Medical
Communication
Biosci. Biotech. Res. Comm. 10(2): 264-269 (2017)
Predictors of knowledge of puberty health among girl
students
Atousa Afsari
1
, Rohollah Valizadeh
2
, Masoomeh Abbasnezhad
3
,
Parisa Rizehvandi
4
and Samira Fatahi
5
*
1,4,5
Master of Nursing, Operating Room Department, Kermanshah University of Medical Sciences, Kermanshah, Iran
2
MSc student of Epidemiology, Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran
3
Master of Nursing, Nursing Department, Babol University of Medical Sciences, Mazandaran, Iran
ABSTRACT
Puberty and its consequence changes are one of the most important events of each person’s life. Knowledge about
puberty health lead to successful passage of this period. This study was aimed to determine factors predicting the
knowledge of girl students about puberty health in Tabriz high schools. This study was a cross-sectional study con-
ducted on 364 students in seventh and eighth grades in 2015. The participants were selected using random cluster
sampling. Their knowledge and socio-demographic characteristics about puberty health were collected using self-
completed questionnaires which is standardized questionnaire for Iran society. General Linear Model was used for
determining the socio-demographic predictors of knowledge about puberty health. The mean score of students’
knowledge was 8.26±2.21 (in the range of 0-15 scores). Fathers’ education (P=0.023) and previous obtained informa-
tion (P=0.001) were knowledge predictors. Regarding the mean score of students’ knowledge and their direct relation-
ship some factors such as father’s education, it is suggested to increase the knowledge of parents especially mothers
about puberty health by health providers at schools and the related organization using in present learning pamphlets,
sessions and classes.
KEY WORDS: KNOWLEDGE, PUBERTY, GIRL STUDENTS
264
ARTICLE INFORMATION:
*Corresponding Author: samira.fattahi312@gmail.com
Received 1
st
April, 2017
Accepted after revision 28
th
June, 2017
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Online Contents Available at: http//www.bbrc.in/
Atousa Afsari et al.
INTRODUCTION
According to the de nition of World Health Organi-
zation (WHO), adolescence refers to 10-19 age groups
(Russell & Robert,2005). Since adolescents are a great
part of the population of the world, addressing various
related issues of them is very important (Alavi, Poush-
aneh,& Khosravi,2009; Taghizadeh Moghaddam , et
al, 2016). Based on statistics published by the Statis-
tical Center of Iran, more than 20% of the population
(of approximately 80 million) consists of 10 to 19 year-
old adolescents (Statistical Center, 2006; Valizade, Tay-
moori, Youse , et al, 2016 and Afsari et al., 2017).
Puberty is an important dimension of adolescence.
Knowledge of its natural process and its problems suc-
cessfully pass the individual to adulthood and fertility
(Khakbazan, et al, 2008; Charkazi, et al, 2016). The health
of girls in puberty is speci cally important compared to
boys. Puberty characteristics and speci c physical and
mental conditions of this period, related needs and their
fundamental role in reproduction have a signi cant
effect on their whole aspect of their life (Maleki, Delk-
housh & Haji Amini, 2010).
Puberty is the predictable sequence of hormonal and
physical changes, and these physical and physiologi-
cal changes are critical in most girls and boys (Wong
& Baker, 1998). Puberty health includes principles and
taking actions that result in maintenance and improve-
ment of physical, mental, and emotional health during
this period and requires education more than anything
else (Malekshahi & Farhadi, 2006).
According to previous studies in Iran, most adoles-
cent girls do not have enough information regarding
menstruation health and most of them have unpleas-
ant feelings about puberty and their rst menstruation
(Golchin, et al, 2012; Karimi, 1998). Sometimes, some
of puberty problems put the person at crisis. Three main
educational factors including family, school and society
play active role in order to eliminate or reduce these
problems (Kohstani, et al., 2010). Since the health of girls
in present will supply the health of future generations,
the conduction of vast studies on their knowledge and
behavior about puberty health and efforts for increasing
it, are kind of investments for achieving personal and
social health (Charandabi, et al, 2014). Therefore, the
present study has been tried to evaluate the knowledge
of adolescent girls in seventh and eighth high school
grades about puberty health.
