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ISSN 2394-7330
International Journal of Novel Research in Healthcare and Nursing
Vol. 7, Issue 1, pp: (497-509), Month: January - April 2020, Available at: www.noveltyjournals.com
Page | 497
Novelty Journals
Effect of structured audio educational sessions
on visually challenges adolescent school-girls’
knowledge and practices regarding
menstruation
Rania El-Kurdy1, Eman A. Fadel2, Amel Ahmed Elsayed3
1,2 Lecturer of Woman’s Health & Midwifery Nursing, Faculty of Nursing, Mansoura University, Egypt.
3Lecturer of Community Health Nursing, Faculty of Nursing, Mansoura University, Egypt.
*Corresponding author: elkurdyrania@gmail.com
Abstract: Visual challenges adolescent girls (either blind or week vision) is a group of disable girls who needs a
special attention especially during their start of reproductive period with menstruation since they are not widely
being properly addressed. The study aimed to investigate the effect of structured audio educational sessions on
visually challenges adolescent school-girls’ knowledge and practices regarding menstruation. Design: A quasi-
experimental one-group pre/post-test research design was utilized. Setting: Al-Nour School for the Blind,
Mansoura, Egypt. Sample: A convenient sample of fifty-three visually challenges adolescent school-girls. Tools:
Three tools were used for data collection; I: Structured interviewing Questionnaire which consisted of three parts;
first part to assess socio-demographic data; second part to assess menstrual characteristics; and the third part to
assess participants’ knowledge regarding menstruation. II: menstruation check list to assess participants’ practices
regarding menstrual hygiene and management of its minor alignment. III: School-girls’ satisfaction Questionnaire
with the audio-educational sessions regarding menstruation. Results: There were lack of visually challenges
adolescent school-girls’ knowledge and practices regarding menstruation before implementing the Audio
educational session. In addition, there were an improvement in the total knowledge and practices scores of the
participants regarding menstruation after provision of the Audio educational sessions with highly statistically
significant differences (P<0.001). Conclusion: the audio educational sessions were effective in enhancement of the
visually challenges adolescent school-girls’ knowledge and practices regarding menstruation. Recommendation:
Raising awareness of adolescent school-girls regarding menstruation by further educational programs especially
for school-girls with disabilities.
Keywords: Menstruation, Visually challenges adolescent, menstrual knowledge and practices.
1. INTRODUCTION
Literally visually challenges individuals are called visual impairment individuals. According to World Health
Organization (WHO) report, visual impairment individuals are those who have eyes condition either congenital or by
accident that affect the visual system and vision functions (WHO a, 2019). Visually challenges adolescent girls are
estimated to be more than adolescent boys. As the girls biological changes develop, visual challenges adolescent girls
face many challenges because of their disabilities, they may need for a help even in their daily living activities. Having
any physical disability carries stigma for the disable individual and may face varieties of discrimination when they are
menstruating (Wilbur et al., 2019). Menstruation is an event of life that can transit a girl from childhood to womanhood.
It is a very sensitive landmark event in a female life; even normally adolescent girls may have lack of awareness of proper
management during menstruation (Flagg & Pillitteri, 2018.)
ISSN 2394-7330
International Journal of Novel Research in Healthcare and Nursing
Vol. 7, Issue 1, pp: (497-509), Month: January - April 2020, Available at: www.noveltyjournals.com
Page | 498
Novelty Journals
Menstruation is also called monthly bleeding, or menstrual period. Menstruation is the female life process from menarche
to menopause. With menstruation, the girl explore the biological development process, to have the power to generate in a
community with mature body and mind. When first menstruation occurs which is called menarche, the girl starts a real
being as a female, starting asking about reproductive organs function and physiology, menstrual pattern, nature and
normality to judge about her own menstrual wellbeing. If communities and institutions provide awareness and answering
all girls’ questions regarding menstruation, even without asking as most girls are mostly shy to ask, this may expand the
inner girl feeling of a real self-trust and self-confidence (Pope & Wurlitzer, 2017).
Adolescent girls’ awareness of menstruation physiology, hygiene and its minor alignment figure the correct girls’
response for managing. Menstrual hygiene management (MHM) is an essential aspect of adolescent girls’ awareness
toward menstruation. According to WHO and UNICEF, (2012) menstrual hygiene can be defined as using a clean
menstrual management material to absorb the menstrual blood, using soap and water for washing the body as required,
and having access to discard the spoiled menstrual materials and know how to manage menstruation with dignity and
without discomfort or fear. Over the last decade, the attention on MHM has increased. Examples include the socio-
ecological framework for MHM developed for school girls and their families (Emory University, UNICEF, 2013). In
addition, MHM had included in the Sustainable Development Goal 6 (UNICEF, 2015).
