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ABSTRACT
An experimental study was conducted to assess the impact and suitability of
menstrual education program (MEP) for 1st and 2nd graders at a girls'
secondary school in Riyadh city. The MEP was conducted on 5 classes,
through one session and one assessment. The results revealed that the mean
scores of knowledge, attitude and practice of the intervention classes (1st and
2nd graders) were significantly higher than that of the control classes.
Stepwise linear regression models show that the age of menarche and grade
were the predictors of students' knowledge among the control group and
explained 7.8% of the variation of the knowledge score. Knowledge was a
predictor of students' attitude of both groups (control and intervention)
(=0.359, 0.300 respectively). Knowledge was also a predictor of students'
menstrual practice among control group (=-2.12). Attitude was a predictor of
students' menstrual practice for both groups (=0.360, 0.252 respectively).
The study recommended the replication of the same program among
elementary, preparatory, and other secondary schools for improvement of
students' menstrual knowledge, attitudes and practice.
Corresponding Author:
Dr. Ebtisam M. Fetohy
Health Education & Behavioral Sciences Dept.,
High Institute of Public Health
Alexandria University
E-mail: ebtisammf@yahoo.com
INTRODUCTION
A woman goes through several developmental milestones that
greatly influence her reproductive health. Menarche, which is the
establishment of menstruation, is one of these milestones. The profile of
the woman's reproductive health is greatly influenced by the girl's
reaction to menarche, her beliefs and attitude towards menstruation,
and more important her behavior during it.
(1)
(3)
The menstruating
Muslim woman is not allowed to enter the mosque for prayer, touch the
Qur'an, or fast in Ramadan. In addition, she cannot engage in sexual
intercourse nor divorce at this time. During Hajj, she can do with the
exception of circumambulating in Makkah. Yet the small girl must keep
clean, tidy, in good condition, and practice all daily activities. (4)
Health education (HE) processes a mixture of knowledge, attitude
and behaviors. The problem under scrutiny may be based in a lack of
knowledge,
uncompromising
attitude
or
unrewarding behavior
106
(5)
(7)
Furthermore, 17% of girls who seek medical help from primary health
care centers in Riyadh are suffering from menstrual related disorders. (8)
Before planning for HE programs about menstruation, a study of
adolescents' knowledge of menstruation, and their beliefs and practices
will help the health educator, maternity nurse, school nurse, community
nurse discovers deficiencies in their knowledge and troubling
misconception-related issues.
(6)
107
between intervention classes and the control. For ethical reasons, the
content of the program was presented to the control group in the next
week. Any incompletely filled questionnaire was excluded from the
study. The number of students in all classes was (248).
108
Methods of teaching:
Lecture and group discussion were used. Visual aids in the form of
posters, handouts and pamphlets were used.
109
Evaluation procedure:
Impact evaluation is the level of evaluation used to assess shortterm effects of the MEP on students menstrual knowledge, attitude and
practices. One assessment was approached through the administration
of predesigned pilot-tested questionnaire to the pupils as a class
activity, so all pupils were encouraged and expected to participate. A
pilot study was done in another, one class from 1st and another from
second. According to the result of the pilot study, some items were
removed and others were changed. Pupils were instructed to use a
cover sheet for their responses and not to answer aloud.
The
110
like format (not sure, sure or very sure), and scored from 1 to 3
with higher score indicating positive attitude. The total score
ranged from 22-66. Standardized item alpha reliability
coefficients was .736
Data analysis
Data from the completely filled questionnaires were analysed using
SPSS program (version 11). The influence of MEP on the knowledge,
attitude and practice scores was assessed by examining the mean
posttest-data at each grade level of the experimental versus the control
group using independent t test. Also, examining the two means of 1st
and 2nd graders of the intervention versus the control group using
independent t test. A general linear model procedure from SPSS was
employed.
RESULTS
The intervention and control groups were comparable with no
statistically significant difference as regard socio-demographic factors
except that most of the control group (66.9%) belonged to age group 1416years, compared to 54% of the intervention group. The difference was
statistically significant, X =4.319, p<0.05 (Table 1).
