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Year first Published: 2019
Language: English
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Comparing Two Different Methods of Communication by Assessing the Refinement in Knowledge Among Adolescent Girls on Menstrual Hygiene– A Comparative Interventional Study
Dheepika Arumugaperumal1*, Dharini Raveendiran2
1GVN Riverside Hospital, India
2Kombupalayam, Nadayanur post, Pugalur taluk, Karur, Tamil Nadu, India
Received Date: January 01, 2023; Accepted Date: January 07, 2023; Published Date: January 17, 2023;
*Corresponding author: Dheepika Arumugaperumal. 29, Vin Paradise, State bank officer’s colony, Cantonment, Trichy, Tamil Nadu, India. Contact no: +91 9865859000. Email: dheepika555@gmail.com
Citation: Arumugaperumal D, Raveendiran D (2022) Comparing Two Different Methods of Communication by Assessing the Refinement in Knowledge Among Adolescent Girls on Menstrual Hygiene– A Comparative Interventional Study. Adv Pub Health Com Trop Med: APCTM-173.
DOI: 10.37722/APHCTM.2023101
Abstract
Introduction
Though menstruation is a physiological process, the influence of social taboos, a lack of information, and inaccurate awareness among adolescent girls make menstrual health an important factor to be taken care of. This study has been conducted to compare PowerPoint presentations and group discussions in improving the awareness of menstrual hygiene among adolescent girls in schools and suggest better one for schools to follow the same for better outcomes.
Methodology
This comparative interventional study was done in the Perambalur district with Adolescent girls aged 12 to 16. Girls who did not attain menarche and ones who refused to participate were excluded from this study. A semi-structured questionnaire was created to assess their current knowledge about menstruation. The education was provided in two formats: group discussion and PowerPoint presentation and the knowledge was reviewed using the same questionnaire immediately and again after a month and the difference in knowledge was assessed with McNemer’s test.
Results
Among the 70 girls who participated in the study, 61.4 per cent belonged to the Group discussion batch and 38.6 belonged to the PowerPoint presentation batch. Among these 8.6 per cent of them did not have a separate toilet. Factors like the duration of the menstrual cycle, knowledge about an ideal interval of changing pads, and awareness about the complications of poor menstrual hygiene were taught and assessed. Both batches have shown improvement in the knowledge before and after intervention with statistical significance. (P value less than 0.005 with 95 per cent confidence interval).
Conclusion
Both interventions were equally efficient in improving the knowledge and awareness of adolescent girls about menstrual hygiene but a PowerPoint presentation having a pictorial advantage can be suggested as a better source for creating awareness of menstrual hygiene in school-going girls. Rural schools which lack technological advancement can use Group discussions to create the same effect as both are equally potent.
Keywords: Adolescent girls and India; Group discussion, Menstrual hygiene; PowerPoint presentation
Introduction
According to the WHO, adolescence is a vital time in human growth and development that occurs between the ages of ten and nineteen, after childhood but before adulthood [1] Menstruation is a physiological process that marks the beginning of a woman's reproductive life. Yet social taboos, a lack of information and inaccurate awareness among adolescent girls display it to be an impure occurrence in Indian society resulting in unnecessary constraints in their day-to-day routines [2] Education for girls has a long-term positive impact on personal well-being as well as economic and social growth, particularly in low-income areas. Educated girls not only participate in the formal labour market and earn higher wages, but they also engage in healthy behaviours such as marrying later in life and having fewer children, potentially ensuring better health and education for their children, which can help to alleviate poverty and contribute to the development of a country. However, many school-age girls avoid going to school during menstruation due to shame, fear of developing noticeable stains on their clothes, a lack of a private and secure space to handle menstruation in school, and dysmenorrhoea, according to several primarily qualitative research.[3,4] Adolescent girls being one of the most vulnerable groups in society and forthcoming mothers require adequate and correct knowledge of menstrual hygiene to reduce their risk of developing reproductive or sexually transmitted infections (RTI/STI) which are a significant burden on our society, rendering many females infertile and causing other negative health outcomes. So, if sound knowledge is delivered at the basic level, a healthy girl will grow up to be a healthy mother, contributing to the reduction of maternal and infant mortality, resulting in total women's reproductive health empowerment.[5,6] Adolescent girls and women must receive health education in order to be self-sufficient in managing menstruation difficulties.[7] With this above background, this study has been conducted with the aim of assessing and comparing the refinement of knowledge and practice of menstrual hygiene among school-going children between the teaching methods of PowerPoint presentation and group discussion.