For visually challenges adolescent girl, it is very difficult to manage menstruation with improper knowledge and
practices. Therefore, visually challenges adolescent girls have great efforts to know and practice the menstrual hygiene in
a proper way. Good hygienic practices such as the proper use of sanitary pads and adequate washing of the genital area
and hands are essential to be known for all adolescent girls for practicing during menstruation (White, 2016). Adolescent
girls constitute a vulnerable group not only with respect to their social status but also in relation to their health. The issue
of menstrual hygiene was inadequately acknowledged and has not received proper attention among visually challenges
girls. Thus, the consequences of reproductive tract infections are severe and may result in significant negative impact to
adolescent health including chronic pelvic pain, painful periods and in severe cases of infertility. Reproductive tract
infections, which have become a silent epidemic that devastates adolescent’s lives and closely related to poor menstrual
hygiene (Samantaray et al., 2017).
Significance of the study
World Health Organization (WHO b, 2019) reported that globally, at least 2.2 billion people have a vision impairment and
blindness, of whom at least 1 billion have a vision impairment that could have been prevented and has yet to be addressed.
In Egypt, the prevalence of low vision in all ages in is 3.1%, which is nearly equal to 2.3 million people (Ramadan, 2011;
Pokharel, 2010). World Health Organization (WHO) and Ministry of Health and Population (MOHP) (2013)
reported that the visually impaired people reached 3 million in Egypt. According to the fifth axis of the social dimension
of Egypt's 2030 strategy, providing support for the marginalized segments of society and achieving protection by
providing care is essential for achieving the social justice for all persons in the society. One important marginalized
segment of society is the visual challenges adolescence girls. They have limitations to perform their activities due to loss
of vision, and also limited ability to learn from observing and performing self-care activities. Among the most important
senses that Almighty Allah have replaced the visual challenges individuals is the sense of hearing, followed by the sense
of touch. Therefore, these girls acquire different knowledge and skills through the sense of hearing and the sense of touch
more than any other senses. Assessment of the visual challenges adolescent girls’ knowledge and practices regarding
menstruation is very important, also providing supporting educational materials to enhance their monthly experience of
menstruation is very needed. Egyptian studies which investigated effect of audio-educational sessions on the visual
challenges adolescent girls’ knowledge and practices regarding menstruation are so limited thus, this study was
conducted.
Operational definition:
Visual challenges adolescent school girls: are adolescent girls who had visual impairment which mean that their visual
acuity is ranged from 6/60 to 6/24 or those who are blind which mean that their visual acuity is less than 6/60 either
congenital or by any other acquired cause.
The aim of the study
The present study aimed to investigate the effect of structured audio educational sessions on visually challenges
adolescent schoolgirls’ knowledge and practices regarding menstruation.
ISSN 2394-7330
International Journal of Novel Research in Healthcare and Nursing
Vol. 7, Issue 1, pp: (497-509), Month: January - April 2020, Available at: www.noveltyjournals.com
Page | 499
Novelty Journals
Research hypothesis:
This study hypothesized that:
1. Visually challenges adolescent schoolgirls who receive structured audio educational sessions exhibit improvement in
knowledge regarding menstruation post implementation of the educational sessions than before.
2. Visually challenges adolescent schoolgirls who receive structured audio educational sessions exhibit improvement in
practices regarding menstruation post implementation of the educational sessions than before.
2. MATERIAL AND METHODS
2.1 Research Design
A quasi-experimental one group pre/ post-test research design was utilized to conduct this study to achieve the study aim.
2.2 Setting
This study was conducted at Al-Nour School for the Blind, Mansoura, Egypt. Al-Nour School for the Blind is the only school
that serves Dakahlia Governorate. It was established in 1990 and aimed to provide knowledgble experiences to help the
visually challenges students to deal healthy and safely with the external environment and community in addition to the
providence of the educational opportunities as their mates in governmental and private schools who are without disabilities.
The School includes visually challenges (blind and weak vision) boys and girls at Kindergarten, primary, preparatory and
secondary level of learning. The school has an internal residence for students from long distances. The school schedule timings
start from 8.00 AM and end at 3.00 PM.
2.3 Sampling
A convenient sampling technique of 53 visually challenges menstruated adolescent girls were included regardless the
cause of their disability, who have no hearing or verbal response problem and were available at the previous setting
throughout the period between the start of February 2019 to the end of April 2019. This experimental research proposed
to investigate the effect of structured audio educational sessions on visually challenges adolescent school-girls’
knowledge and practices regarding menstruation. Based on data from literature (Neelkanth, Singh & Bhatia, 2017).
