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2003 NCC Task Analysis Content Validation Study
Telephone Nursing Practice Examination
Final Report
______________________________________
NCC
645 N. Michigan #900
Chicago, IL 60611
312 –951-0207
2003 Telephone Nursing Practice Content Validation/Task Analysis Study
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Table of Contents
Background and Overview
Development Process
Data Collection
Results
_________________________________________________________
2003 Telephone Nursing Practice Content Validation/Task Analysis Study
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1.
Background and Overview
The purpose of the task analysis/content validation study is to
describe the domain of practice, knowledge, skills and
abilities that are essential to the telephone nursing specialty
practice.
The application of the data collected is used to identify test
content to be included in the NCC certification examination to
insure the examinations are reflective of current practice, skills and
knowledge.
The focus of the NCC certification core examination to demonstrate
the special knowledge of the telephone nurse.
Phase I
a. Logistic review: NCC content team members, a
geographically diverse group representing both academic and
clinical practice venues were charged with the task of development
of the tasks as associated with existent test outlines.
b. Development process and data collection
c. Statistical compilation for the data
2003 Telephone Nursing Practice Content Validation/Task Analysis Study
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Phase II
a. Review of the data collected using a holistic
approach to analysis. The area of concerns were
Description of Patient Population and Frequency of Calls
Frequency of Patient Calls from Special Populations
The Nature of the Disposition of Patient Calls
Selected Practice Issues
The specific questions asked for each of the above areas are
described in Task Analysis Map,
Attachment 2.
The content team will consider maintaining or altering the test
outline for examination development based on survey outcomes at a
web conference to be held in March 2003. Staff comparative
analysis of survey results and current item bank content coverage is
listed in
Attachment 3.
2.
Development Process
The process used to identify essential knowledge, skills and abilities
is described in
Attachment 1.
A task analysis map was generated
and is included in
Attachment 2.
3. Data
Collection
With psychometric consultation, the tasks/skills identified by
2003 Telephone Nursing Practice Content Validation/Task Analysis Study
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the content team were formulated into a survey instrument.
Questions asked for each task are shown on the task analysis map.
All participants were asked the questions relevant to Description of
Patient Population and Frequency of Calls, Frequency of Patient Calls
from Special Populations and Selected Practice Issues. Because of
the volume of the questions related to the Nature of the Disposition
of Patient Calls, these questions were divided into four separate
parts.
All NCC certified telephone nurses were asked to participate (542)
either via email contact or post card notice, In addition, a general
notice via the NCC web site inviting those working in the specialty
who were not yet certified and employers of certified nurses were
contacted inviting them to encourage their nurse employees to
participate. 293 surveys were returned 191 or 40% of certified
nurses participated and 102 non-certified nurses completed the
survey. For the survey questions related to Disposition of Patient
Calls, the response was as follows:
Part 1
74
Part 2
82
Part 3
68
Part 4 69
2003 Telephone Nursing Practice Content Validation/Task Analysis Study
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In addition biographical information was also solicited as follows:
Education
level
Practice Setting
Length
of
Current
Practice
Certification
Status
Geographic
Location
4. Results
Summary of survey data are shown below:
a. Biographical
Data
Education Level
Diploma
Prepared
12%
Associate Degree
31%
BSN
45%
Master's
11%
Doctorate
0%
Practice Setting
Call
Center
39%
Hospital Based Center
25%
Nurse Advice Line
10%
Physician’s Office
12%
Managed Care
3%
Information Line
9%
Clinic
2%
NCC Certification Status
Yes
65%
No
35%
2003 Telephone Nursing Practice Content Validation/Task Analysis Study
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Geographic Location
Northeast
16%
Southeast
23%
Midwest
23%
Southwest
18%
West
19%
Outside US
1%
b.
Description of Patient Population and Frequency of
Calls
c. Frequency of Patient Calls from Special Populations
d. The Nature of the Disposition of Patient Calls
e. Selected Practice Issues
The results are summarized in
Attachment 3.
