Knowledge, Awareness and Attitude on Polycystic Ovarian Syndrome

Among Students from Levels 1-4 of Northern Luzon Adventist

College

A Thesis Proposal Presented to The Faculty of School of Nursing Northern Luzon

Adventist College

In Partial Fulfillment of The Requirements for The Course

Of Nursing Research, I

Andal, April Jean A.

Dawe, Joshue A.

Emoy, Mary Juvielyn A.

Gasatan, Reva Fe B.

Juliano, Wealth M.

Oligan, Kristine Joy P.

Pambalan, Jubil P.

Pati, Lara Drew M.

Perez, Britney S.

Ruiz, Glydel J.
 1

Chapter I

Introduction

The Problem and Its Background

Polycystic Ovarian Syndrome (PCOS) is a common endocrine

disorder affecting a significant number of women yet the disorder

has remained an enigma for many decades, with little progress

made towards the improvement of symptoms and wellbeing of

patients. According to (World Health Organization,2023) it

affects 8-13% of reproductive age group and up to 70% of affected

women remain under diagnosed worldwide. Highlighting the

importance of increased awareness, early detection, and better

healthcare access for those with PCOS.

Base on the report the global prevalence of PCOS varies

from 5 to 18%, with an average prevalence of 276¢4 cases per 100

000 people in Europe (Lancet Regional Health Europe,2022). Around

50% of women are not aware that they have PCOS or they have a

delayed diagnosis. Within the United States, current estimates

indicate that approximately 5 to 6 million women are affected by

Polycystic Ovary Syndrome (PCOS). While the Philippines has one

of the highest ratios of PCOS with 1 out of 10 impacting around

4.5 million women (Jain 2021).

Hence, it is the aim of the study to assess PCOS knowledge,

awareness and attitudes among female students of Northern Luzon

 2

Adventist College. Understanding their level of awareness and

knowledge about PCOS can help prevent incidences of PCOS, as well

as in developing educational programs and interventions.

Additionally, examining their attitudes towards this PCOS can

provide insights to potential barriers or misconceptions that may

exist. This research can contribute to improving health literacy

and support for individuals with PCOS in the college community.

Theoretical Framework

Theoretical Framework During the 1960s, western scholars

have proposed a theory in order to assess the phase of behavior

change, that is the KAP (Knowledge, Attitude and Practice)

theory, this theory has been used in most of the study research

that seek to understand the participant’s level of knowledge,

point of view or attitude and level of practice or application

towards a certain field of study. According to the KAP theory,

behavior change is achieved when there is acquisition of

knowledge, development of attitude and development of behavior

for change. In this study, the researchers will be adopting the

KAP theory in order to assess the participant’s level of

Knowledge, attitude and awareness on PCOS.

 3

KNOWLEDGE
(awareness)

PRACTICE
(compliance)

ATTITUDE

Figure 1. KAP (Knowledge, Attitude and Practice) Theory

Conceptual Framework

Our aim was to assess the knowledge, awareness and attitude

on Polycystic Ovarian Syndrome Among the Students of Northern

Luzon Adventist College through a survey questionnaire. Following

the survey, the data underwent statistical processing, ultimately

informing the development of a program which consist of the

distribution of flyers, posters and conducting seminars.

 4

TROUGHPUT
INPUT (PROCESS) Output

A. Knowledge Awareness and

B. Awareness Strategic program:
Survey
C. Attitude a. Flyers/
Pamphlets
b. Posters
c. Seminars

Moderator Variable

A. YEAR LEVEL
B. COURSE

Figure 2. Paradigm of the Study

Statement of the Problem

The researchers sought to find out the knowledge, awareness

and attitude of NLAC female students, specifically to answer the

following:

1. What is the level of knowledge, awareness, and attitude of

NLAC female students regarding PCOS according to

a. year level

b. course

2. What significant differences exist between knowledge,

awareness, and attitude on PCOS and the demographic profile

of the respondents?
 5

3. What PCOS Awareness Programs can be proposed to enhance the

knowledge, awareness, and attitude of NLAC female students

regarding PCOS?