Considering level of significance = 5%, Power = 80%, Type of test = two-sided, the following formula is used for
calculating sample size is n = [2(Zα/2 + Zβ)2 × p (1-p)]/(p1 - p2)2 where n = sample size required in each group, p =
pooled proportion (proportion of event in group 1 + proportion of event in group 2)/2, p1-p2 = difference in proportion of
events in two groups, Zα/2: This depends on level of significance, for 5% this is 1.96, Zβ: This depends on power, for
80% this is 0.84. n = [2(1.96 + 0.84)2 × 0.58 (1-0.58)]/ (1.00 – 0.16)2=52.9. Based on above formula the sample size
required per group is 53
2.4 Tools of Data Collection
Tool (1): A structured Interview Questionnaire which designed by the researchers after reviewing the related literature
(Emory University, UNECIF, 2013). It consists of three parts. The first part related to socio-demographic characteristics
such as age, educational level, family monthly income, and area of residence, the second part concerned to the menstrual
characteristics such as age at menarche, regularity of menstruation, duration of menstrual cycle, material used during
menstruation for absorbing the menstrual blood and source of information regarding menstruation. While, the third part of
the structured Interview Questionnaire concerned with assessing visually challenges school-girls’ knowledge regarding
menstruation. It consists of 22 multiple choice questions; the first 11 questions related to female reproductive system
anatomy and physiology of menstruation, the next 4 questions related to management of minor alignments during
menstruation and the next 7 questions related to menstrual hygiene. Each question has 3 options, the right option was
scored as one while the other 2 options scored as zero. The total scores ranges from 0 to 22.
Tool (2): Menstruation checklist. It was developed by the researchers after an extensive review of literature in
consultation with experts for assessment of practice regarding menstrual hygiene of visually challenges schoolgirls and
management of its minor alignment. It contains 20 items; the first 15 items related to menstrual hygiene and the next 5
items related to management of minor alignments during menstruation. Each item has two responses, the correct response
was scored as one while the incorrect response was scored as zero.
ISSN 2394-7330
International Journal of Novel Research in Healthcare and Nursing
Vol. 7, Issue 1, pp: (497-509), Month: January - April 2020, Available at: www.noveltyjournals.com
Page | 500
Novelty Journals
Scoring system for knowledge and practice: The obtained score was converted into percentage. If the total percentage was
less than 65, it interpreted as poor knowledge or practices, if the total percentage was more than or equal 65, it interpreted
as good knowledge or practices. This tool was assessed three times; the first time was at the baseline assessment (pretest),
the second time was after one month of the enrolment after her next menstruation finished (post I), and the third time after
three months of the enrolment (post II).
Tool (3): School-girls’ satisfaction with the audio-educational sessions regarding menstruation: it was adapted by the
researchers after reviewing the national and international literature (Jeyanthi, 2017). It consists of ten items, five items
related to satisfaction with the researchers performance at the educational sessions and five items related to the audio-
educational sessions. Each items had a three point Likert scale responses. This tool was assessed after the end of the
educational sessions after the third session.
Tools validity and reliability:
Tools validity tested by five experts; two expertise in maternity nursing and two expertise in community nursing and one
expertise in obstetric medicine. Their suggested configurations were made, such as more simplifying the Arabic language
of certain statement of assessing the school-girls’ knowledge and practice. Tools reliability for the knowledge
questionnaire was 0.857, for practice check list was 0.865 and for satisfaction questionnaire regarding the educational
sessions was 0.877 by Alpha Cronbach test. Which indicates an accepted reliability of the tools.
2.5 Methods:
1. Ethical consideration:
The study was conducted after obtained ethical clearance from Research Ethics Committee, Faculty of Nursing, Mansoura
University and a permission letter was obtained from Al-Nour School for the Blind, Mansoura, Egypt to conduct the
research. A written consent made by braille method was obtained from all the participants before the data collection after
clarification the purpose and benefits of the research and that the research did not expose the participants to any risks.
Confidentiality was maintained throughout the study and the safety of the intervention. In addition, the right to be
withdraw from the study was permitted.
Pilot study
Pilot study carried on 6 visually challenges Schoolgirls to test the objectivity and applicability of the research tools and
the feasibility of the research process. Participants in the pilot study were excluded from the research study. The pilot
study revealed the feasibility, effectiveness and appropriateness of the study instruments.
Data collection
The required data collected from the beginning of February 2019 to the end of April 2019. The baseline data collected by
a structured interview questionnaire (Tool I) (pretest) to collect the school-girls’ socio-demographic data, menstrual
characteristics and knowledge regarding menstruation. Also school-girls’ practices regarding menstruation was assessed
by a non- observational Checklist (Tool II). After completion of the educational sessions and providing the Arabic booklet
which made by braille method as a supportive material. The school-girls’ knowledge regarding menstruation was
reassessed by the same pretest questionnaire (post I for knowledge) immediately after the third session, while the school-
girls’ practices was reassessed after one month of the enrollment after finishing the coming menstruation (post I for
practice). Finally, the school-girls’ knowledge and practices were reassessed (Post II for both knowledge and practices)
and also school-girls satisfaction with the educational sessions (Tool III) was assessed.
Research process:
Three phases was utilized to carry out the research process. Firstly, was the preparatory phase, secondly, was the
implementation of the structured audio- educational sessions and thirdly, was measuring the outcomes evaluation.