Materials and Methods
During the months of December 2019 and March 2020, a comparative interventional study was done in the Perambalur district of Tamil Nadu. Due to a lack of time and resources, two private schools, Dhanalakshmi Srinivasan higher secondary school and Rovers CBSE higher secondary school were chosen from all the high schools in the Perambalur district. Both of the institutions had a co-educational atmosphere. Adolescent girls aged 12 to 16 were included in the study. After obtaining consent from the students and their parents, the study was done among the girls who were willing to participate. Approximately 94 of them agreed to take part in the study. Among them, about 70 girls had reached menarche and were included in the study. We went to the schools before the pre-test to acquire permission to perform the study and provide health education. A semi-structured questionnaire in English was created to assess their current level of knowledge about menstruation. There were four sections to the questionnaire. The participant's socio-demographic information was questioned in Section A. Section B includes questions to assess the knowledge regarding menstruation (source of information, normal age of menarche, normal menstrual cycle length, normal menstrual bleeding length and anatomy related to menstruation). Questions on the practices (absorbent used, frequency of changing pads, absorbent disposal) and restrictions during menstruation (taking bath, sleeping, entering the kitchen, entering pooja room, attending schools, playing sports) were found in Section C. In section D, questions about awareness of the consequences of poor menstrual hygiene were addressed. Following the collection of completed questionnaires, health education about menstruation was provided in two formats: group discussions and PowerPoint presentations (each session lasting approximately 45 minutes) about the physiology of menstruation, health practices, myths about menstruation, and the consequences of poor menstrual hygiene. Following that, a question-and-answer session was held to clear up any remaining doubts. The knowledge was then promptly reviewed using the same questionnaire immediately and again after a month. All the obtained data were entered in MS Excel and the results were analysed using SPSS version 21. McNemar’s test was used separately for both groups to assess the difference in knowledge acquired after the intervention.
Results Standard deviation - 1.07 correctly .004 wrongly correctly < 0.001 wrongly correctly < 0.001 wrongly of normal menstrual bleeding bleeding correctly 0.143 bleeding correctly < 0.001 bleeding correctly < 0.001 pads said pads pads undergarments undergarments undergarments complications of poor menstrual hygiene P- Value menstrual hygiene menstrual hygiene menstrual hygiene about white discharge Value discharge discharge white discharge Value correctly wrongly discussion menstrual correctly organ wrongly point presentation menstrual correctly organ wrongly menstrual correctly organ wrongly
About 70 girls participated in the study. The mean age of the study participants was 14 years. About 61.4 percent of the study participants comprised the group discussions group and 38.6 percent of the girls comprised the PowerPoint group. Most of them (about 87 percent were Hindu by religion. About 74 percent of girls had nuclear families. The general characteristics of the study participants were shown in table 1. Data about the factors related to menstruation were shown in table 2. The association for menstrual cycle length, duration of menstrual bleeding, the ideal interval of changing pads, about sun drying of the undergarments, awareness of complications of poor menstrual hygiene, opinion on white discharge and organ responsible for menstrual bleeding between pre-test and review test (after one month) were shown in table 3, 4, 5, 6, 7, 8 and 9 respectively. The P – Value less than 0.005 were considered statistically significant with a 95 percent confidence interval. For finding an association, McNemar’s test was used separately for both groups (PowerPoint presentation and group discussion).
S. No
General characteristics
Frequency
Percent
1
Age (in Years)
Mean - 14.01
2
Group
Group discussion
43
61.4
Power-point presentation
27
38.6
3
Class
7
11
15.7
8
20
28.6
9
27
38.6
11
12
17.1
4
Religion
Christian
3
4.3
Hindu
61
87.1
Muslim
6
8.6
5
Type of family
Joint family
18
25.7
Nuclear family
52
74.3
6
Mother's education
Graduation
30
42.9
High school certificate
14
20.0
Illiterate
3
4.3
Intermediate or diploma
6
8.6
Middle school certificate
10
14.3
Primary school certificate
3
4.3
Profession of honours
4
5.7
7
Mother's occupation
Employed
29
41.4
Unemployed
