims of the research study can be enlisted as under:
 To investigate the social determinants responsible for the poor prevalence of
menstrual hygiene among the female population within the rural areas of Nepal
 To critically analyse and determine the existing barriers in terms of access to health
care facilities
 To critically investigate the gaps in terms of policies aimed at developing menstrual
hygiene
 To organize awareness campaigns in order to facilitate positive promotion of
menstrual hygiene and provide effective family planning strategies
Hence, it can be expected that the designed aims would effectively help in designing
strong health promotion strategies in order to promote positive health and hygiene among
the adolescent and young female population of rural Nepal.

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Research questions/ Objectives:
A research question has been defined as the central theme around which the entire
project is based on. It typically comprises of the key elements of the research objectives and
determined the methodology that would be undertaken for the successful completion of the
study (Szolnoki & Hoffmann, 2013). It should also be noted here that the research question
broadly considers the stages of investigation, data analysis and documentation of the findings
to formulate an effective research question. In this case, the research questions on the basis of
the designed research objectives comprise of the following three important questions:
RQ1: What are the factors that serve as barriers for women in accessing health care
facilities within the rural areas of Nepal?
RQ2: What are major gaps within the existing medical policies?
RQ3: Which are the major areas where there is a scope of introducing improvement
to enhance the standard of medical health facilities?
Study methods:
An appropriate study method has been identified as a major contributor in enhancing
the effectiveness of the study. It should be noted here that a study-design helps in determining
the approach that would be undertaken in order to analyse the finding of the research study.
In close association with the designed research objectives and the research questions framed,
it can be commented that the research study would be qualitative in nature (Barathalakshmi et
al., 2014). This is primarily because the objectives of the research are mainly connected with
subjective data analysis. Therefore, the study design adapted for this research study would be
qualitative that would involve conducting surveys and semi-structured interviews with open-
ended questions. In addition to this, the research study would also involve conducting an
intensive systematic review on the retrieved literatures that deal with the maintenance of

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menstrual hygiene among the women population based at Nepal. Therefore, the study method
for this research study would widely comprise of adapting a qualitative study design to
evaluate and analyse the primary research findings. On the other hand the secondary data that
would be retrieved from the literature review would be analysed on the basis of meta-
analysis study design.
Sampling methods:
Sampling method plays an integral part in a research study (Thompson, 2013). It
should be noted here that the sampling technique help in determining the key findings and
analyse the obtained results. Sampling methods have been categorically into two basic
categories. The first category comprises of probability sampling and the second category
comprises of non-probability sampling. The sampling technique widely depends upon the
sample size. The sampling method adapted for this research study would comprise of random
sampling and it would lay emphasis on the female population based in the rural regions of
Nepal between the age group of 14-38 years of age. Based on the sampling method a
maximum of 10 participants would be chosen to conduct the primary research study
comprising of face to face interview session with open-ended questions.
Sample size and power:
The sample size of the research study would essentially determine that how many
participants would be participating in the research study. Research studies predict that in
order to conduct a valid research, it is advisable to study a specific section of the population
rather than the entire population (Szolnoki & Hoffmann, 2013). After the successful selection
of the participants in the research study, these participants are effectively used in the
determination of facts about the entire population set. However, it should be critically noted
here that there might be instances when the participant population would exhibit different

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characteristics that cannot be aligned to the population in general. These criterion form a part
of limitations of the research study. Also, it should be noted here that applying correct
exclusion and inclusion criterion is essentially important in determining the sample size and
according gathering participants of the research study so as to obtain results that can be
generalized.
Power can also be considered as an important aspect that helps in determining the
appropriateness of the research study undertaken (Thompson, 2013). Power is basically the
estimation that encompasses of the consideration that how many participants would be
required to substantially gain a standard response to validate and support the research
findings. In most of the research studies, it is common that researchers proceed with the
consideration of two important hypothesis that include, null hypothesis and alternative
hypothesis. The null hypothesis proceeds with the positive implication of the research study
and the alternate hypothesis considers any alternate form that might be present in support of
the research idea. A number of factors play a key role in determining the power calculations
that affect the sampling size. The factors can be enlisted as the accuracy and precision by
virtue of which a sample size can be critically measured and analysed. Also, the magnitude of
the clinical difference, the type of data analysis that would be used to analyse the findings
and consideration of the parameters that would be required for the data analysis.
In this case, the research study would be conducted within the rural areas of Nepal
preferably around the four rural areas and the sample size that would be considered for the
primary research h would include 10 participants.
Intervention:
The interventions that would be proposed for offering better health facilities to the
women residing within the rural communities of Nepal would include educating them and