1) Preparatory phase
After reviewing the relevant literature to the study, the tools were designed, the educational sessions and the supportive
material (an Arabic booklet designed by braille method) were developed and finally the pilot study was conducted to
assess applicability of the study tools after confirming the content validity of the developed tool and the educational
sessions and material by a panel of experts in maternity nursing, community nursing and obstetric medicine.
ISSN 2394-7330
International Journal of Novel Research in Healthcare and Nursing
Vol. 7, Issue 1, pp: (497-509), Month: January - April 2020, Available at: www.noveltyjournals.com
Page | 501
Novelty Journals
Modifications were made according to their comments (to simplify the Arabic language used in the tools and the
educational material and sessions).
Development of the structured audio educational sessions. The researcher prepare three structured audio-educational
sessions which given for three sequent days. It designed in a simple Arabic language to improve the knowledge and
practices of the visually challenges school-girls adolescents regarding female reproductive organs anatomy and
physiology of menstruation, menstrual hygiene and management of its minor ailments. In addition, the supportive
material which was an Arabic booklet made by braille method was prepared, the content of the supportive booklet was
prepared by the researchers in an Arabic simple understood language and then a permission to print the educational
booklet in a braille method was attained from the director of the central library at Mansoura University. The researchers
bring a soft copy of the educational booklet to the Central Library as they have the printer, which programed to print the
given educational material to a braille paper, which collected and made in a booklet form designed in a braille method.
2) Implementation
First obtaining a permission letter from El-Nour school for the blind to conduct the study and a consent from the
adolescent school-girls who agree to be included at the research were taken. The total number of the participants was
fifty-three, they distributed into three small groups, the first two groups consists of 18 school-girls for each group and the
last group consists of 17 school-girls. Each researcher take one group to illustrate the educational sessions to the students.
On the recruitment day, in which the base line assessment was performed, the researchers introduce themselves to the
visual challenges adolescent schoolgirls and the aim of the educational sessions were illustrated to the participants. The
researchers took assessment of the participants’ socio-demographic, the menstrual characteristics, knowledge and
practices regarding menstrual hygiene and its minor alignments after distributing structured questionnaire and a non-
observational checklist. Demonstrators Volunteers from Woman’s Health and Midwifery Nursing Department, Faculty of
Nursing, Mansoura University helped each participants in each group to blot their answers in the questionnaire and the
checklist form. The baseline assessment taken about fifteen minutes for each participant to be completed by the
researchers and their volunteer assistances. A break for half an hour was taken, then the first educational session started in
the form of audio lecture provided by the researchers in an Arabic simple language easily understood to the participants.
The objective of the first educational session was to provide basic scientific facts about reproductive system anatomy and
physiology of menstruation. On the second day of the enrollments, a brief summary was given about the previous first
session then the second educational session was provided, the objective of the second session was to illustrate the
menstrual hygiene items and importance. On the third day of the enrollment, a brief summary was given about the
previous second session then the third educational session was provided, the objective of the third session was to illustrate
simple measures for management of menstruation minor alignments. After the end of the third educational session, the
supportive educational booklet, which made in simple Arabic language by braille method was given to all participants. At
the end of the each session, the researchers answered all participants’ questions. Each educational session take about
forty- five minutes with a break in between.
3) Outcomes evaluation
The outcome evaluation conducted immediately at the end of the third and last educational session, the participants were
re-assessed for their knowledge regarding menstrual hygiene and management of it minor alignments (Immediate post I
for knowledge). After one month of the enrolment, the participants were re-assessed for their practices regarding
menstrual hygiene and management of it minor alignments (post I for practice). Then after three months of the enrolment,
the researchers re-assess the participants’ knowledge and practices regarding menstrual hygiene and management of its
minor alignment (Post II for knowledge and practice). It take about thirty minutes to be completed by the researchers for
each school-girl adolescents.
Data analysis:
Statistical Package for Social Sciences (SPSS) version 21.0 used for the statistical analysis of the obtained data. Analysis
and interpretation of the data were carried out by using descriptive and inferential statistics. Descriptive statistics such as
mean, frequency, percentage and standard deviation was used for quantitative variables. Chi-square test used for non-
continuous variables such as the visually challenges school-girls knowledge and practices Pre and post the educational
sessions differences. The Cronbach"s alpha was used to assess the reliability of a set of components of the structured
knowledge questionnaire, non-observational practice checklist and satisfaction questionnaire. Statistical significance was
ISSN 2394-7330
International Journal of Novel Research in Healthcare and Nursing
Vol. 7, Issue 1, pp: (497-509), Month: January - April 2020, Available at: www.noveltyjournals.com
Page | 502
Novelty Journals
considered at p-value < 0.05, a highly significant difference obtained at p <0.000l and non-significant difference obtained
at P >0.05.
3. RESULTS
Table (1): Reveals that mean of age for the visually challenges adolescent schoolgirls was 13.2 ±1.0. Also, table one
presents that more than three- fifths of the schoolgirls (66%& 64.2% respectively) were residing in rural areas and had
inadequate family income. Furthermore, slightly less than one- third of their father (32.1%) were middle educated and
slightly more than one- third of their mother (37.7%) were primary educated.