2003 Telephone Nursing Practice Content Validation/Task Analysis Study
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Attachment 1
TASK ANALYSIS CONTENT VALIDATION
PROCEDURES
Purpose:
The purpose of the task analysis/content
validation study is to describe the domain of practice,
knowledge, skills and abilities that are essential to the
specialty practice of telephone nursing.
Participants:
The Content Team is the responsible party
for development of task analysis content validation
procedures.
PHASE 1
DEVELOPMENT PROCESS
The identified development process utilized included:
a
.
Review of relevant practice standards and current
literature
The following documents will be reviewed as appropriate:
Standards of Practice and Guidelines from
* AAACN Task Force, AAACN Telephone Nursing Practice
Administration and Practice Standards, 1997
2003 Telephone Nursing Practice Content Validation/Task Analysis Study
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* AAHC/URAC 24 Hour Telephone Triage and Health
Information Standards, American Accreditation Health
* Emergency Room Nurses Association, Position on Telephone
Advice,
Revised
2001
*
American College of Emergency Physicians, Policy Statement,
Providing Telephone Advice from the Emergency Department,
2000
b. Review of current NCC competency statements
and general and detailed test outlines for the
Telephone
Nursing
Practice.
c. Identification of Essential Knowledge, Skills and
Abilities
PHASE II
SURVEY TOOLS
A survey tool was developed based on the content team’s direction
and psychometric consultation to insure that
all designated content areas were addressed:
Description of Patient Population and Frequency of Calls
Frequency of Patient Calls from Special Populations
The Nature of the Disposition of Patient Calls
Selected Practice Issues
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The survey was made available online and certified nurses, certified
eligible and employers of certified nurses were solicited for
participation.
Raw data was compiled using a percentage scoring system.
This will assign a percentage value each question asked
about each task. Actual percentage ratings were recorded.
2003 Telephone Nursing Practice Content Validation/Task Analysis Survey Results
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Attachment 2
____________________________________________________________________
2003 Telephone Nursing Practice Content Validation/Task
Analysis Study Map
The following questions relate to the telephone triage process and your role as
a telephone nurse.
Description of Patient Population and Number of Calls
Is your primary patient population?
Adult
Pediatric
Geriatric
Mixed Population
Specialized (List) i.e., ob/gyn, neurology, etc. ___________________________
Patient is defined as the caller, i.e. could be the patients themselves or a parent or spouse, etc.
On average, how many calls do you handle in any given day?
1-5
6-10
11-15
16-20
Over 20
Identification of calls from Special Populations as follows
In given week, what percentage of the calls you receive are from
2003 Telephone Nursing Practice Content Validation/Task Analysis Survey Results
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Parents with children under the age of 1
Parents of adolescents
Adult Females
Adult Males
Elderly
Minors
Disabled persons
Persons who don’t speak English
Disposition of Calls
In a given week, what percentage of calls you receive have the disposition of
Emergency/911 Ambulance
Go to the emergency room
Refer to urgent care within 2-4 hours
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Refer to PCP within 24 hours
Give home care advice
Give health education advice
Description and Frequency of Handling Specific Conditions/Issues
In a given week, how often do handle calls from patient reporting the following
conditions.
More than 15 times
5 – 14 times
Less than 5 times
Never
Conditions
Abdominal pain
Abrasions
Acne
Allergic reactions
Anxiety/stress
Arm/leg pain
Animal/human bites
Back problems
Body Piercing/tattoo problems
Breastfeeding problems
Breast problems
Breathing problems
Burns
Chest pain
Child abuse
Choking
Cold Exposure
Constipation
Contact lens problems
Cough
Dental Problems
Depression
Diarrhea
DIzziness/Fainting
Domestic violence
Ear problems
Elder abuse
Electric shock
Extremity injury
Eye problems
Facial injury
Fever
Flatulence
Foot/ankle problems
Foreign bodies
Genital problems
Hair loss
Hand/wrist problems
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Hay fever
Headache
Head Injury
Heart palpitations
Heartburn
Heat reactions
Immunization reactions
Itching without rash
Jaundice
Lacerations/cuts
Leg problems
Lethargy/fatigue
Lice infestation
Lump
Menstrual problems
Mental Health problems
Mouth problems
Nausea/vomiting
Neck problems
Neurologic problems
Newborn care issues
Nosebleed
Pelvic pain
Penile problems
Pregnancy problems
Postoperative problems
Postpartum problems
Problems that fit no protocol
Rash
Substance abuse
Suspected STDs
Seizures
Sore Throat
Stroke
Suicide
Trauma of any body party
Urinary tract infection
Upper respiratory infections
Vaginal bleeding
Practice Issue Questions
What type of practice guidelines, protocols or algorithms do you use in
your practice setting?