Hypothesis of the study

There is no significant difference in the level of

knowledge, awareness, and attitude regarding PCOS among students

and their demographic profile.

Significance of the Study

This study regarding the knowledge, awareness and attitude

on Polycystic Ovarian Syndrome is significant to the following:

The research findings inform WHO's reproductive health and

women's rights programs by revealing PCOS's prevalence and

impact. It can help create worldwide evidence-based standards and

regulations.

The DOH can improve PCOS healthcare services and programs

using this study's findings. The study can inform educational

resources, awareness efforts, and training programs for

Healthcare Practitioners to improve PCOS care and support.

Nursing Education by emphasizing PCOS-related topics and

effective teaching approaches using research to implement

patient-centered PCOS care, education policies and protocols. The

 6

study expands Nursing Research on PCOS in specific demographics,

laying the groundwork for future research and evidence-based

treatments.

Women are also affected by the study. Measurement of PCOS

knowledge, awareness, and attitudes helps women to make informed

health, lifestyle, and reproductive decisions, potentially

enhancing well-being.

Understanding students' knowledge and attitudes helps them

notice signs and seek medical advice for PCOS. It also addresses

PCOS stigma and mental health issues and offers emotional support

to affected persons. The results can inform college policy and

curriculum about women's health and PCOS that could aid on future

studies.

Assumption of the Study

1. The study posits that Woman of reproductive age ignore signs

and symptoms and are not open for consultation for several

reasons.

2. It is postulated that the successful implementation of a

structured teaching program will lead to a measurable improvement

in the knowledge, awareness, and attitude levels of female

students concerning Polycystic Ovarian Syndrome (PCOS). This

 7

foundational assumption underpins the efficacy of the proposed

research intervention.

Scope and Delimitation

This research will center on assessing the knowledge,

awareness, and attitude toward PCOS among female students at

Northern Luzon Adventist College during the academic year 2023-

2024. The scope is restricted to female students within Northern

Luzon Adventist College, excluding males, students from other

institutions, and those not currently enrolled in the college.

Definition of terms

In this study, we have defined several key terms to better

understand Polycystic Ovary Syndrome (PCOS) and its profound

influence among female students enrolled in Levels 1-4 across

multiple courses, specifically focusing on BSN, BSED, BSA, BSBA,

BSIT, and BSPsy programs at Northern Luzon Adventist College.

Polycystic Ovary Syndrome (PCOS):

Refers to an endocrine disorder that affects individuals

assigned females at birth. PCOS is characterized by a range of

symptoms, including irregular menstrual cycles, hyperandrogenism,

and the presence of multiple small cysts on the ovaries.

Knowledge on PCOS:
 8

Refers to the depth of understanding, comprehension, and

awareness individuals have concerned this syndrome. This refers

to familiarity with its symptoms, causes, diagnostic procedures,

treatment options, and potential health implications.

Awareness on PCOS:

Refers to the level of consciousness, recognition, and

perception within a community or among individuals concerning the

prevalence and impact of Polycystic Ovarian Syndrome. This refers

to public education, campaigns, and the dissemination of

information about PCOS.

Attitude towards PCOS:

Refers to the emotional, behavioral, and cognitive

predisposition individuals or society hold toward this syndrome.

This refers to opinions, beliefs, stigmas, and the approach,

empathy, or response toward individuals affected by PCOS across

various educational programs and levels such as BSED, BSA, BSBA,

BSIT, BSN, and BSPsy.

 9

Chapter II

Review of Related Literature

Goh Jia Ean et al,(2022), the global prevalence of PCOS in

2020 will range from 2.2 to 48%. Since the late 1800s, studies

have revealed an increase in the prevalence of PCOS. Locally, a

prevalence research at Malaysia's University Putra Malaysia

discovered that 12.6% of staff had PCOS. Many countries have done

studies on prevalence, knowledge, and health-related activities,

but Malaysian data are limited.