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spreading awareness about the importance of maintaining menstrual health. To facilitate
proper education among the rural women would include, the organization of health care
campaigns across four rural regions in Nepal. The education strategies would include
spreading awareness about the physiological cause that governs the menstrual cycle and the
manner in which menstrual hygiene must be maintained during the cycle. Further,
government funded support programs such as distribution of sanitary napkins and menstrual
cups can help in maintaining positive menstrual hygiene. Further, to identify the existing gaps
between the existing health care facilities and the non-availability of proper medical facilities
within the rural setting of Nepal, the relevant literatures would be thoroughly scrutinised and
reformed so as to establish stronger policies to promote positive health.
Data collection method:
The data collection method forms an integral part of the research and varies across
different research design. Generally for a qualitative research, the data collected method is
through either survey responses or interview responses. It should be noted here that after the
collection of the interview and data responses, the responses are critically evaluated on the
basis of thematic discussion by grouping segregating the responses under different focus
groups. On the other hand, it should also be noted that for quantitative study a variety of data
collection methods are used depending upon the study design. The most common form of the
data collection method is a randomized control trial or an experimental data analysis. It
should be noted here that in order to evaluate the data gathered from quantitative research
study, the data is analysed on the basis of software analysis using various statistical software
tools. For this research study, the primary data collection would be based upon collecting
interview responses and segregating the responses among focus groups so as to conduct
thematic analysis (Szolnoki & Hoffmann, 2013). On the other hand the secondary data

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collection would be broadly dependent upon conducting a systematic analysis of the relevant
literatures and accordingly assemble data on the basis of thematic discussions.
Ethical statement:
In order to conduct a research, it is essential to critically observe the ethical guidelines
and proceed with the research study (Palinkas et al.,2015). Ethical guidelines incorporate a
number of factors such as obtaining a formal permission from the health department in order
to proceed with the research idea and formally obtain the sanctioning of the budget for the
research project. Further, the ethical consideration would involve convincing the partnering
health care organization that would offer assistance and community nursing professionals for
the launch of community programmes across the four rural regions of Nepal. In addition to
this, it should be noted that in order to seek support from the partnering health care
organizations, it is important to convince the administrative body which would be done by
presenting informative posters, bulletin and a power point presentation presenting a detailed
over view about the research program. Further, on obtaining the consent from the
administrative body, a review committee would be set up which would comprise of the
researcher along with a project coordinator and an administrative post holder of the
healthcare organization. The body would recruit the support professionals for the community
program and obtain a consent prior to recruiting them from the project. Further, the rural
participants who would be short-listed for the interview process would be selected on the
basis of the set inclusion criteria. A formal consent would be obtained from the participants
and the researcher would elaborate the details of the research study and the purpose of
conducting the research in a one-on-one session. Finally, the interview procedure would be
conducted and the names of the participants would be kept anonymous so as to respect the
privacy of the participants

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Data analysis
The data analysis process, which will be used in this research to interpret the primary and
secondary data collected from the field work and literature review of previous research works
will base of the thematic process (Braun, Clarke & Terry, 2014, King, 2012). Thematic data
analysis is the process in which, data collected from extensive research process are identified,
analyzed and interpreted depending on several patterns or themes depending on which the
qualitative data obtained from the research study is analyzed (O’reilly & Parker, 2013, Clarke
& Braun, 2013). There are research evidences that indicated to the fact that thematic analysis
procedure is one of the widely used data analysis process which is used to formalize or
systematize different analytical procedures. Further the researchers Alhojailan (2012) also
indicated to the fact that the thematic analysis is a flexible and due to the fact that qualitative
data requires extensive explanation about the data and need to be explained depending on
different themes, thematic analysis procedure is applied. This analysis process provides
distinction to the each explanations and hence, the analysis continuous properly (Braun,
Clarke & Terry, 2014). Further, researches also mentioned that to properly identify and
analyze the raw data collected from the experiment, it is important to conduct a thematic
analysis because using it, it is easier to determine the validity and reliability of the research
findings as the results are divided in several themes and explanations are provided depending
on the themes (Gale et al., 2013, Vaismoradi et al., 2016). Besides, thematic analysis is the
process that helps the researchers by providing a systematic element in the analysis procedure
that ultimately explains both implicit and explicit ideas depending on the raw data obtained
from the research. Therefore, the data analysis process for this research aspect will follow the
thematic analysis methodology for both primary and secondary set of data (Vaismoradi,
Turunen & Bondas, 2013, Bazeley, 2013).