111
Intervention
N=124
No
%
Control
N=124
No
%
Total
N=248
No
%
80
44
64.5
35.5
82
42
66.1
33.9
162
86
65.3
34.7
67
57
54.0
46.0
83
41
66.9
33.1
150
98
60.5
39.5
27
71
26
21.8
57.2
21.0
29
68
27
23.4
54.8
21.8
56
139
53
22.6
56.0
21.4
16
85
23
12.9
68.5
18.6
19
78
27
15.3
62.9
21.8
35
163
50
14.1
65.7
20.2
10
16
43
55
8.1
12.9
34.4
44.4
17
18
34
55
13.7
14.5
27.4
44.4
27
34
77
110
10.9
13.7
31.0
44.4
22
26
48
28
17.7
21.0
38.7
22.6
26
20
45
33
21.0
16.1
36.3
26.6
48
46
93
61
19.4
18.5
37.5
24.6
104
20
83.9
16.1
102
22
82.3
17.7
286
42
83.1
16.9
67
57
54.0
46.0
66
58
53.2
46.8
133
115
53.6
46.4
11
95
18
8.9
76.6
14.5
21
89
14
16.9
71.8
11.3
32
184
32
12.9
74.2
12.9
112
There
was
no
statistically
significant
difference
between
70
60.2
56.7
60
50
40
%
Control
30
Intervention Group
20
15.3
15 14.7
11.3
9
10
5.3
3.8
5.3
0.8
2.7
0
Mass Media
School Nurse
Mother
Grangmother
Sister
Friends
Sources of information
=4.22, p>0.05
113
+SD
82
80
27.84+2.30*
19.75+3.96**
15.840***
42
44
27.98+2.16
21.23+4.21
9.408***
*t
between intervention groups 1st& 2nd grade=-0.322, p=0.753,
**t between control groups 1st& 2nd grade=-1.907, p=0.060
*** p<0.001
+SD
82
80
54.76+5.89*
43.06+6.81**
11.679***
42
44
52.36+5.38
42.75+5.30
8.339***
Table 4 points out that the mean practice scores of the intervention
classes among 1st & 2nd graders were significantly higher than that of
their controls, (t=6.240, 4.433, p<0.001 respectively). There is no
114
significant difference between the mean practice scores of 1st & 2nd
graders among control group. The mean practice score of the 1st graders
among intervention group was significantly higher than that of the 2nd
graders (t=2.33, p<0.05).
Table (4) Impact of Menstrual Education Program on Menstrual Practice
of Secondary School Saudi Girls.
Total attitude score
First grade
Intervention
Control
Second grade
Intervention
Control
+SD
82
80
99.23+9.01*
89.33+11.07**
6.240***
42
44
95.60+8.36
85.73+12.04
4.433***
115
Beta
SE
F ratio
27.213
-0.726
1.776
3.730
-0.290
0.754
7.297
-2.502
0. 208
0.078
5.097
-0.221
0.208
0.000
0.014
0.020
31.772
0.551
2.682
0.130
4.845
4.252
0.129
18.077
0.359
0.000
0.000
20.563
0.777
-4.911
-0.541
1.210
10.617
0.217
1.619
0.239
0.595
1.937
3.580
-3.034
-2.269
2.032
0.072
6.244
0.300
-0.401
-0.190
0.270
0.055
0.000
0.003
0.025
0.044
7.060
0.143
0.223
1.778
0.871
5.933
4.524
4.519
-2.855
2.077
0.372
17.596
0.000
0.000
0.000
0.005
0.040
7.299
10.565
2.878
0.064
8.281
0.000
0.005
41.892
0.647
1.010
-5.077
1.810
77.116
0.387
0.354
0.360
-0.212
0.152
0.252
116
(9, 10)
Studies done in Riyadh 1999, 2001 demonstrated that the mean age at
menarche was 12.8+1.1 and 12+1 years respectively. (11, 12) In a study in
Mansoura, Egypt 2004, the mean age of menarche was 12.9 years.