Table (2): Shows that the mean of age of menarche of the visually challenges adolescent schoolgirls was 13.9 ±1.5.
Moreover, more than two- thirds of them had irregular menstruation, their interval between menstruations were above 35
days, and their menstruation lasts from 3 to 5 days (71.7%, 67.9% &69.8% respectively). In addition, all of the visually
challenges adolescent schoolgirls (100%) had minor alignments during menstruation and slightly more than two-fifths of
them (41.5%) had abdominal pain during menstruation. Table (3): Demonstrates that immediately after the providence of
audio educational sessions and after three months of the enrolment, most of the visually challenges schoolgirls’ correct
knowledge regarding menstruation increased than pre-intervention in all items with highly statistically significant
differences.
Also, table three illustrates that (100%, 98.1%, 94.3%, 94.3% &94.3% respectively) of participants had correct knowledge
immediately after the providence of audio educational sessions (post I) while after three months of the enrolment, it
reached (96.2%, 90.6%, 92.5%, 92.5% &90.6% respectively) (post II) regarding concept of ovulation, composition of the
menstrual cycle, causes of menarche, concept and causes of menstruation. Concerning management of minor alignments
during menstruation, table three shows that most of the visually challenges school-girls (96.2%,92.5% &92.5%
respectively ) had correct knowledge immediately after the providence of the educational sessions (post I), while after
three months of the enrolment, it reached ( 88.7%, 90.6% &94.3% respectively ) (post II) regarding measures used for
managing the menstrual pain, measures used for managing breast pain during menstruation and measures used for
managing urine retention during menstruation. Concerning menstrual hygiene, it is obvious that most of the visually
challenges schoolgirls (98.1%, 94.3%&94.3% respectively) increased in their correct knowledge immediately after the
providence of the educational sessions (post I), while after three months of the enrolment, it reached (86.8%, 86.8% &
90.6% respectively) regarding ways of drying the clothes, material used for cleaning genitalia, and time of changing the
sanitary bad with highly statistically significant differences.
Table (4): Presents that (100%, 98.1%, 96.2%, 96.2% & 94.3% respectively) of the visually challenges schoolgirls
adolescents after one month of the enrolment after finishing their next menstruation (post I) and (83.0 %) after three
months of the enrolment (post II) had correct practices regarding warp sanitary pads before disposal, removing sanitary
bad from front to back, changing undergarment more than twice daily and washing clothes with soap and water, and
changing cloths daily with highly statistically significant differences. Concerning practices to manage minor alignments
during menstruation, most of the visually challenges schoolgirls adolescents (92.5%, 88.7%,88.7%,88.7% & 88.7%
respectively) after one month of the enrolment after finishing their next menstruation (post I) and (83.0%) after three
months of the enrolment (post II) had correct practices regarding drink warm fluid to decrease lower abdominal pain and
avoid chocolate, cola and coffee during menstruation and regarding all practices for managing minor alignments during
menstruation.
Table (5): Illustrates that most visually challenges adolescent schoolgirls (92.5% &90.6% respectively) had total incorrect
knowledge and incorrect practices scores regarding menstrual hygiene and management of its minor alignments before
providing the structured audio educational sessions (pretest). While, majority of them (84.9% &75.5% respectively) had
correct knowledge scores immediately post providing the structured audio educational sessions (post I) and after three
months of the enrolment (post II). Concerning the schoolgirl’s practices regarding menstrual hygiene and management of
its minor alignments after providing the structured audio educational sessions, table five shows that most of the
participants (90.6%) had correct practice after one month of the enrolment and majority of them (83.0%) had correct
practices after three months of the enrolment with highly statistically significant differences.
Table (6): Denotes that majority of the visually challenges schoolgirls adolescents (88.7%, 86.8% &79.2% respectively)
were satisfied with the overall sessions, the structure of the sessions and the covered content and the explanation of the
educational sessions.
ISSN 2394-7330
International Journal of Novel Research in Healthcare and Nursing
Vol. 7, Issue 1, pp: (497-509), Month: January - April 2020, Available at: www.noveltyjournals.com
Page | 503
Novelty Journals
Table 1. Distribution of visually challenges adolescent school-girls according to their socio-demographic
characteristics (n=53)
Socio-demographic characteristics
No.
%
Age
12 years
18
34.0
13 years
15
28.3
14 years
14
26.4
15 years
6
11.3
Mean ±SD
13.2 ±1.0
Area of residence
Urban
18
34.0
Rural
35
66.0
Father education
Illiterate
6
11.3
Read and write
9
17.0
Primary
16
30.2
Middle education
17
32.1
High education
5
9.4
Mother education
Illiterate
3
5.7
Read and write
10
18.9
Primary
20
37.7
Middle education
11
20.8
High education
9
17.0
Monthly income of the family
Adequate
19
35.8
Inadequate
34
64.2
Figure 1. Shows that majority (88.7%) of the challenges adolescent school-girls were blind.