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Anticipated outcomes and significance
This public health awareness is about menstrual hygiene among rural women of Nepal and it
has been seen that the rate of menstrual hygiene related infections and complications is higher
in rural women that in urban areas. Therefore, the research project bears major significance in
this context as it helps to provide a clear overview about the presence of menstrual hygiene
within the women of Nepal and provide them with interventions so that they can improve
their menstrual hygiene related condition and prevent several infectious diseases that could be
deleterious for their health. As per the first objective, the anticipated outcome will be
associated with the identification of the social and communal issues due to which the women
are not aware of the hygienic alternatives for their menstrual cycle and uses unhygienic
counterparts during their cycle. This is an important step as after the identification of the
reasons for the less usage of sanitary pads in the rural areas of the country, setting objectives
for spreading awareness about the menstrual hygiene could be achieved. This awareness will
be spread by arranging public awareness campaigns, medical campaigns and providing them
with the information about the diseases and infections they could develop by using the
unhygienic means of the menstrual cycle. These anticipated outcomes will completely depend
on the degree of success of the health promotion campaigns arranged in the rural regions
around the country and hence, the significance of it depend on the availability of the data and
conduction of the research.

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Proposed timeline
Jan-June July-Dec Jan-June July-Dec Jan-June July-Dec
Identification
of the social
and cultural
barriers
Recruitment
of volunteers
for the health
campaign
Meeting with
government
leaders to
arrange
places
Arranging
sanitary
napkins for
women
Providing
them with
educational
interventions
Arranging
health
promotional
campaign
Collecting
data from
the research
Analyzing
the data
This is the time line decided for the health promotional campaign for sanitary and menstrual
health of women in rural region of Nepal. The health promotional campaign and the research
related to their menstrual health will continue for three years and within that period all the

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important steps for conduction of health promotional campaign will be carried out such as
recruiting volunteers for the promotional campaign, preparing educational and awareness
related materials for the rural regions in Nepal, providing educational intervention to the
women who are unaware of the degree of deleterious effect of their unhygienic menstrual
practices and then providing them with hygienic menstrual cycle pads so that they can protect
their health from different infections. The time line is widespread in half-yearly manner and
the processes have been divided in a manner so that it could be conducted smoothly and the
benefit could be provided to the women in the rural areas who suffer from infections due to
unhygienic menstrual practices.
Budget and justification of the budget
The budget, which has been allotted for this health promotional campaign is $200,000 which
will be divided for different sections of the promotional campaign as per the requirement and
need of the campaign. This amount of budget is important as there are several sections in the
health promotional campaign and due to this, the recruitment process, organization of health
promotional campaign, distribution of sanitary napkins and providing the women with
educational sessions so that they can understand the importance of sanitary napkins and use
them for hygienic practice of health promotional campaign is an important step which will be
conducted, if they have the support of monetary strength. Further, monetary strength is
important for the recruitment of volunteers, healthcare professionals, arrangement of
community halls and places where the health promotional campaigns will be arranged.
Furthermore, it should be understood that this research project has a timeline of three years
and to successfully conduct the process, it need to be arranged properly with volunteers,
ample amount of helathcare interventional materials and medications, and sanitary napkins so
that a smooth conduction of the helathcare promotional campaign, and educational

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interventions could be carried out. Hence, this specific amount of budget and distribution will
be attempt and will be achieved with specific goals and objectives so that research goals and
aims could be achieved.

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