Ismayilova and Yaya (2022) conducted twenty-five in-depth

interviews with participants from various regions in Canada,

ranging in age from 18 to 63. The interviews revealed three main

areas that require improvement regarding PCOS. Firstly,

participants emphasized the need for primary care physicians

(PCPs) to have greater knowledge and awareness of PCOS, along

with a call for the medical community to prioritize women's

health. Secondly, there was a strong advocacy for increased PCOS

awareness and destigmatization within the general community and

among women, girls, and individuals with female reproductive

systems. Lastly, participants highlighted the need for various

resources, including increased funding and research on PCOS,

availability of PCOS specialists and experts, reliable

information provided by doctors through pamphlets and websites,

 10

and age-specific support groups and mental health services.

Participants generally expressed unawareness of existing PCOS

organizations and emphasized the importance of such organizations

in training and retraining doctors and promoting local awareness-

building initiatives within communities.

Mehwish Rizvi et al. (2023) a study revealed that the level

of knowledge about Polycystic Ovarian Syndrome (PCOS) among a

sample of undergraduate students was found to be inadequate.

Furthermore, it was observed that medical students did not

possess the required level of understanding about the disease,

raising concerns about the lack of awareness in this demographic.

The study indicated that lifestyle changes are recommended,

particularly as obesity was identified as a determinant of PCOS.

Additionally, females with a familial history of PCOS and

hirsutism were found to have a higher likelihood of PCOS. The

study recommended clinical consultations with gynecologists for

early diagnosis; however, it noted some level of hesitancy in

discussing the condition with healthcare professionals. On a

positive note, the study highlighted that the topic of PCOS is

not considered taboo in society; there is an acknowledgment of

PCOS as a problem for Pakistani women. This indicates a positive

mindset of society towards addressing this health issue. The

study suggested that observing an awareness month within academic

premises, conducting campaigns, promoting disease education, and

 11

distributing merchandise with disease awareness logos and signage

could significantly contribute to raising awareness and reducing

stigma and hesitancy.

Bassam et al. (2018) cited that 71% of students knew what

polycystic ovary syndrome was. 12% of students had PCOS. The most

frequent symptom reported was an irregular menstrual cycle (87%),

and the least frequent symptom was voice alteration (13%). 62% of

the PCOS-afflicted students were receiving hormone medication and

surgical surgery. With regard to PCOS, attitudes, and behaviors

revealed misunderstandings and the need for education.

Zaitoun et al. (2023) cited those 349 participants, or

84.3%, knew what PCOS was. However, only 21.7% of them had

adequate knowledge of the syndrome. Knowledge of PCOS was

substantially correlated with having a previous diagnosis and

studying or working in the medical industry. Additionally, women

who had a friend or family member with PCOS were five times more

likely to be aware of the condition than those without such a

connection. There was no relationship between age, education, or

nationality with the level of awareness.

Mona A. AlFadeel et al. (2020) was discovered that 64%

of PCOS cases had a positive family history, compared to 32% of

students who did not have PCOS and 11% of those who were not

PCOS-tested. There are 11% of overweight students who have not

 12

been tested, followed by 8% PCOS positives and 2% non-PCOS

positives. Comparing medical students with other courses, it was

discovered that 21% of medical students have a great

understanding of PCOS symptoms.

Pramodh (2020) stated in his work that most of the

students demonstrated inadequate knowledge of PCOS and

reproductive health. Low levels of physical activity and eating

regularly at fast food were found in their lifestyle preferences.

