A quasi-experimental study was conducted to evaluate the personal health and hygiene of high school girls during menstruation.
An experimental study is a research design which researcher manipulates one or more variables, and measures any change in other variables. It includes pre-post test, a study group and a control group, and random sampling methods. A quasi-experimental study is lack one or more of these design characters.
Ethical approval was obtained from the Ethics Committee of the Mazandaran University of Medical Sciences (code number: 87-10-16-87-92) for this research project. Informed consent was obtained from parents of all teenagers who participated in the study.
The health promotion initiative by the education organization in Mazandaran province, in north of Iran, was conducted in selected high schools. The project included 10 two-hour educational sessions using adolescent health resources. The educational manual was developed by adolescent health professionals' team. Educational topics included the significance of adolescence, physical and emotional changes during adolescence, pubertal and menstruation health and premenstrual syndrome. Participants comprised 689 high school girls (349 in the study group and 349 in the control group) 14 to 18 years of age in urban and rural public high schools with low socio economic status in Mazandaran province. The control group comprised high school students in Mazandaran province who did not participate in the education. As much as possible, the control samples were selected from the nearest neighbor school.
Factors matched in the study and control group were school type (rural or urban), grade, age and educational field of study. Inclusion criteria were students in high school, 14 to 18 years of age, parental consent for participating in the project and having had at least one menstrual period. Sampling was done in cooperation with the Ministry of Education in Mazandaran province and related administrations.
A questionnaire developed by the researcher was used for data collection. The menstrual health education was a government-sponsored program. The Youth and School Health Department delivered the training and evaluated menstrual health status before the education. Menstrual health was considered poor or average in Mazandaran province. The questionnaire in the present study was administered by the researcher to both the experimental and control group after the education. This self-administered questionnaire comprised 71 items in five sections: demographic characteristics, behaviors during menstruation, menstrual-related patterns, sources of information about menstruation and questions related to personal health.
We determined the validity and reliability of the questionnaire as follows. Face and content validity were determined based on viewpoints of the adolescent girls, health sciences specialists, and experts in the community. Test-retest reliability was examined using a 10-14 day interval with 20 qualified and available female students. These students were not part of the study. The questionnaire was reviewed and analyzed for repeatability and internal consistency aspects. Cronbach's alpha coefficient was used to assess internal consistency. Repeatability was estimated using the intra-class correlation coefficient (ICC). Cronbach's alpha coefficient and mean ICC were 0.88, and 0.90, respectively.
Based on ICC reliability ranges of less than 0.4 (poor), 0.4-0.7 (fair to good), 0.6-0.8 (good) and 0.8-1 (excellent), the reliability of the questionnaire was considered excellent .
Menstrual health was measured by investigating variables such as the pad material used, daily use of a clean pad, number of pad replacements during 24 hours, changing the pad at night or when in school, tendency to stay at home or not exercise, ability to properly perform daily tasks, negative impact of menstruation on studying, frequency of school absences during menstruation, noting the first day of the monthly menstruation, noticing typical period occurrence, paying attention to sudden changes in menstruation, changes in diet during menstruation including eating more protein and less salt and sugar, reduced consumption of snacks, sweets or pickles and increased consumption of vegetables, fruits and grains, avoiding certain foods, iron supplements during menstruation and hygiene habits including bathing the genitals.
The socio-economic level was categorized into four groups, based on the occupation of the father of the family: the higher class, including major landowners, merchants and manufacturers; the middle class, including government administrators, teachers, minor landowners, army officers, clergymen, individuals with personal professions and professionals; the working class, including professional and skilled workers; and the lower class, including the unemployed and the unskilled workers.
It is noteworthy that scores 0 and 1 were allocated to each of the questions of menstrual health and individual health status. Adolescent were arrived at percentile 0-25 (poor), 25-50 (average), 50-75 (good), and 75-100 (excellent).
The data collected were analyzed using the Statistical Package for the Social Sciences version 16 for Windows (SPSS Inc., Chicago, IL, USA). Descriptive and analytical indicators were determined. T-tests and chi square tests were employed for analysis, and the level of significance was set at 0.05.