41
58.6
S. No
Factors related to menstruation
Frequency
Percent
1
Separate toilet in the house
No
6
8.6
Yes
64
91.4
2
Source of information regarding menstruation
Grandmother
1
1.4
Friends
3
4.3
Health workers
2
2.9
Mother
64
91.4
3
Sun drying undergarments
No
6
8.6
Yes
64
91.4
4
Skin rashes
No
55
78.6
Yes
15
21.4
5
Forced to sleep separately
No
43
61.4
Yes
27
38.6
6
Restricted for school
No
68
97.1
Yes
2
2.9
7
Restricted from playing sports
No
61
87.1
Yes
9
12.9
Group
Review test menstrual cycle length
Total
P-Value
Said correctly
Said wrongly
Group discussion
Pre-test menstrual cycle length
Said
Count
19
4
23
%
82.6%
17.4%
100.0%
Said
Count
18
2
20
%
90.0%
10.0%
100.0%
Power- point presentation
Pre-test menstrual cycle length
Said
Count
5
2
7
%
71.4%
28.6%
100.0%
Said
Count
18
2
20
%
90.0%
10.0%
100.0%
Total
Pre-test menstrual cycle length
Said
Count
24
6
30
%
80.0%
20.0%
100.0%
Said
Count
36
4
40
%
90.0%
10.0%
100.0%
Group
Review test duration
Total
P-Value
Said correctly
Said wrongly
Group discussion
Pre-test duration of normal menstrual
Said
Count
22
5
27
%
81.5%
18.5%
100.0%
Said wrongly
Count
12
4
16
%
75.0%
25.0%
100.0%
Power-point presentation
Pre-test duration of normal menstrual
Said
Count
6
2
8
%
75.0%
25.0%
100.0%
Said wrongly
Count
19
0
19
%
100.0%
0.0%
100.0%
Total
Pre-test duration of normal menstrual
Said
Count
28
7
35
%
80.0%
20.0%
100.0%
Said wrongly
Count
31
4
35
%
88.6%
11.4%
100.0%
Group
Review test ideal interval of changing pads
Total
P-Value
Correctly said
Wrongly said
Group discussion
Pre-test ideal interval of changing
Correctly
Count
25
2
27
0.002
%
92.6%
7.4%
100.0%
Wrongly said
Count
15
1
16
%
93.8%
6.3%
100.0%
Power-point presentation
Pre-test ideal interval of changing
Correctly said
Count
10
1
11
< 0.001
%
90.9%
9.1%
100.0%
Wrongly said
Count
16
0
16
%
100.0%
0.0%
100.0%
Total
Pre-test ideal interval of changing
Correctly said
Count
35
3
38
< 0.001
%
92.1%
7.9%
100.0%
Wrongly said
Count
31
1
32
%
96.9%
3.1%
100.0%
Group
Review test is it essential to sundry undergarments
Total
P-Value
No
Yes
Group discussion
Pre-test is it essential to sundry
No
Count
0
6
6
0.125
%
0.0%
100.0%
100.0%
Yes
Count
1
36
37
%
2.7%
97.3%
100.0%
Power-point presentation
Pre-test is it essential to sundry
No
Count
0
5
5
0.219
%
0.0%
100.0%
100.0%
Yes
Count
1
21
22
%
4.5%
95.5%
100.0%
Total
Pre-test is it essential to sundry
No
Count
0
11
11
0.022
%
0.0%
100.0%
100.0%
Yes
Count
2
57
59
%
3.4%
96.6%
100.0%
Group
Review test aware of
Total
No
Yes
Group discussion
Pre-test aware of complications of poor
No
Count
3
15
18
0.041
%
16.7%
83.3%
100.0%
Yes
Count
5
20
25
%
20.0%
80.0%
100.0%
Power-point presentation
Pre-test aware of complications of poor
No
Count
4
11
15
0.006
%
26.7%
73.3%
100.0%
Yes
Count
1
11
12
%
8.3%
91.7%
100.0%
Total
Pre-test aware of complications of poor
No
Count
7
26
33
0.001
%
21.2%
78.8%
100.0%
Yes
Count
6
31
37
%
16.2%
83.8%
100.0%
Group
Review test opinion
Total
P-
Abnormal
Normal
Group discussion
Pre-test opinion about white
Abnormal
Count
3
7
10
0.344
%
30.0%
70.0%
100.0%
Normal
Count
3
30
33
%
9.1%
90.9%
100.0%
Power-point presentation
Pre-test opinion about white
Abnormal
Count
0
7
7
0.180
%
0.0%
100.0%
100.0%
Normal
Count
2
18
20
%
10.0%
90.0%
100.0%
Total
Pre-test Opinion about
Abnormal
Count
3
14
17
0.064
%
17.6%
82.4%
100.0%
Normal
Count
5
48
53
%
9.4%
90.6%
100.0%
Group
Review test menstrual bleeding organ
Total
P-
Said
Said
Group
Pre-test
Said
Count
15
4
19
0.019
%
78.9%
21.1%
100.0%
bleeding
Said
Count
15
9
24
%
62.5%
37.5%
100.0%
Power-
Pre-test
Said
Count
8
3
11
0.021
%
72.7%
27.3%
100.0%
bleeding
Said
Count
13
3
16
%
81.3%
18.8%
100.0%
Total
Pre-test
Said
Count
23
7
30
0.001
%
76.7%
23.3%
100.0%
bleeding
Said
Count
28
12
40
%
70.0%
30.0%
100.0%
Discussion
The onset of menstruation is the most significant event that occurs in adolescent girls. It is usual for girls to have a variety of questions and concerns about menstruation. Instilling correct knowledge about menstruation at the appropriate time will prevent children from forming false beliefs and will help them avoid a variety of harmful genital and urinary infections, which are a major source of revenue for our primary care physicians. As a result, menstruation hygiene is critical in defining a woman's overall health [8]. In our study, the mean age of the study participants was 14 years. Similar to our study a study done by Singh et al., in 2021 in Uttar Pradesh, among 9 to 19 years girls found that maximum number of study participants belong to Hindu religion. This shows the prevalence of the Hindu religion among the Indian population [8] About 74 percent of girls had nuclear families. In contrast to our study a study done by Singh et al., in 2021, Uttar Pradesh, among 