Alshdaifat et al. (2021) conducted a study in the

United States among university students, approximately 29.9% of

the 1182 students reported having a formal diagnosis of

polycystic ovary syndrome. The study identified that being a 6th

or 5th year college student and studying veterinary medicine,

nursing, pharmacy, or dentistry were the strongest predictors for

recognizing the term polycystic ovary syndrome. Age was also

found to be a significant predictor of polycystic ovary syndrome

awareness score. The study found that healthcare professionals

were the most common source of information reported by the

participants. Additionally, the study revealed that lectures were

the most effective method in increasing awareness scores,

although they were not widely utilized outside of the curriculum.

Haq et al. (2017) conducted a study involving 451 female

students from various public universities in Quetta, Pakistan,

 13

aged between 18 and 26. The research revealed that initially,

72.5% of participants were unaware of Polycystic Ovarian Syndrome

(PCOS) and acquired knowledge through the brochures provided.

Following educational intervention, 90.2% of all respondents

demonstrated sufficient knowledge about PCOS. Regarding

prevalence, it was categorized into three groups: 17.5% of

respondents were suspected to develop PCOS, 3.5% were diagnosed

based on signs and symptoms, and 5.5% had already developed and

been diagnosed with PCOS. The collected data also showed that

7.8% of participants were overweight, and 2.9% were classified as

obese.

Upadhye & Shembekar (2017) conducted research to evaluate

the awareness of medical students in Amman, Jordan, regarding

Polycystic Ovarian Syndrome (PCOS). The results, derived from 200

respondents, revealed that half of the female participants had a

normal BMI, with some being overweight or obese, and a small

portion being underweight. Additionally, respondents reported

experiencing symptoms such as acne, irregular menstrual cycles,

hirsutism, and infertility. Regarding PCOS knowledge, respondents

accessed information from various sources including teachers,

friends, doctors, newspapers, and the internet. However,

approximately 28 adolescent and young girls were found to be

unaware of PCOS. The study concludes that creating awareness and

providing knowledge and counseling to adolescents are crucial

 14

efforts in addressing this disorder. Early and accurate diagnosis

is identified as a key factor in managing PCOS effectively.

Sabitha and Sunanda (2016) carried out a study involving 150

nursing students at Nitte Usha Institute of Nursing Sciences to

evaluate their understanding of Polycystic Ovarian Syndrome

(PCOS). Using a structured questionnaire, the study found that

76% of the students possessed an average knowledge of PCOS, while

only 10.7% exhibited a good understanding. Significantly, the

research revealed a connection between the students' level of

knowledge and their dietary patterns, emphasizing the potential

influence of education on lifestyle choices.

Hansa et al. (2016) conducted a cross-sectional study in

Sambalpur, Odisha, India, aiming to determine the prevalence and

raise awareness of Polycystic Ovarian Syndrome (PCOS) among

school-going girls. Out of the 100 girls aged 14-17 years, 12%

showed signs of hirsutism, 20% had severe acne, and 36%

experienced menstrual irregularities. Surprisingly, 78% of the

students had never encountered information about PCOS before,

underscoring the significance of timely diagnosis for symptomatic

adolescent girls.

Jayshree and Chaitanya (2017) conducted a survey to assess

the knowledge of PCOS among medical students in India. Among the

200 girls surveyed, the study showed varying BMI percentages and
 15

a range of PCOS symptoms, including acne, menstrual irregularity,

hirsutism, and infertility. The study underscored the need for a

thorough knowledge of the disorder and counseling for adolescents

to raise awareness and promote lifestyle modifications.

Nivetha et al. (2016) conducted a survey to assess the

prevalence of PCOS among female students of Bishop Heber College

in Tamil Nadu. Their research identified a prevalence of 7.14%

using Rotterdam's criteria. The study aimed to create awareness

among adolescent college girls about PCOS, modify their

lifestyle, and enable the identification of adolescents at risk

for PCOS, thereby emphasizing the importance of early diagnosis

and awareness programs.