Disease Based
Symptom
Based
Mixed
Other
None
Are your practice guidelines, protocols or algorithms
Computer
Paper
Other
2003 Telephone Nursing Practice Content Validation/Task Analysis
Survey Results
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N/A
Do you routinely give over the counter drug advice over the phone?
Yes
No
Do you routinely give prescription drug advice over the phone?
Yes
No
Is your telephone triage system
Live
answer
Call
back
Both
Do you contact patients via communication methods other than the
phone?
Yes
No
If yes, by what means
Fax
Email
Web
Chart
Other
Biographical Data
Please provide the biographical data requested below.
Practice Setting
Call
Center
Nurse Advice Line
2003 Telephone Nursing Practice Content Validation/Task Analysis
Survey Results
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Physician
Office
Managed Care Nurse Information Line
Clinic
Other (list) ___________________
Highest Level of Education
Ph.D.
Master’s
Baccalaureate
Associate
Diploma
Other
____________________
How long have you been in telephone nursing practice?
1-5 years
6-10 years
11-15 years
16-20 years
Over 20 years
Are you certified in Telephone Nursing Practice?
Yes
No
Location
Northeast
Southeast
Midwest
Southwest
West
Outside the US
2003 Telephone Nursing Practice Content Validation/Task Analysis
Survey Results
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Patient Population and Frequency of Calls
Patient Population
(Respondents 293)
Number of Calls
Per day
(Respondents) 293
34 12%
1-5
1
1%
Pediatric 41
13%
6-10
9
3%
Geriatric
5 2%
11-15
15 5%
Mixed 187
64%
16-20
24
8%
Specialized 26
9%
Over 20
244 83%
Calls from Special Populations
% of Calls from Parent w/
Children Under Age 1
(Respondents
293)
Less than 5%
84
28%
5-25% 131
45%
26-50% 63
21%
51-75% 14
5%
76-100% 1
<1%
% of Calls from Parents
re: Adolescents
(Respondents) 293
Less than 5%
67
23%
5-25% 116
40%
26-50% 84
28%
51-75% 21
7%
76-100% 5
2%
% of Calls Adult Females
(Respondents 293)
Less than 5%
25
9%
5-25% 65
22%
26-50% 84
28%
51-75% 88
30%
76-100% 31
11%
% of Calls from Adult
Males
(Respondents) 293
Less than 5%
79
27%
5-25% 131
45%
26-50% 60
20%
51-75% 7
2%
76-100% 16
6%
2003 Telephone Nursing Practice Content Validation/Task Analysis
Survey Results
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% of Calls from the Elderly
(Respondents) 293
Less than 5%
81 28%
5-25% 111
37%
26-50% 58
19%
51-75% 30
10%
76-100% 18
6%
% of Calls from Minors
(Respondents) 293
Less than 5%
236 81%
5-25% 43
14%
26-50% 9
3%
51-75% 3
1%
76-100% 2
1%
% of Calls from the
Disabled
(Respondents) 293
Less than 5%
235 80%
5-25% 43
14%
26-50% 10
3%
51-75% 10
3%
76-100% 2
1%
% of Calls Those Who
Don’t Speak English
(Respondents) 293
Less than 5%
206 70%
5-25% 69
24%
26-50% 8
3%
51-75% 9
2%
76-100% 1
1%
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Survey Results
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Disposition of Calls
%of Calls Referred to
911 Per Week
(Respondents) 293
Less than5%
212 72%
5-25% 70
24%
26-50% 10
3%
51-75% 1
1%
76-100% 0
--
% of Calls Referred Go
to ER Per Week
(Respondents) 293
Less than5%
127
43%
5-25% 145
