Polycystic Ovary Syndrome (PCOS) is a multifaceted disease which affects 6-20% of women in the reproductive years worldwide. Though, the rate of PCOS is rising continuously in South Asian particularly in Pakistani women as compared to western women (Akram & Roohi, 2015). PCOS can be a major reason of several other diseases in women including infertility, increase chances of miscarriages, vitamin D deficiency and complicated pregnancy (Azharet al., 2020). PCOS results in various complications including obesity, diabetes, anxiety and depression. The treatment usually starts with life style changes including healthy diet and regular exercise to minimize the weight gain and to maintain a healthy life routine (AlSinan & Shaman, 2017). However, the main limitation towards PCOS treatment is undiagnosed PCOS or delayed diagnosis. It is usually diagnosed when women start facing issues of menstrual irregularity, difficulty in conceiving, dyslipidemia or insulin resistance. The other reasons are the diverse nature of symptoms form hirsutism, irregular menses to infertility and the absence of precise diagnostic criteria which makes PCOS difficult to diagnose (Sheehan, 2004).

Education intervention plays a significant role in the management of Polycystic Ovary Syndrome (PCOS) and has been shown to improve the knowledge, attitudes, and behaviors of women and adolescents with the condition (Hajivandiet al., 2021). The educational interventional programs have been reported to significantly improve the women’s knowledge and attitudes towards lifestyle modifications for PCOS management. This suggests that education is an important aspect of managing PCOS and can help improve women’s understanding and attitudes towards PCOS. The structured education program significantly improved the participants’ knowledge and understanding of PCOS, as well as their self-efficacy and self-care behaviors related to the condition. The results suggest that structured education programs may be an effective approach for improving health outcomes in women with PCOS (Maniet al., 2018).

Literature studies have revealed that there is an inadequate and insufficient knowledge of PCOS including its symptoms and management among young students, women and society. They are not aware of various factors including life style choices and dietary habits which can worsen PCOS. Most of the women are unaware that delay in the diagnosis of PCOS may lead to metabolic and reproductive abnormalities associated to PCOS (Alshdaifatet al., 2021), (Ahmadiehm et al., 2022). Furthermore, other than absence of disease awareness and lack of management, women living in rural area or with lower educational background are reluctant to visit doctors. They even hesitate to talk regarding PCOS with their family and friends. This reluctance and hesitancy lead to various complications (Sidraet al., 2019). Rizvi et al., (2014) found that there is a lack of awareness and understanding about PCOS among the general population in Pakistan. It was observed that patients have negative attitude towards PCOS. They showed unacceptance of the disease consider it to be a stigmatizing condition. The findings highlighted the need for improving public education and awareness about PCOS in Pakistan. The study aimed to evaluate the impact of an educational intervention on the knowledge and attitude in among university students.

An educational-intervention based quasi-experimental study was conducted. The study was approved by the Institutional Human Ethics Committee (IU/FHS/ERC/023-031). Written consent was taken from the study participants. The female students with age 18 years or above and less than 35 years old were enrolled in the study. All the male students were not allowed to participate in the study. Only female students registered in the various disciplines of Faculty of Health Sciences degree programs, i.e. Pharmacy, Physical therapy, Nursing and Health Nutrition were enrolled in the study. The non-probability purposive sampling technique was utilized for collecting data from participants fulfilling the eligibility criteria. The sample size was calculated using 90% confidence level with a response distribution of 50% and margin of error of 5%. The minimum sample required for the study was calculated as 149 participants (Raosoft, 2021).

The educational intervention included a lecture organized with title “PCOS: an obstacle to fertility”. It was given by a senior gynecologist and fertility expert. The session was conducted to raise awareness on PCOS. The speaker efficiently covers the topic, and gave detailed information on symptoms, treatment, diagnosis and risk factors to increase the understanding and awareness of PCOS. All the queries of the students were answered by the speaker at the end of the session. Pre seminar and post seminar evaluation forms were given to the students to evaluate impact of education awareness on improvement in knowledge and attitude towards PCOS.