MATERIALS AND METHODS
This study was a descriptive-analytical study conducted
on 364 students in seventh and eighth grades in the
rst semester of the academic year (2015) in public and
private girl secondary schools in Tabriz. Tabriz is a big
city in North West of Iran. The participants were selected
using random cluster sampling. Out of the 107 second-
ary schools for girls (67 public schools and 40 private
schools besides schools for exceptional students) covered
by the Of ces of Education in the 5 districts of Tabriz, 8
public schools and 4 private schools were selected using
the simple random sampling method. Regarding that the
population of this study included 2,856 people, the size
of the sample was considered 364 people using Morgan
Table at 95% con dence interval. One-third of seventh
and eighth grades students in each school were randomly
selected using a table of random digits, and students who
had not experienced menstrual bleeding for more than 3
months, or who had taken part in similar research, were
omitted. After participants’ consent, the knowledge and
socio-demographic characteristics questionnaires were
lled by the students using one standard questionnaire
that was standardized in Iran by different authors. The
information was collected for one month from October
23, 2015 to November 23, 2015 in one shift from the sec-
ondary school girls in seventh and eighth grades.
The questionnaires used in studies conducted by
Mohammad Alizadeh et al. were employed to com-
plete the required information (Mohammad Alizadeh
Charandabi, Mirghafourvand, Rahmani, et al, 2014;
Mohammad Alizadeh Charandabi, Mirghafourvand,
Saghi, et al, 2014). The content and face validity of these
questionnaires (that included the three sections of socio-
demographic characteristic, questions about knowledge,
and questions about practice) were re-determined by
asking the opinions of 11 faculty members of the Nurs-
ing and Midwifery school in Tabriz. First names and
family names of the girls were not recorded on the ques-
tionnaires to keep anonymity.
The section on knowledge questionnaires included
15 questions with 4 possible answers for each one. One
point was given to each correct answer, and a zero for
a wrong answer or for an unanswered question. The
questions were on physical health such as understand-
ing puberty changes and the female reproductive sys-
tem, nutrition during the puberty period, physical activ-
ity and rest, skin health, menstrual health, and mental
health during puberty.
The section assessing practice of the girls included 32
items on physical health such as menstruation, nutri-
tion, sports, and physical activity and on mental health.
In fact, the students themselves reported their practice
because direct observation of the practice related to
puberty health in students was not possible. Each item
was answered based on the 4 point Likert scale (never,
sometimes, often, always) that received scores of 1 to 4,
respectively. Six items were scored inversely. The aspect
of practice was not evaluated in this article.
BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS PREDICTORS OF KNOWLEDGE OF PUBERTY HEALTH AMONG GIRL STUDENTS 265
Atousa Afsari et al.
In both elds, the primary score of each individual
and the total obtained scores were calculated and then,
knowledge scores for each individual were considered
very weak, weak, average, good, and excellent if they
were less than 3.83, 3.84 to 6.49, 6.50 to 10.46, 10.47 to
12.67, and more than 12.68, respectively. The practice
scores were also considered very weak, weak, average,
good, and excellent if they were less than 72, 72 to 81,
82 to 101, 102 to 111 and more than 112, respectively.
Inclusion criteria included having 13-14 year-old, hav-
ing no mental disease, high school students and sat-
isfaction to participate in the study. Exclusion criteria
included participation in other classes related to puberty
health and unwillingness to continue the participation
in the study.
This study was approved by the Ethics Committee of
Tabriz University of Medical Science (ID Code: 9381)
and the objectives of the study were explained to all
participants and all of them accepted to participate and
were assured of the con dentiality of their individual
information as well as the voluntary nature of partici-
pating in the study. SPSS version 13.0 was used for data
analysis. In order to describe socio-demographic char-
acteristics, knowledge about puberty health, descriptive
statistics including frequency and percent, mean and
standard deviation were used. In order to determine the
relationship of the knowledge scores in area of puberty
health with socio-demographic characteristics, the rela-
tionship was rst measured using bivariate tests such
as independent t-test and one-way ANOVA. Then, in
order to determine the effect of each independent vari-
able (socio-demographic characteristics) on the depend-
ent variable (knowledge in area of puberty health), those
variables whose signi cance were con rmed (P<0.05) in
bivariate tests were inserted to the General Linear Model
together. The signi cance level of P<0.05 was selected.
RESULTS AND DISCUSSION
The socio-demographic characteristics of the partici-
pants are presented in Table.1. The mean age of partici-
pants were 12±3.6 years old. The majority of students
had experienced their rst menstruation within the last
12 months. 57% of the students were in seventh grade
and 43 % of them were in eighth grade from 364 stu-
dents. The knowledge of the participants are shown in
Table.2. The mean score of knowledge score was 8.3±2.2
(in the range of 0-15 scores) that mean the students have
average knowledge.
The results of bivariate tests showed that there was
a relationship between knowledge score and the age of
students (P=0.002), their parents’ age (P=0.001), their
fathers’ education (P=0.001), previous obtained infor-
mation (P=0.002), and the most preferred source of
information (P=0.001). According to adjusted General
Linear Model, fathers’ education and previous obtained
information had a signi cant relationship with knowl-
edge that predicts 73% percent of variance in knowledge
scores (Table.3).