9 to 19 years girls found that maximum study participants belonged to joint families. This difference may be due to the difference in the geographical distribution of the study participants in both the study [8] Similar to the above discussion a study done by Choudhary et al., in 2019 in Rajasthan shows that a maximum number of the study participants belonged to joint family and were Hindus by religion [9]. Among 8.6 percent of the girls have no separate toilet in the house. In contrast to our study, a study done by Paria et al., in 2014, in West Bengal to compare rural and urban difference found that 83.6 percent of the girls in urban and 56.4 percent of the girls in rural have separate toilet facility. This shows the improvement in the general sanitation around recent years in India [10]. In contrast to the above statement a study done by Deshpande et al., in 2018, in Maharashtra with the aim of assessing menstrual hygiene among urban slum found that only 21 percent of the study participants have separate toilet in the house which shows the need for further improvement in the slum areas [11]. A systematic review done by Van Eijik et al., in 2016 with 138 studies done in India, from 2000 to 2015, states that only half of the study participants have separate toilet in home, about 25 percent of the girls were restricted for attending school [12]. But in our study about 3 percent of the girls had been restricted for going to school and about 13 percent were restricted to playing sports. This indicates the effectiveness of the awareness programme in India and also signifies the role of community participation. But in contrast to the above discussion a qualitative study done by Garg et al., in 2021 in New Delhi in which about 30 accredited social health activists, 30 Anganwadi Workers, and 30 auxiliary nurse midwives participated in in-depth interviews, as well as five focus group talks with 28 government school instructors had concluded that the frontline workers have failed to give information about optimal menstrual hygiene management. [13] This indicates need for further research to fill the gap of knowledge. Our study shows, about 38.6 percent of girls were forced to sleep separately during menstrual period time. In contrast to the above statement a study done by Deshpande et al., in 2018, in Maharashtra with the aim of assessing menstrual hygiene among urban slum found that about 27 percent of the study participants were sit/sleep separately [11]. This shows that the prevalence of social stigma on restrictions is high in Perambalur district. Coming to duration of menstrual cycle, knowledge about ideal interval of changing pads, and awareness about the complications of poor menstrual hygiene, both PPT and Group discussion have shown improvement in the knowledge before and after intervention and that difference in proportion is statistically significant by McNemar’s test. Regarding duration of normal menstrual bleeding, PPT is more efficient in improving knowledge than group discussion. A intervention study done by Dwivedi et al., in 2020 in Rajasthan, intending to assess the effectiveness of structural programme through peer educators conclude that the intervention gave statistically significant change in the attitude and practice of menstrual hygiene among the adolescent girls [14]. This indicates the need for intervention specifically focused on menstrual hygiene in schools.
Strength and Limitations of the Study
In our study, the data were collected by a single investigator for both the pre–test and review tests. A pilot study was done to improve the validity of the study questionnaire. A pilot study was done to improve the validity of the study questionnaire. Yet, the members in two groups were not equal due to variations in the number of students in each class which may influence the study results. Due to resource constraints, only two schools were selected with convenient sampling so a better result will be obtained by increasing the number of samples with a better sampling technique.
Conclusion
Among the teaching-learning methods, both PowerPoint presentation and Group discussion were equally efficient in improving the knowledge and awareness of the adolescent girls about menstrual hygiene. Powerpoint Presentations were noted to be more efficacious than group discussions in refining the knowledge about duration of menstrual bleeding. Owing to feasibility and pictorial advantage, PowerPoint presentations can be used in the schools of Tamilnadu to improve the menstrual hygiene knowledge among adolescent girls and contribute to the betterment of India.
Funding: Nil
Conflict of Interest: None declared.
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