The first section of study was about the demographic characteristics of participants such as age, occupation, marital status, degree enrollment, and awareness of term PCOS. In the second section of study, students were inquired about awareness of most common symptoms related to PCOS i.e., irregular menstrual cycle, facial acne, and hirsutism, reduce fertility, weight gain, pelvic pain, diabetes, hypertension & psychological disturbance. The information about same symptoms was inquired again after post education awareness. The third section of comprises of 15 items of knowledge related statements. The questions were based on characteristic, treatment, diagnosis and risk factors of PCOS. The part of characteristics-based knowledge statements includes whether PCOS is characterized by multiple cysts in the ovaries, increase in hair growth at specific sites, increase in acne and abnormal menstruation. The treatment section comprises of items based on PCOS is a chronic disease and has no treatment, can be treated with drug and can be treated by decreasing body weight. The last part of this section was based on risk factors and it includes whether PCOS patients have an increased risk of cardiac diseases and breast cancer, increased blood sugar levels, increased insulin resistance, increased risk of endometrial cancer, increased risk of infertility and increased risk of depression and anxiety. The fourth section was based on 8 attitude related questions towards PCOS. The section included that whether after diagnosis of PCOS; individual will consult doctor or go toward treatment with natural products, frequency of treatment and impact of fertility. The psychological impact of PCOS was questioned in this section including possibilities of depression, negatively target self-confidence, declining effect on work/study and need emotional support.

The items of the third and fourth sections were formulated on Likert-scale ranging from 1-to-5 score, where a score of 5 meant strongly agree while a score of 1 meant strongly disagree. These validated 23 items (15 items related to knowledge & 8 items related to awareness) of research questionnaire were adopted from educational intervention studies conducted by (Aripinet al., 2022).

Statistical data entry and analysis of results was performed using Microsoft Excel and Graph pad prism analyzed data using descriptive statistics, with mean and percentage. Chi square was also performed on symptoms, knowledge related statement and attitude related questions. McNemar’s test was used to determine improvements in knowledge and attitude between pre- and post-education intervention measurements.

A total of 150 female adult participants were enrolled in the study. The mean age of participants was 26.73±3.64 years. Around two-third of participants i.e., 97 (64.7%) aged in between 18-23 years old, and only 26 (17.3%) participants were aged above 30 years. Majority of participants were single female participants i.e., 65 (43.3%). A total of 35 (13.4%) participants were currently doing job as full-time or part-time. Majority of participants were enrolled in 108 (72%) in bachelor’s degree. Around three-fourth participants (72.7%) stated that they have aware of PCOS as a disease, while, 36 (24%) participants declared history of PCOS. The demographic characteristics are summarized in Table 1.

For awareness of PCOS among participants, the overall mean symptom awareness score was improved statistically significant after educational intervention (6.10±2.7 vs. 8.19±3.7; p < 0.001). For symptoms of hirsutism, reduce fertility, weight gain, abortion, early puberty, diabetes, and psychological disturbance, the post-intervention awareness was improved statistically significant. The pre- and post-intervention statistics of study participants are summarized in Table 2. The overall mean knowledge score of participants was statistically significant (p < 0.001) from 31.93±8.48 at pre-intervention phase to a mean score 53.96±5.53 of for enrolled participants. Except for the knowledge statements about increased risk of developing cardiac diseases and breast cancer, the mean knowledge score of participants was statistically significant improved for participants. The pre- and post-intervention mean scores of knowledge statements are summarized in Table 3. The overall mean attitude score of enrolled participant’s pre-intervention was found to be 17.79±5.14, and is statistically significantly (p < 0.0001) improved post-intervention to mean score of 27.34±2.80 with a mean difference of 9.55±6.21. For all the attitude related statements, the mean score was statistically significant improved post-intervention. The pre- and post- intervention mean scores for attitude related statements are summarized in Table 4.