49%
26-50% 21
7%
51-75% 1
1%
76-100% 0
---
% of Calls Referred to
Urgent Care 2-4 Hours
/wk (Respondents
)
293
Less than 5%
72
25%
5-25% 170
58%
26-50% 40
14%
51-75% 9
3%
76-100% 2
<1%
% of Calls Referred to
PCP/wk
(Respondents) 293
Less than 5%
14 5%
5-25% 112
38%
26-50% 114
39%
51-75% 49
17%
76-100% 4
1%
% of Calls Disposed to
Home Care/wk
(Respondents) 293
Less than 5%
14 5%
5-25% 79
27%
26-50% 114
39%
51-75% 75
26%
76-100% 11
3%
% of Calls Where
Health
Advice is given/wk
(Respondents) 293
Less than 5%
74
25%
5-25% 109
37%
26-50% 65
22%
51-75% 31
11%
76-100% 14
5%
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Survey Results
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Practice Issues
Type of Guidelines
Used
(Respondents) 293
Disease Based
5
2%
Symptom Based
200 68%
Mixed 79
27%
Other
5
2%
None 4
1%
Format of Guidelines
Used
(Respondents) 293
Computer 195
67%
Paper 80
27%
Other 12
4%
N/A
6
2%
Type of Telephone
Triage
System
(Respondents) 293
Live Answer
122 42%
Call Back
33
11%
Both 138
47%
Are clients contacted
by means other than
telephone?
(Respondents)
293
Yes 93
32%
No 200
68%
If contacted by means
other than phone, what
are they?
(Respondents) 93
Fax 7
8%
Email 38
41%
Web Chat
12
13%
Other 36
39%
Is prescriptive drug
advice an expectation
of practice
(Respondents) 293
Yes 152
52%
No 141
48%
Is OTC drug advice an
expectation of practice
(Respondents) 293
Yes 187
63%
No 106
37%
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Description and Frequency of Handling Specific Conditions/Issues
Abdominal Pain/wk
(Respondents) 74
More than 15 times
31
42%
5 to 14 times
36 49%
Less than 5 times
4
5%
Never 3
4%
Abrasions/wk
(Respondents) 74
More than 15 times
4
5%
5 to 14 times
23
31%
Less than 5 times
37 50%
Never 10
14%
Allergic Reactions/wk
(Respondents) 74
More than 15 times
10
14%
5 to 14 times
31 42%
Less than 5 times
29
39%
Never 4
5%
Acne/wk
(Respondents) 74
More than 15 times
0
0%
5 to 14 times
1
1%
Less than 5 times
47 64%
Never 26
35%
Anxiety/Stress/wk
(Respondents) 74
More than 15 times
9
12%
5 to 14 times
34
46%
Less than 5 times
30
41%
Never 1
1%
Arm/Leg Pain
(Respondents) 74
More than 15 times
13
18%
5 to 14 times
40 54%
Less than 5 times
18
24%
Never 3
4%
Back Problems
(Respondents) 74
More than 15 times
20
27%
5 to 14 times
39 53%
Less than 5 times
13
18%
Never 2
2%
Animal/Human Bites
(Respondents) 74
More than 15 times
2
2%
5 to 14 times
17
23%
Less than 5 times
47
64%
Never 8
11%
2003 Telephone Nursing Practice Content Validation/Task Analysis
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Body Piercing
(Respondents) 74
More than 15 times
0
0%
5 to 14 times
0
0%
Less than 5 times
50 68%
Never 24
32%
Tattoos Problems
(Respondents) 74
More than 15 times
0
07%
5 to 14 times
0
03%
Less than 5 times
34 46%
Never 40
54%
Breastfeeding Problems
(Respondents) 74
More than 15 times
9
12%
5 to 14 times
24
32%
Less than 5 times
33
45%
Never 8
11%
Breast Problems
(Respondents) 74
More than 15 times
4
5%
5 to 14 times
20
27%
Less than 5 times
44 60%
Never 6
8%
Breathing Problems
(Respondents) 74
More than 15 times
26
357%
5 to 14 times
35 47%
Less than 5 times
10
14%
Never 3
