Aim and free from any mental disabilities were

Aim of the present study is to estimate the effectiveness 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: A quasi-experimental design was used.
Study setting: This 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.
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

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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 of menstruation, intervals, regularity complains and associated pre-menstrual symptoms.
? Sources of information about menstrual hygiene.
Part II: -participants’ knowledge about menses and its hygiene:
as definition, signs and symptoms associated with menstruation.
Part III: – participants’ menstrual hygienic beliefs:
as beliefs of girls related to eating or drinking 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.
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.
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
Health Educational Program:
The analysis of data of the preliminary assessment revealed that girls who were categorized as having poor knowledge and poor self-care practice constituted …… girls (……..%) The preliminary assessment was considered as a pre-test.

-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. each session was ranged between 45-60 minutes, Each group was attended according to their available times and place, 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 program was constructed to assist the girls to correct their knowledge and try to modify their behaviors. The program was covered in six sessions for needy groups of patients.

Methods of instructions: Several teaching methods were used as lectures, demonstration, group discussion and role play to help girls share information, give them confidence and motivate them to comply with the contents of the intervention.
? Selection of audio-visual materials
The researchers used illustrations, real objects and power point presentations. The researchers presented handouts to the girls after ending each session. The program schedule (about 45-60 minutes per each session) was distributed to the girls and included the topics of each of the 3 sessions.
Content of the program:
1. First session included pretest and general knowledge about menses as definition, age of menarche, circulation of menses, duration and complains associated with menses.
Reasons of pain, abnormal menstruation,
2- Second session included practices regarding diet, physical exercise and hygienic care during menses , pads type, frequency of change, perineal hygiene, underwear and methods of cleansing, some of dangerous behaviors during menses, Pain relievers, using aspirin, at the point when to contact physician, healthy practice to manage pain and correction of misconceptions about menses. At the end of each session the researchers ensured that the girls understanding of the instructions.

Evaluation phase:
, the same questionnaire of menstrual hygiene introduced for participants three months after the end of the intervention program to estimate the effect of the program on knowledge, beliefs and practices among study girls.
Scoring system
A) Scoring system for assessing the participant’s knowledge regarding menstruation; This section contains of six items 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 ranged as (0-12). And classified into Percent;
? Good level of knowledge ? 80 % ” ? 9″ points
? Fair level of knowledge 60 – < 80 % " 6- < 9" points
? Poor level of knowledge < 60 % " < 6" points

B) Scoring system for assessing the participant's practices regarding menstruation;
This section of the questionnaire consists of 8 items estimating girls' practices of menstrual hygiene. A score of (3) was given to good hygienic practice, a score of (2) was given to fair practices and a score of (0) was given to poor practice.
The total practice score was ranged from (0-24 points). and classified into;
? Good ? 80 % "? 18″ points.
? Fair 60 – < 80 % "12 – < 18" points.
? Poor < 60 % "< 18" points.

V- Statistical analysis:
? After data collection, the collected data was coded and transferred into especially designed format to be suitable for computer feeding.
? Data was entered into and analyzed using the statistical package of social science (SPSS) version 20.
? The level of significance selected for this study was p? 0.05.
? Paired t-test was used to compare between sample means for quantitative data with normal distribution (pre-post).
? Correlation coefficient (rs) was used to test correlation between two quantitative variables not normally distributed.
? McNemar test (matched analysis) was used to assess significance between two correlated proportions.

VI- Ethical considerations:
? Permission was obtained to collect the data from the previous settings.
? Written informed consent obtained from the director of each institution included in the study after explanation of the aim of the study and assure them that collected data will be used only for the study purpose.
? Each director of residential institutions informed about the date and the time of data collection.
? Confidentiality and anonymity of individual response was guaranteed through using a code numbers instead of names.
VII- Limitation of the study:
Difficulty encountered during this study was obtaining the permission from Social Solidarity directorate in El-Beheira governorate to conduct the study was time consuming since it was taken about 6 months.


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