The impact of educational intervention on knowledge and attitude of enrolled participants is summarized in Tables 5 and 6. Knowledge related to PCOS such as characterized by multiple cysts, hirsutism, diagnosis from laboratory tests, and insulin resistance were correctly chosen by 100% participants post-intervention. In terms of improvement post-intervention, only knowledge-related statements about a higher risk of breast cancer and potential pharmacological treatments were shown to be statistically non-significant (p > 0.05). Over 50% of participants correctly answered each statement on the impact of educational intervention on attitudes.

It is evident that knowledge and awareness of PCOS is significant because early diagnosis and intervention reduce the risk of long-term health problems and improve quality of life. Despite its prevalence, many women with PCOS may not be aware of their condition, as its symptoms can be mistaken for other health problems or dismissed as normal changes during reproductive years. The study conducted by Gaferi et al., (2018) found that two third of their study participants were unaware of PCOS and general reproductive health and concluded that education at home and educational institutes can act as an effective tool to increase awareness. Similarly, a study conducted in India concluded that most of the study participants were ignorant of PCOS regardless of having PCOS symptoms (Kirthikaet al., 2019). Therefore, it is crucial for healthcare providers and the general public to be knowledgeable about the signs and symptoms of PCOS, as well as its causes and risk factors. With the right information and support, individuals with PCOS can better manage their condition and improve their overall health and well-being (Pramodh, 2020).

In current study, the pre intervention and post intervention data revealed that the PCOS educational seminar enhanced the overall knowledge of respondent regarding PCOS symptoms. The study showed a positive and significant increase in knowledge regarding PCOs symptoms particularly fertility issues, weight gain, early puberty and psychological disorders. The study questionnaire included various statements about regarding PCOS knowledge including diagnosis, symptoms, management and risk of various complication and attitude toward PCOS. The pre intervention data showed an insufficient and poor knowledge of PCOS among young women while the post intervention is evident that respondents’ knowledge was significantly increased. The study results proved the educational intervention can play an important role in PCOS early diagnosis. The study results coincide with similar studies conducted in Pakistan and other countries evaluating the impact of educational interventions on knowledge. Qadir et al., (2021) also found limited awareness and understanding of PCOS among both women with the condition and healthcare providers. The study highlighted the need for increased education and training for both women with PCOS and healthcare providers to improve awareness, understanding, and the quality of care for individuals with PCOS in Pakistan. Related results were concluded by similar research studies conducted in various countries (Jaberet al., 2022; Gohet al., 2022). The study also validates the results of research studies conducted in public universities (Haqet al., 2017) and tertiary hospitals of Pakistan (Rizviet al., 2014) with PCOS patient that there is a negative and reluctant attitude towards the understanding of the PCOS. However, our result also showed that with an effective educational intervention the attitude can be transformed into a positive and more acceptable attitude. The study calculated the percentage improvement towards the knowledge and attitude in the young female after an educational intervention of PCOS. A highly statistically significant and positive change resulted in enhancement of the knowledge and attitude towards PCOS. The result concluded that educational interventions significantly increase the knowledge and understanding of symptoms of PCOS which can act as key player in early diagnosis of PCOS that can help in better management of PCOS. These results are also validated by other studies which proved that educational interventions are helpful. Mohamed et al., (2016) emphasized on need of increasing the knowledge of PCOS in young females and established that educational interventions might be an effective tool in the management of PCOS. While Hajivandi et al., (2021) and Dashti et al., (2022) studied educational intervention including nutritional behaving and eating pattern for young PCOS patients. They suggested that these programs can improve the nutritional health of PCOS patients. Moreover, an awareness and life style modification study established that inclusion of education programs for young girls is an effective way for early identification and prevention of PCOS (Selvarajet al., 2020).

The study concluded that educational interventions play a major role in improving the understanding of PCOS symptoms as well as results in improved attitude and more acceptability towards the PCOS by patients and the society. These interventions can help in early diagnosis, disease acceptance by the patients and more emotional support by society. Further research should be conducted to evaluate the impact of PCOS in the Pakistani population and to develop effective strategies for managing the condition and improving the health and well-being of individuals affected by PCOS in Pakistan.

We are thankful to all the respondents for giving time for the study.