4%
Burns
(Respondents) 74
More than 15 times
0
0%
5 to 14 times
16
21%
Less than 5 times
48 65%
Never 10
14%
Chest Pain
(Respondents) 74
More than 15 times
21
29%
5 to 14 times
34 46%
Less than 5 times
15
20%
Never 4
5%
Child Abuse
(Respondents) 74
More than 15 times
0
07%
5 to 14 times
0
0%
Less than 5 times
52 70%
Never 22
30%
2003 Telephone Nursing Practice Content Validation/Task Analysis
Survey Results
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Choking
(Respondents) 74
More than 15 times
0
0%
5 to 14 times
3
4%
Less than 5 times
44 59%
Never 27
37%
Cold Exposure
(Respondents) 74
More than 15 times
1
1%
5 to 14 times
6
8%
Less than 5 times
30
41%
Never 37
50%
Constipation
(Respondents) 74
More than 15 times
11
157%
5 to 14 times
38 51%
Less than 5 times
23
31%
Never 2
3%
Contact Lens Problems
(Respondents) 74
More than 15 times
0
0%
5 to 14 times
0
0%
Less than 5 times
41 55%
Never 33
45%
Cough
(Respondents) 82
More than 15 times
41 50%
5 to 14 times
34
41%
Less than 5 times
7
9%
Never 0
0%
Dental Problems
(Respondents) 82
More than 15 times
2
2%
5 to 14 times
17
21%
Less than 5 times
63 77%
Never 0
0%
Depression
(Respondents) 82
More than 15 times
2
2%
5 to 14 times
17
21%
Less than 5 times
61 75%
Never 2
2%
Diarrhea
(Respondents) 82
More than 15 times
33
407%
5 to 14 times
36 44%
Less than 5 times
13
16%
Never 0
0%
2003 Telephone Nursing Practice Content Validation/Task Analysis
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Dizziness/Fainting
(Respondents) 82
More than 15 times
4
5%
5 to 14 times
35
43%
Less than 5 times
43 52%
Never 0
0%
Domestic Violence
(Respondents) 82
More than 15 times
0
0%
5 to 14 times
0
0%
Less than 5 times
58
71%
Never 24
29%
Ear Problems
(Respondents) 82
More than 15 times
36
44%
5 to 14 times
37 45%
Less than 5 times
7
9%
Never 2
2%
Elder Abuse
(Respondents) 82
More than 15 times
0
07%
5 to 14 times
0
0%
Less than 5 times
24
29%
Never 58
71%
Electric Shock
(Respondents) 82
More than 15 times
0
0%
5 to 14 times
0
0%
Less than 5 times
46 56%
Never 36
34
Extremity Injury
(Respondents) 82
More than 15 times
13
16%
5 to 14 times
45 55%
Less than 5 times
22
27%
Never 2
2%
Eye Problems
(Respondents) 82
More than 15 times
19
23%
5 to 14 times
40 49%
Less than 5 times
22
27%
Never 1
1%
Facial Injury
(Respondents) 82
More than 15 times
3
47%
5 to 14 times
23
28%
Less than 5 times
52 63%
Never 4
5%
2003 Telephone Nursing Practice Content Validation/Task Analysis
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Fever
(Respondents) 82
More than 15 times
70 86%
5 to 14 times
6
7%
Less than 5 times
6
7%
Never 0
0%
Flatulence
(Respondents) 82
More than 15 times
3
4%
5 to 14 times
11
13%
Less than 5 times
57 70%
Never 11
13%
Foot/Ankle Problem
(Respondents) 82
More than 15 times
4
5%
5 to 14 times
26
32%
Less than 5 times
47 57%
Never 5
6%
Foreign Bodies
(Respondents) 82
More than 15 times
4
5%
5 to 14 times
26
32%
Less than 5 times
47 57%
Never 5
6%
Genital Problems
(Respondents) 82
More than 15 times
12
15%
5 to 14 times
37 45%
Less than 5 times
31
38%
Never 2
2%
Hair Loss
(Respondents) 82
More than 15 times
0
0%
5 to 14 times
1
1%
Less than 5 times
40
49%