Ruba M. Jaber et al. (2022) emphasized the complex and

frequently ignored nature of Polycystic Ovarian Syndrome (PCOS),

emphasizing its role in the convergence of chronic multi-system

endocrine abnormalities. Given most women's lack of information

about the problems connected with PCOS, the study emphasized the

importance of increased awareness and a positive attitude toward

the condition. Because study participants preferred to get

information from doctors, the researchers suggested healthcare

sector campaigns focused on the long-term implications of PCOS.

Furthermore, the study recommended healthcare providers to

improve their consultations with PCOS patients and maintain

 16

excellent contact with them. To enhance long-term outcomes in

PCOS patients, strict execution of suggestions to test for

metabolic syndromes, cardiovascular disease, and mood disorders

was proposed for future efforts.

Mazia, Farhana (2018) evaluated the understanding and

familiarity regarding PCOS among female students across four

universities in Narayangonj. Findings indicated that 62.75% of

the student’s lacked awareness about PCOS, while 50.5% believed

that PCOS was a condition that could be managed.

Carl Brandon C. Barlis et al. (2021) highlights the under-

addressed global issue of health literacy and awareness of

Polycystic Ovarian Syndrome (PCOS) in the Philippines. The study

in Barangay Dagatan, Sabang, and Marauoy Lipa, Batangas,

emphasizes the importance of early treatment to prevent

complications. The findings indicate proficient health literacy

among 76% of respondents, with 87% having prior knowledge of

PCOS. However, awareness of PCOS symptoms was limited, suggesting

the need for targeted education. Educational attainment showed a

significant association with health literacy and PCOS awareness,

underscoring the importance of reproductive health education and

accessible information. The study recommends optimizing

reproductive health education, conducting seminars, and

 17

emphasizing early screening to enhance awareness and engage in

PCOS management.

Chapter III

Methodology

In this chapter, it presents a comprehensive overview of the

research methodologies to be employed in this study. It provides

detailed insights into the study’s participants, elucidating

their identities, the methodology employed for their selection.

Furthermore, it delves into the primary objectives of the study

and the rationale behind our choice of research design. In

addition, it provides detailed explanations of the specific

techniques and methodologies that will use for data collection,

along with a comprehensive description of tools to analyze to

scrutinize the acquired data.

Research Design

In this study, the researchers use descriptive type of

research. According to (Unimrkt, 2022), Quantitative research, as

its name implies, attempts to collect quantifiable data to

support statistical analysis of a sample population. It is a

commonly used tool in market research that helps companies to

collect and interpret data about a certain demographic group. The

characteristics of the variables under study are outlined with

the aid of descriptive research methods. The focus of the

 18

quantitative descriptive research methodology is on answering

"what" inquiries concerning a specific study topic rather than

"why" ones. To put it briefly, the primary objective of

descriptive research is to elucidate the features of the sample

population.

Moreover, this quantitative research approach would provide

valuable insights into the current state of PCOS awareness,

knowledge, and attitudes among female students, allowing for

evidence-based interventions and educational initiatives to

address any gaps or misconceptions (Adedoyin,2020).

Locale of the Study

The study will be conducted at the Northern Luzon Adventist

College, located in Sison Artacho, Pangasinan, Philippines. The

college is a private, coeducational institution that is part of

the Seventh-day Adventist Church.

 19

Figure 3: Territorial Map of NLAC

Respondents of the study

The participants in this study focus on female students

enrolled in various departments and year levels at Northern Luzon

Adventist College. A complete enumeration sampling technique will

be used to ensure a thorough assessment of the participants. This

approach aims to gather data from every individual or element

within the population, providing a comprehensive and accurate

representation of the entire group.