Figure 1: State of visually challenges adolescents school-girls’ vision (n= 53)
Figure 2. Presents that almost two-thirds (66%) of the visually challenges adolescents school-Al-Nour school for the blind
as internal residence
Figure 2: State of Staying as internal residence at Al-Nour School for the Blind (n= 53)
Figure 3. Denotes that majority (79.2%) of the visually challenges adolescents school-girls’ source of information
regarding menstruation were their mothers while, only 15.1% were their teachers and 5.7% were from media.
ISSN 2394-7330
International Journal of Novel Research in Healthcare and Nursing
Vol. 7, Issue 1, pp: (497-509), Month: January - April 2020, Available at: www.noveltyjournals.com
Page | 504
Novelty Journals
Figure 3: Source of information regarding menstruation (n= 53)
Table 2: Distribution of visually challenges adolescent school-girls according to their menstrual characteristics
(n=53)
Menstrual Characteristics
No.
%
Age at Menarche
12 – 14 years
31
58.5
15 – 16 years
22
41.5
Mean ±SD
13.9 ±1.5
Regularity of Menstruation
Regular
15
28.3
Irregular
38
71.7
Interval between Menstrual Cycles
28 – 35 day
17
32.1
>35 days
36
67.9
Duration of Menstrual Flow
<3 days
3
5.7
3 – 5 days
37
69.8
6 – 7 days
13
24.5
Presence of Minor Disorder
Yes
53
100.0
No
0
0.0
Type of alignment disorder
Abdominal pain
22
41.5
Back pain
14
26.4
Breast pain
5
9.4
Nausea
12
22.6
Table 3: Distribution of visually challenges school-girls according to their correct knowledge regarding
menstruation (n= 53)
Knowledge regarding menstrual physiology,
hygiene and its minor alignments
Pre-
intervention
Immediately
after-
providing the
structured
audio-
educational
sessions
After three
months of
the
enrolment
Chi square test
%
%
%
X2
p
Female reproductive system anatomy and physiology of menstruation
1. Concept of menstruation
28.3
94.3
92.5
73.828
<0.001
2. Causes of menstruation
35.8
94.3
90.6
58.436
<0.001
3. Proper time for menarche
28.3
86.8
86.8
54.924
<0.001
4. Female reproductive organ
32.1
92.5
86.8
56.604
<0.001
5. Organ responsible for ovum maturation
28.3
92.5
94.3
73.828
<0.001
ISSN 2394-7330
International Journal of Novel Research in Healthcare and Nursing
Vol. 7, Issue 1, pp: (497-509), Month: January - April 2020, Available at: www.noveltyjournals.com
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6. Number of ovum released in every month
22.6
90.6
88.7
72.070
<0.001
7. Concept of ovulation
28.3
100.0
96.2
91.659
<0.001
8. Causes of menarche
24.5
94.3
92.5
80.527
<0.001
9. Composition of the menstrual cycle
32.1
98.1
90.6
71.249
<0.001
10. Duration of normal menstrual cycle
24.5
28.3
41.5
3.909
0.142
11. Average blood loss during menstruation
22.6
20.8
20.8
0.075
0.963
Management of Minor Ailments of Menstruation
12. Measures used for managing the menstrual
pain
35.8
96.2
88.7
59.018
<0.001
13. Measure used for managing breast pain
during menstruation
20.8
92.5
90.6
81.232
<0.001
14. Measure used for managing urine retention
during menstruation
22.6
92.5
94.3
83.976
<0.001
15. Measure used for managing anxiety
20.8
88.7
77.4
59.745
<0.001
Menstrual Hygiene
16. Concept of menstrual hygiene
22.6
90.6
84.9
67.133
<0.001
17. Main purpose menstrual hygiene
26.4
30.2
35.8
1.121
0.571
18. Best method to absorb menstrual blood
30.2
60.4
54.7
10.929
0.004
19. Time of changing the sanitary bad
30.2
94.3
90.6
67.691
<0.001
20. Ways to dispose the sanitary bad
22.6
92.5
90.6
77.779
<0.001
21. Ways of drying the clothes
22.6
98.1
86.8
82.361
<0.001
22. Best hand hygiene method during
menstruation
20.8
35.8
30.2
2.998
0.223
23.Direction of perineal care cleanness
20.8
32.1
37.7
3.760
0.153
24. Material used for cleaning genitalia
41.5
94.3
86.8
45.222
<0.001
25.Bath pattern during menstruation
34.0
86.8
77.4
37.521
<0.001
P ≤ 0.001 highly statistically significant
Table 4: Distribution of visually challenges school-girls according to their correct practices regarding
menstruation (n= 53)
practices regarding menstrual hygiene and
management of its minor alignments
Pre-
intervention
After one
month
of the
enrolment
After three
months
of the
enrolment
Chi square test
%
%
%
X2
p
Practices related to menstrual hygiene
Do you ………….