(13)
(15)
117
Also, Hassanen et al
2004., in Egypt, found that all girls had poor level of knowledge before
the program. (17) Such lack of knowledge was attributed to lack of either
formal or informal pre-menarche preparation.
(3)
of
the
girls
were
having
correct
knowledge
about
menstruation. (18)
The results of the present study revealed that the mean score of
students' attitudes was low among the control group, Table 3. Studies
revealed that girls' reasons for avoiding bathing, perneal care and pad
changing included the fear of causing increased blood loss (12,17) or pain
or hair loss(17) or of trapping menstrual flow within the body, (11-13, 17)
leading to insanity. (12) Similar beliefs have been reported among African
tribes. (19, 20) Studies also revealed that one to three fifths of the students
were absent from school or work and stayed home fearing the pain on
the first day of menstruation. (11, 13, 17, 21) In addition, the majority of girls
avoided exercising during menstruation due to fear of the pain;
increased bleeding
(3, 11-13);
uterine displacement
(12)
118
The present study shows that the mean score of practice was low
among control group, Table 4. The study of Hassanen et al., (2004)
revealed that 59% of the girls had poor practice during menstruation
before the program.(17) Mobarak et al., (2004) concluded reported that
Alexandria girls adopt some unhealthy practices during menstruation
which were found to have sociocultural origin.
(14)
Several studies
(11, 12)
hygiene. (12) This is one of the leading causes of later difficulties such as
infertility precipitated by salpingitis and similar conditions.
(19, 20)
Moreover, other studies pointed out that there are many of the
restricting activities, such as refraining from doing any housework,
going out of house
14)
In
addition, other studies showed that there were many useful behaviors
such as drinking worm milk(11), and avoiding cold drink, (3) and other
harmful practices like drinking tea and coffee, (11) increasing the intake
of both salty and sweet food(12), avoiding eggs, chicken, meat(11, 12) and
foods containing vitamin C(12) and the use of self-medication. (11, 18)
The most appropriate source of information was the girl's mother.
(23)
of the maternal role. It was an opportunity for the mother to share with
her daughter the realization of the girl's evolving physical maturity.
Such discussion could strengthen the mother daughter relationship. (24)
Because of cultural and religious beliefs in Kingdom of Saudia Arabia
(KSA), menstruation is not considered an appropriate topic of
discussion, leading to the lack of accurate and available information. In
the present study more than half of the girls in both groups reported
119
that they got information from their mothers. Higher proportions of the
control group mentioned mother, mass media and sister as sources of
information. Meanwhile, higher proportions of the intervention groups
mentioned school nurse, grandmother and friends as sources of
information (figure 1). Al Ayafi (1999) found that 61.5% of the students
went to their mothers for answers to their questions. Religious books as
Fikgh Al-Sunnah were the second source of information. Peers,
teachers, medical personnel, television and other media were the last
sources of information.
(11)
Drakashayani Devi
and Venkata Ramaiah (1994) reported that 73.8% of the girls received
information from their mothers. Other information sources included
grandmothers, friends and sisters. (18) On the other hand, In Egypt, in
Mansoura, El-Gilany et al., (2005) found that 92.2% of the girls reported
mass media as their source of information followed by mothers
(45%).(10) These sources not only vary in quality of information provided
but also show how girls value potential information.
Although, 60.2% of the girls of the control group got their
information from their mothers (Figure 1), their mean score of
knowledge was poor (Table 2). This may be due to ignorance of the
mothers
themselves
educational level.
(17)
about
menstruation
irrespective
to
their
120
(5)
The
present work was in agreement with Seidman who stated that women's
knowledge seemed to affect their practices during menstruation(27), as it
revealed that knowledge score was a predictor of attitude of both
intervention and control groups. It was also one of the predictors of the
practice of the control group. Attitude was a predictor of practice of
both groups. Table 5. Olds et al., (1988) mentioned that when
individuals had adequate knowledge about lifestyle, they only have at
least some control over their situation. (28) On the other hand, Mobarak et
al., (2004) concluded that there is insignificant correlation between girls'
percent score of knowledge and that of health take caring practice. (14)
121
The present study pointed out that girl order between her siblings is
122
123
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