Table 1.0 Respondents of the Study

COURSE No. of 1st No. of 2nd No. of 3rd No. of 4th TOTAL
year year year year
students students students students (N)

BSED 15 15 14 16 60

BSA 7 19 14 19 59

BSBA 3 9 7 9 28

BSIT 1 9 7 5 22

BSN 87 69 55 23 234

BSPsy 9 22 9 11 49
 20

113 143 106 83 445

Instrumentation

Data Gathering Procedure

Prior to the actual data gathering, the researchers will

seek approval to gather data from NLAC Research Development

Center to permit the student researchers to conduct and

distribute the questionnaire. The questionnaire will be

distributed to all female students only of Northern Luzon

Adventist College. The nature of the study will be explained to

the respondents to consent or decline participation in the study

voluntarily and the informed consent of each respondent will be

secured.

The researchers will distribute the questionnaires to the

respondents and will ask them to answer them in their available

time. They will be given enough time to answer the questionnaire

and are allowed to ask questions and clarifications.

Statistical Treatment

The data collected will be analyzed using statistical

methods, such as descriptive and inferential statistics, to

 21

quantify levels of awareness, knowledge, and attitudes among the

participants.

The following scoring and interpretation will be used in

this study.

Table 2.0 Statistical Treatment

Scale of Interpretation

QI. Knowledge QI. Attitude QI. Awareness

4.21-5.00 Extremely Very Positive Extremely Aware

Knowledgeable

3.41-4.20 Very Positive Very Aware

Knowledgeable

2.61-3.40 Moderately Neutral Moderately Aware

Knowledgeable

1.81-2.60 Slightly Negative Slightly Aware

Knowledgeable

1.00-1.80 Not Very Negative Not Aware

Knowledgeable

Upon completion of data collection, the subsequent step in

data processing will involve careful tasks such as cleaning,

organizing, and entering the data into IBM SPSS Statistics 20.

The analysis will rely on descriptive and inferential statistics,

encompassing fundamental measures such as mean, frequency, T-Test

and Analysis of Variance (ANOVA). These statistics will offer the

 22

initial insight into female students' understanding and

perceptions of PCOS.

Multiple Comparisons
Tukey HSD
Mean Difference 95% C
Dependent Variable (I) YEARLEVEL (J) YEARLEVEL (I-J) Std. Error Sig. Lower Bou
1. Polycystic ovarian syndrome Level 1 Level 2 .030 .117 .994
is characterized by multiple Level 3 -.309 .125 .066
cysts in the ovaries that can be Level 4 -.193 .134 .476
diagnosed by ultrasound. Level 2 Level 1 -.030 .117 .994
*
Level 3 -.339 .122 .029
Level 4 -.223 .131 .324
Level 3 Level 1 .309 .125 .066
Level 2 .339* .122 .029
Level 4 .116 .138 .836
Level 4 Level 1 .193 .134 .476
Level 2 .223 .131 .324
Level 3 -.116 .138 .836
*
2. Polycystic ovarian syndrome Level 1 Level 2 -.424 .130 .006
is characterized by increase in Level 3 -.792 *
.138 .000
hair growth in places like on Level 4 -.719 *
.148 .000
the upper lip, around nipples, Level 2 Level 1 .424* .130 .006
and belly. Level 3 -.368 *
.135 .033
Level 4 -.295 .145 .177
 23