1. Perform daily path
20.8
92.5
84.9
73.359
<0.001
2. keep perineal area clean dry
71.7
88.7
81.1
4.889
0.087
3. Wash perineal area with soap and water
5.7
92.5
83.0
100.479
<0.001
4. Clean perineal area from front to back
5.7
86.8
83.0
91.545
<0.001
5. Use cotton undergarments
5.7
90.6
83.0
97.335
<0.001
6. Wash undergarments with soap and water
92.5
90.6
100.0
4.947
0.084
7. Change undergarment more than twice
daily
9.4
96.2
83.0
99.335
<0.001
8. Change cloths daily
13.2
94.3
83.0
88.321
<0.001
9. Wash cloths with soap and water
9.4
96.2
83.0
99.335
<0.001
10. Cloths dried in sunlight
88.7
94.3
94.3
1.622
0.444
11. Cloths stored in clean and dry place
9.4
90.6
83.0
89.520
<0.001
12. Remove sanitary pads from front to back
13.2
98.1
83.0
95.323
<0.001
13. Change sanitary pads more than 3 times
88.7
94.3
96.2
2.539
0.281
14. Warp sanitary pads before disposal
13.2
100.0
83.0
99.125
<0.001
15. Sanitary pads disposed in separate dustbin
13.2
86.8
83.0
76.512
<0.001
ISSN 2394-7330
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Practices related to management of minor alignment during menstruation
Do you ………….
16. Drink warm fluid to decrease lower
abdominal pain and avoid chocolate, cola and
coffee during menstruation
11.3
92.5
83.0
88.815
<0.001
17. Perform regular exercise such as walking
9.4
88.7
83.0
86.598
<0.001
18. perform abdominal massage to decrease
abdominal pain
5.7
88.7
83.0
94.359
<0.001
19. Eat fruits and vegetables containing to
reduce tension and anxiety
5.7
88.7
83.0
94.359
<0.001
20. Avoid salty and spicy foods to decrease
urinary retention during menstruation
1.9
88.7
83.0
102.509
<0.001
P ≤ 0.001 highly statistically significant
Table 5: Comparison of the school-girls’ total knowledge and practices scores regarding menstruation pre- and
post-intervention (n=53)
Knowledge and practices
of visually challenges
adolescent schoolgirls
Chi square test
No.
%
No.
%
No.
%
X2
p
Knowledge
Pre-intervention
Immediately after-
providing the
structured audio
educational sessions
After three months
of the enrolment
In correct (<65%)
49
92.5
8
15.1
13
24.5
Correct (>65%)
4
7.5
45
84.9
40
75.5
76.616
<0.001
Practice
Pre-intervention
After one month of
the enrolment
After three months
of the enrolment
Chi square test
X2 p
Incorrect (<65%)
48
90.6
5
9.4
9
17.0
Correct (>65%)
5
9.4
48
90.6
44
83.0
89.520
<0.001
P ≤ 0.001 highly statistically significant
Table 6. Denotes that majority of the visually challenges schoolgirls adolescents (88.7%, 86.8% &79.2% respectively)
were satisfied with the overall session, the structure of the session and the covered content and the explanation of the
educational session.
Table 6: Distribution of participants according to their satisfaction’ score regarding the structured audio-
educational sessions on menstruation ( n= 53)
Structure audio educational session
Disagree
Uncertain
Agree
No.
%
No.
%
No.
%
1. Was structured well
5
9.4
2
3.8
46
86.8
2. Was satisfactory explained by the researchers
5
9.4
6
11.3
42
79.2
3. Was adequately covered by the researchers
5
9.4
6
11.3
42
79.2
4. Had a successful communication process
8
15.1
26
49.1
19
35.8
5. Had an easy technique to follow and understand
6
11.3
34
64.2
13
24.5
6. Illustrated clearly with examples
6
11.3
32
60.4
15
28.3
7. Had adequate duration
19
35.8
18
34.0
16
30.2
8. Was easy to practice
14
26.4
16
30.2
23
43.4
9. Added knowledge regarding menstrual hygiene
and management of its minor discomforts
8
15.1
9
17.0
36
67.9
10. On the whole was effective
2
3.8
4
7.5
47
88.7
P ≤ 0.001 highly statistically significant
ISSN 2394-7330
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4. DISCUSSION
Adolescence is a critical period in the girls’ lives. It is a transition from the girl childhood to the responsibilities of
adulthood. Adolescence when complained with any physical disability need special focus to increase the adolescent
female correct knowledge and practices and prevent any physical or psychological hazards. The current study aimed at
investigating the effect of structured audio-educational sessions on visually challenges adolescent school-girls’ knowledge
and practices regarding menstruation.
The current study finding revealed that majority of the visually challenges adolescent school-girls source of information
regarding menstruation was their mothers and minority of them had their information from their teachers and mass media.
