Aim of the present study is to appreciate the effectuation of health educational program on menstrual knowledge

Aim of the present study is to appreciate the effectuation of health educational program on menstrual knowledge, beliefs and practices of adolescent girls at governmental and non-governmental residential institutions for care of children deprived from family care in El Behiera Governorate.
Hypothesis of this interventional study was: Menstrual educational program will have positive or negative impact on knowledge, beliefs and practices of adolescent girls at governmental and non-governmental residential institutions for care of children deprived from family care in El Behiera governorate.
Study design: Quasi-experimental pre-posttest design was conducted to all adolescent girls in the institutions.
Study setting: The study was carried out in 5 governmental and non-governmental residential institutions for care of children deprived from family care affiliated to the Ministry of Solidarity and Social Justice in El-Beheira governorate namely: “Tahseen Elseha”, “El-Abaadia “, “El-Hanan”, “El-Waldine El-Khairia”, and “Elsayeda El-Azraa” female institutions.
Those institutions provide care for children grew up in a harsh social condition that prevent them from the care of their natural families, because of orphanhood or cracked family or family inability to provide proper care.
Subjects:
Inclusion into the study was entirely on a voluntary basis and girls who agreed to participate in the study were reassured that all information obtained are confidential and secure. Only girls who had attained menarche were eligible. All adolescent residents’ girls in the previously mentioned residential institutions aged from 10 to 17 years and free from any mental disabilities were included in the study. They were 87 girls as illustrated in the following table: –
Table I: Distribution of studied children in residential institutions.

Name of institution Girls aged
10-18 years
1. Tahsen Elseha 11
2. El-Abaadia female institution 14
3. El-Hanan 24
4. El-Waldine El-Khairia 17
5. Elsayeda El-Azraa 21
Total 87

Tool for data collection: This tool was developed by the researcher after reviewing recent literature in order to collect required data. It was included the following parts: –
Part I: participants’ personal data:
? Demographic characteristics of institutionalized girls: as age, grade.
? Menstrual history: as age of menarche, frequency, regularity of menstruation, intervals, associated pre-menstrual symptoms and complains.
? Sources of information about menstrual hygiene.
Part II: -participants’ knowledge about menstruation and menstrual hygiene:
as definition of menstruation, age of menarche, signs and symptoms associated with menstruation.
Part III: – participants’ menstrual hygienic beliefs:
as beliefs of girls related to drinking or eating cold /hot food during menstruation, and if women may have or haven’t menstruation during pregnancy.
Part IV: -It includes items about girls ‘hygienic practices, behaviors and restrictions during menstruation.
Method
I- Administrative process.
1. Official letters from Faculty of Nursing, University of Alexandria were directed to the directorate of Social Solidarity in El-Beheira governorate to inform them about the study objectives and to seek their permission to conduct the study in the previous settings affiliated to this directorate.
2. Meeting was held with the Deputy Minister of Social Solidarity and the directorate agent of social solidarity in El-Beheira governorate to inform them about the study objectives and to take their permission to conduct the study in the previous settings.
3. Approval letters were directed from directorate of social solidarity in El-Beheira governorate to the directors of selected institutions via the researchers.
4. Meetings were held with the directors of the selected institutions to explain the aim of the study, set the date and time of data collection, assure them that collected data will be used only for the study purpose, and to gain their approval and cooperation during data collection.
II- Development of study tools
? Tool for data collection was developed by the researchers after reviewing recent literature in order to li and was administered to the institutionalized girls to study their existing level of knowledge, beliefs and practices regarding menstruation
The tool was revised by Jury composed of (3) experts in the field of Community Health Nursing for content validity and their recommended modifications were done accordingly.

III- Pilot study
The Pilot study was carried out on a sample of 10 female institutionalized girls, they were selected randomly from two institutions namely El-waldine El-khairia and El-hanan, and they were excluded from the study sample.
Purposes of Pilot study:
Pilot study was conducted for the following purposes:
– Evaluate items clarity and relevance of study tools.
– Estimate time required for data collection.
– Identify the possible obstacles that may hinder the process of data collection.
The data obtained from the pilot study were analyzed. Based on the findings of the pilot study, some questions were clarified and few others added.

IV- Data collection
? The data was collected individually from the girls in their institutions after a brief explanation of the purpose and the nature of the research. The girls were asked for an oral consent for participation in the study.
? A self-administrated questionnaire was used as a tool for data collection, it included personal data related to age, age of menarche, and the participant’s knowledge, beliefs and practices about menstruation at the previously mentioned settings
? At the beginning of the interview with each girl the researchers were introduced themselves, clarify the purpose of interview, and ensure the anonymity and confidentiality of the collected data.
? Menstrual educational program was designed based on relevant literature and participant’s needs.
? Menstrual educational program was implemented in one month.
? Finally, participants were assessed to determine the effect of menstrual educational program on their knowledge, beliefs and practices.
? Data collection: Data was collected during the academic years February 2018 – July
2018.

Intervention phase: -Selection of the place: The educational sessions were held at a room of each one of selected institutions
-Selection of participants All adolescent residents’ girls in the previously mentioned residential institutions and Only girls who had attained menarche , they were divided into smaller groups; each group (10-17 girls) attended 2 sessions/week. The duration of each session was ranged between 30-45 minutes, started with 5 minutes for establishing relationships with participants, then 20 minutes lecture and followed by group discussion for 10-20 minutes questions and answers.
-Menstrual educational program (MEP): The objectives of the program were to encourage voluntary changes in behavior favorable to health. This improvement in behavior could be attained by improving knowledge and beliefs and practice.

Methods of teaching: Lecture and group discussion were used. ,Visual aids in the form of posters and handouts were used.

Content of the program:
1. General information about definition of menstruation, age of menarche, menstrual cycle, duration of menstruation and problems associated with menstruation.
2. Causes of pain, abnormal menstruation, what to do to relieve pain, washing during menses, type of pads, frequency of change, perineal hygiene, underwear and methods of cleaning.
3. Exercises during menses, dangerous behaviors during menses.
4. Pain relievers, aspirin use, when to contact doctor, healthy practice to relieve pain.
5. Correction of misconceptions regarding menstruation.
Evaluation phase:
The same questionnaire of menstrual hygiene introduced for participants three months after the end of the intervention program to evaluate the impact of the program on knowledge, beliefs and practices of girls.
Scoring system
A) Scoring system for assessing the student’s knowledge regarding menstruation; This section consists of 6items and the correct answers were pre-determined according to the literature. A score of (2) was given to the correct complete answer, a score of (1) for correct but incomplete answer and a score of (0) for the wrong or missed answers. The total knowledge score was obtained for each student (0-12). Percent of the total knowledge score was calculated as follows;

• Poor knowledge