Level 3 Level 1 .792* .138 .000

Level 2 .368* .135 .033
Level 4 .074 .152 .963
*
Level 4 Level 1 .719 .148 .000
Level 2 .295 .145 .177
Level 3 -.074 .152 .963
3. Polycystic ovarian syndrome Level 1 Level 2 -.117 .131 .808
is characterized by an increase Level 3 -.515 *
.139 .001
in acne in a clear and a higher Level 4 -.441 *
.149 .017
than expected manner. Level 2 Level 1 .117 .131 .808
*
Level 3 -.398 .136 .019
Level 4 -.324 .146 .119
*
Level 3 Level 1 .515 .139 .001
Level 2 .398* .136 .019
Level 4 .073 .154 .964
*
Level 4 Level 1 .441 .149 .017
Level 2 .324 .146 .119
Level 3 -.073 .154 .964
4. Polycystic ovarian syndrome Level 1 Level 2 .175 .135 .565
is characterized by abnoraml Level 3 -.075 .144 .954
menstruation. Level 4 -.099 .154 .917
Level 2 Level 1 -.175 .135 .565
Level 3 -.250 .140 .283
Level 4 -.274 .151 .265
Level 3 Level 1 .075 .144 .954
Level 2 .250 .140 .283
Level 4 -.025 .158 .999
Level 4 Level 1 .099 .154 .917
Level 2 .274 .151 .265
Level 3 .025 .158 .999
5. Polycystic ovarian syndrome Level 1 Level 2 .078 .131 .933
can be diagnosed by Level 3 -.002 .139 1.000
laboratory tests. Level 4 -.112 .149 .876
Level 2 Level 1 -.078 .131 .933
Level 3 -.080 .136 .935
Level 4 -.190 .146 .563
Level 3 Level 1 .002 .139 1.000
Level 2 .080 .136 .935
 24

Level 4 -.110 .154 .892

Level 4 Level 1 .112 .149 .876
Level 2 .190 .146 .563
Level 3 .110 .154 .892
6. Polycystic ovarian syndrome Level 1 Level 2 -.108 .136 .857
is chronic and has no Level 3 -.147 .145 .739
treatment. Level 4 -.264 .155 .325
Level 2 Level 1 .108 .136 .857
Level 3 -.039 .141 .993
Level 4 -.156 .152 .735
Level 3 Level 1 .147 .145 .739
Level 2 .039 .141 .993
Level 4 -.116 .160 .886
Level 4 Level 1 .264 .155 .325
Level 2 .156 .152 .735
Level 3 .116 .160 .886
7. Polycystic ovarian syndrome Level 1 Level 2 -.155 .110 .493
patients have an increased risk Level 3 -.446* .117 .001
of cardiac diseases. Level 4 -.295 .126 .089
Level 2 Level 1 .155 .110 .493
Level 3 -.291 .114 .055
Level 4 -.140 .123 .667
*
Level 3 Level 1 .446 .117 .001
Level 2 .291 .114 .055
Level 4 .151 .129 .648
Level 4 Level 1 .295 .126 .089
Level 2 .140 .123 .667
Level 3 -.151 .129 .648
8. Polycystic ovarian syndrome Level 1 Level 2 -.271 .122 .118
patients have an increased risk Level 3 -.264 .130 .178
of breast cancer. Level 4 -.307 .139 .124
Level 2 Level 1 .271 .122 .118
Level 3 .008 .127 1.000
Level 4 -.035 .136 .994
Level 3 Level 1 .264 .130 .178
Level 2 -.008 .127 1.000
Level 4 -.043 .143 .991
Level 4 Level 1 .307 .139 .124
 25

Level 2 .035 .136 .994

Level 3 .043 .143 .991
9. Polycystic ovarian syndrome Level 1 Level 2 -.192 .115 .339
patients have increased blood Level 3 -.251 .122 .168
sugar levels. Level 4 -.425 *
.131 .007
Level 2 Level 1 .192 .115 .339
Level 3 -.060 .119 .959
Level 4 -.233 .128 .265
Level 3 Level 1 .251 .122 .168
Level 2 .060 .119 .959
Level 4 -.173 .135 .571
*
Level 4 Level 1 .425 .131 .007
Level 2 .233 .128 .265
Level 3 .173 .135 .571
10. Polycystic ovarian Level 1 Level 2 -.225 .120 .240
syndrome patients have Level 3 -.198 .128 .409
increased insulin resistance. Level 4 -.297 .137 .134
Level 2 Level 1 .225 .120 .240
Level 3 .027 .125 .996
Level 4 -.072 .134 .951
Level 3 Level 1 .198 .128 .409
Level 2 -.027 .125 .996
Level 4 -.099 .141 .896
Level 4 Level 1 .297 .137 .134
Level 2 .072 .134 .951
Level 3 .099 .141 .896
11. Polycystic ovarian Level 1 Level 2 -.237 .218 .696
syndrome patients have an Level 3 -.198 .232 .829
increased risk of endometrial Level 4 -.070 .249 .992
cancer. Level 2 Level 1 .237 .218 .696
Level 3 .040 .226 .998
Level 4 .168 .243 .902
Level 3 Level 1 .198 .232 .829
Level 2 -.040 .226 .998
Level 4 .128 .256 .959
Level 4 Level 1 .070 .249 .992
Level 2 -.168 .243 .902
Level 3 -.128 .256 .959
 26