This study finding may be attributed to that menstruation as a topic not covered as educational needs for the school-girls
and that mass media is not concerned with providing information regarding such sensitive topics. This study finding is
congruent with Neelkanth, Singh& Bhatia (2017) who conducted an experimental study on 197 Indian adolescent
school-girls to assess the higher secondary school girls’ knowledge and practices of menstrual hygiene after providence of
educational intervention. They reported that the mother was the primary source of information regarding menstruation and
its hygiene. At the opposite site to our study finding, a cross sectional study conducted by Gultie, Hailu & Workineh,
(2014). They found that the school teachers were the primary source of information for high school students regarding
menstrual hygiene which lead to increase the level of their knowledge regarding menstrual hygiene.
Concerning the visual challenges school-girls’ knowledge regarding menstruation
The current study finding revealed that most visually challenges adolescent school-girls had lack of correct knowledge
regarding reproductive organs and menstruation physiology, menstrual hygiene and management of minor alignments
during menstruation before providence of the structured audio-educational sessions. While after the providence of the
audio-educational sessions, there were enhancement in the participants’ knowledge with highly statistical significant
differences P ≤ 0.001 (Table 5). This study findings may be attributed to that pre intervention, the source of information
for majority of the current study was the mother and there was a little attention from the teachers to fill in the adolescent
school-girls’ needs regarding menstruation. In addition, menstruation is considered a sensitive topic and not all mothers
are properly prepared to transfer correct knowledge to their daughters especially with the low educational level and low
socio-economic status of our target and their special needs as disabling people. While after the providence of the
structured audio-educational sessions which were properly prepared in a simple Arabic language and after providence of
the supportive material which was the educational booklet that made in braille method and validated by a panel of experts
in the maternity nursing, community nursing and obstetric medicine, which had the great effect on enhancement of the
participants’ knowledge regarding menstruation.
These study findings are similar to an experimental study conducted by Kamaljit et al., (2014) who reported that most of
the participants had poor knowledge during pre-test. Nevertheless, after planned teaching program session most of the
participants had good knowledge. Also another supportive study conducted by Krishna Kumari Samantaray et al.,
(2017) who found significant differences between pre-test and post-test of knowledge between 40 visually impaired
adolescent girls regarding personal hygiene. In addition to another study done in India on 300 student that found a
statistically significant improvement in knowledge scores in various aspects of reproductive health Vanusha
&Parvathavarthini, (2018) following periodic health education intervention program.
Contradicting to the current study findings, a joint research method conducted by Tegegne& Sisay (2014) on 595
randomly selected adolescent school girls in Northeast Ethiopia to find out school-girls menstrual hygiene knowledge,
they found that more than half of the participants had correct knowledge regarding menstruation and management of its
minor alignments.
Thus, the first study hypothesis ―visually challenges adolescent schoolgirls who receive audio educational sessions exhibit
improvement in knowledge regarding menstruation post implementation of the educational sessions than before‖ was
accepted.
Concerning the visual challenges school-girls’ practices regarding menstruation
The current study finding revealed that most visually challenges adolescent school-girls poor practices regarding
menstrual hygiene and management of its minor alignments before providence of the structured audio-educational
sessions regarding menstruation comparing to after the providence of the structured audio-educational sessions with
highly statistical significant differences P ≤ 0.001 (Table 5).
ISSN 2394-7330
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This study finding is parallel to an Egyptian experimental study conducted by Ali & Abd-El Aal , (2015) on 71 blind
adolescent school-girls in in El-Nor and El-Aml institution to investigate the effect of health educational program
regarding reproductive health among blind adolescence. They found that there were improvement in the students’
practices regarding personal hygiene, exercise and reproductive health after the program than before with highly statistical
significant differences.
Thus, the second study hypothesis ―visually challenges adolescent schoolgirls who receive audio educational sessions
exhibit improvement in practices regarding menstruation post implementation of the educational sessions than before‖
was accepted.
Regarding the visual challenges school-girls’ satisfaction’ score with the audio-structured educational sessions regarding
menstruation
The current study denotes that majority of the visually challenges adolescent girls were satisfied with the overall sessions,
the structure of the sessions and the covered content and the explanation of the educational sessions by the researchers.
This study finding is on line with the study done by Jeyanthi (2017) who found that the level of satisfaction with audio
drama regarding menstrual hygiene and management of its minor ailments showed that 80% were satisfied and 20% were
highly satisfied with the researcher and audio drama on menstruation and management of its minor ailments of among
visually challenged girls.
5. CONCLUSION AND RECOMMENDATIONS
Conclusion: the audio educational sessions were effective in enhancement of the visually challenges school-girls’
adolescent knowledge and practices regarding menstruation.
Recommendations:
1. Raising awareness of school-girls adolescents regarding menstruation by further educational programs especially for
girls with disabilities.
2. Integrating the menstruation, menstrual hygiene and management of its alignment into the special needs for the
visually challenges school-girls in the blind schools objectives.
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Novelty Journals
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