Never 41
50%
Hand/Wrist Problems
(Respondents) 82
More than 15 times
9
11%
5 to 14 times
32
39%
Less than 5 times
39 48%
Never 2
2%
Hay Fever
(Respondents) 82
More than 15 times
14
17%
5 to 14 times
38 46%
Less than 5 times
29
36%
Never 1
1%
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Headache
(Respondents) 68
More than 15 times
20
30%
5 to 14 times
32 47%
Less than 5 times
15
22%
Never 1
1%
Head Injury
(Respondents) 68
More than 15 times
9
13%
5 to 14 times
19
28%
Less than 5 times
30 44%
Never 10
15%
Heartburn
(Respondents) 68
More than 15 times
13
19%
5 to 14 times
21
31%
Less than 5 times
26 38%
Never 8
12%
Heart Palpitations
(Respondents) 68
More than 15 times
6
9%
5 to 14 times
13
19%
Less than 5 times
42 62%
Never 7
10%
Heat Reactions
(Respondents) 68
More than 15 times
0
07%
5 to 14 times
6
9%
Less than 5 times
46 67%
Never 16
24%
Immunization
Reactions
(Respondents) 68
More than 15 times
6
9%
5 to 14 times
11
16%
Less than 5 times
42 62%
Never 9
13%
Itching w/o rash
(Respondents) 68
More than 15 times
9
13%
5 to 14 times
16
24%
Less than 5 times
34 50%
Never 9
13%
Jaundice
(Respondents) 68
More than 15 times
1
1%
5 to 14 times
5
7%
Less than 5 times
41 61%
Never 21
31%
2003 Telephone Nursing Practice Content Validation/Task Analysis
Survey Results
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Lacerations/Cut
(Respondents) 68
More than 15 times
9
13%
5 to 14 times
29 43%
Less than 5 times
19
28%
Never 11
16%
Leg Problems
(Respondents) 68
More than 15 times
12
18%
5 to 14 times
27 40%
Less than 5 times
25
37%
Never 4
5%
Lethargy/Fatigue
(Respondents) 68
More than 15 times
19
28%
5 to 14 times
19
28%
Less than 5 times
27 40%
Never 3
4%
Lice Infestation
(Respondents) 68
More than 15 times
1
1%
5 to 14 times
12
18%
Less than 5 times
40 59%
Never 15
22%
Lump (Respondents)
68
More than 15 times
3
4%
5 to 14 times
20
30%
Less than 5 times
35 51%
Never 10
15%
Menstrual Problems
(Respondents) 68
More than 15 times
15
22%
5 to 14 times
15
22%
Less than 5 times
26 38%
Never 12
18%
Mental Health Problems
(Respondents) 68
More than 15 times
16
24%
5 to 14 times
15
22%
Less than 5 times
32 47%
Never 5
7%
Mouth Problems
(Respondents) 68
More than 15 times
6
9%
5 to 14 times
15
22%
Less than 5 times
39 57%
Never 8
12%
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Nausea and Vomiting
(Respondents) 68
More than 15 times
35 51%
5 to 14 times
28
41%
Less than 5 times
4
6%
Never 1
1%
Neck Problems
(Respondents) 68
More than 15 times
8
12%
5 to 14 times
23
34%
Less than 5 times
26 38%
Never 11
16%
Neurological Problems
(Respondents) 68
More than 15 times
8
12%
5 to 14 times
24
35%
Less than 5 times
30 44%
Never 6
9%
Newborn Care Issues
(Respondents) 68
More than 15 times
14
21%
5 to 14 times
25 37%
Less than 5 times
13
19%
Never 16
23%
Nosebleeds
(Respondents) 69
More than 15 times
1
1%
5 to 14 times
1
1%
Less than 5 times
61 89%
Never 6
9%
Pelvic Pain
(Respondents) 69
More than 15 times
7
10%
5 to 14 times
25
37%
Less than 5 times
32 46%
Never 5
7%
Pregnancy Issues
(Respondents) 69
More than 15 times
16
23%
5 to 14 times
24
35%
Less than 5 times
18
26%
Never 11
16%
Penile Problems
(Respondents) 6