12. Polycystic ovarian Level 1 Level 2 .108 .125 .823

syndrome patients have an Level 3 -.124 .133 .785
increased risk of infertility. Level 4 -.238 .142 .341
Level 2 Level 1 -.108 .125 .823
Level 3 -.232 .130 .278
Level 4 -.346 .139 .064
Level 3 Level 1 .124 .133 .785
Level 2 .232 .130 .278
Level 4 -.113 .147 .867
Level 4 Level 1 .238 .142 .341
Level 2 .346 .139 .064
Level 3 .113 .147 .867
13.Polycystic ovarian Level 1 Level 2 -.194 .127 .422
syndrome patients have an Level 3 -.449* .135 .005
increased risk of depression Level 4 -.416 *
.145 .022
and anxiety. Level 2 Level 1 .194 .127 .422
Level 3 -.255 .132 .213
Level 4 -.222 .142 .396
*
Level 3 Level 1 .449 .135 .005
Level 2 .255 .132 .213
Level 4 .033 .149 .996
Level 4 Level 1 .416* .145 .022
Level 2 .222 .142 .396
Level 3 -.033 .149 .996
*
14. Polycystic ovarian Level 1 Level 2 -.385 .129 .016
syndrome can be treated with Level 3 -.728* .138 .000
drugs. Level 4 -.732 *
.148 .000
*
Level 2 Level 1 .385 .129 .016
Level 3 -.344 .134 .053
Level 4 -.347 .144 .078
*
Level 3 Level 1 .728 .138 .000
Level 2 .344 .134 .053
Level 4 -.003 .152 1.000
Level 4 Level 1 .732* .148 .000
Level 2 .347 .144 .078
Level 3 .003 .152 1.000
15. Polycystic ovarian Level 1 Level 2 -.340 .136 .062
syndrome can be treated by Level 3 -.609* .145 .000
 27

decreasing body weight. Level 4 -.746* .155 .000

Level 2 Level 1 .340 .136 .062
Level 3 -.269 .142 .229
*
Level 4 -.407 .152 .039
*
Level 3 Level 1 .609 .145 .000
Level 2 .269 .142 .229
Level 4 -.138 .160 .826
*
Level 4 Level 1 .746 .155 .000
*
Level 2 .407 .152 .039
Level 3 .138 .160 .826
KNOWLEDGE OM Level 1 Level 2 -.1504581 .0735745 .173 -.34
POLYCYTIC OVARIAN Level 3 -.3404784 *
.0783432 .000 -.54
SYNDROME Level 4 -.3568306 *
.0839508 .000 -.57
Level 2 Level 1 .1504581 .0735745 .173 -.03
Level 3 -.1900203 .0764455 .064 -.38
Level 4 -.2063725 .0821827 .060 -.41
*
Level 3 Level 1 .3404784 .0783432 .000 .13
Level 2 .1900203 .0764455 .064 -.00
Level 4 -.0163522 .0864780 .998 -.23
*
Level 4 Level 1 .3568306 .0839508 .000 .14
Level 2 .2063725 .0821827 .060 -.00
Level 3 .0163522 .0864780 .998 -.20
*. The mean difference is significant at the 0.05 level.