This study was aimed to determine factors predict-
ing the knowledge of girl students about puberty health
in Tabriz high schools. The mean score of students’
knowledge was 8.26±2.21 (in the range of 0-15 scores).
There was a statistically signi cant relationship between
knowledge and fathers’ education and previous obtained
information.
In this study, the high level of fathers’ education
has been associated with the high level of girls’ knowl-
edge. The high level fathers’ education underlies cul-
tural information exchange about puberty. These nd-
ings were in line with the results of the study done by
Kazemi et al. and Abokoti et al. (Kazemi,2012; Abioye-
Kuteyi, 2000). In the present study, approximately 93%
of the participants argued that they have previously
had knowledge but over half of them (60.1%) consid-
ered their information as average regarding that previ-
ous obtained information is in direct relationship with
knowledge, adequacy of information about puberty and
most students said that their rst source of information
was their mother and a low percentage said that their
source of information was health providers. Thus, the
low level of mothers’ knowledge and correct information
or insuf cient attention to puberty issues can be rea-
sons behind the lack of knowledge of these adolescents.
As noted in studies done by Abdollahi et al. (Âbdol-
lahy, Shabankhani& Khani, 2004), Olfati et al. (Olfati&
Aligholi,2008), Koff et al. (Koff& Rierdan, 2008), Afsari
et al. (Afsari, Valizadeh, Fatahi, et al.2017), Valizadeh
et al. in 2017 (Valizadeh, Taymoori, Youse , et al, 2016)
Mohammadi et al. (Mohammadi, Ghajari, Valizade, et al,
2017) and Valizadeh et al. in 2016 (Valizadeh, Ghaajari,
Ghaderi, 2016), there was a direct relationship between
the amount of primary information and adequacy of
information, and knowledge.
Knowledge of most teenage girls were weaker in
comparison with puberty health. Furthermore, these
some mentioned study indicated that their source of
information were their mothers. Thus, strengthening
the relationship between mothers and teenage daugh-
ters, removing the barriers such as shyness and embar-
rassment in expressing issues relating to puberty and
menstruation by girls or mothers, indifference to lack of
knowledge of the girls in issues related to puberty health
and its consequences should be incorporated into edu-
cational courses. Thus, it is suggested to inform moth-
ers with the adoption of proper and friendly methods
of attracting trust, friendship and necessary attention
related to puberty health.
266 PREDICTORS OF KNOWLEDGE OF PUBERTY HEALTH AMONG GIRL STUDENTS BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS
Atousa Afsari et al.
BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS PREDICTORS OF KNOWLEDGE OF PUBERTY HEALTH AMONG GIRL STUDENTS 267
Table 1. Socio-demographic characteristics of participants in this study (n=364)
Variables Mean SD
Age (year)
Age of student 12 3.6
Age of father 41.7 10.09
Age of mother 37.6 7.9
Mother’s education
Illiterate 20 5.5
Lower than diploma 158 43.3
diploma and Higher than diploma 145 39.8
licentiate and Higher than licentiate 38 10.4
Father’s education
Illiterate 12 3.3
Lower than diploma 141 38.8
diploma & Higher than diploma 145 39.8
licentiate & Higher than licentiate 62 17
Mothers’ job
Housewife 309 85.1
Employed 22 6
Fathers’ job
Worker 40 11
Clerk/retired 117 32.1
Shopkeeper 23 6.3
Private sector 170 46.7
Age at menarche
(each month)
>12 227 62.5
12 - 24 82 26.6
>24 54 14.9
Type of family
Both of father and mother 338 94.2
Living with stepfather and mother 4 1.1
Only with mother 17 4.7
Previous acquisition information Yes 332 91.5
Suf ciency of acquired information
about puberty
Insuf cient 26 7.2
Moderate 218 60.1
Suf cient 103 28.4
Main source of information about
puberty
Mother 251 69
Health providers 55 15.1
Magazines and books 52 14.3
Preferred source of information
about puberty
Mother 234 64.5
Sister and Friends and peer group 56 15.4
Health educator &Teacher 70 19.2
Feeling at onset of menarche
Fear and worry 81 22.3
Shame and embarrassment 120 33.1
Pride and happiness and enlargement 54 14.9
Anger 25 6.9
Table 2. Knowledge and practice of girl students about puberty health
Minimum and maximum scoreMean (SD)* Range Characteristics
65 - 12792.3 ± 1032 - 128 Knowledge
Atousa Afsari et al.
268 PREDICTORS OF KNOWLEDGE OF PUBERTY HEALTH AMONG GIRL STUDENTS BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS
The data collected was drawn from only in seventh
and eighth grades. Another limitation was the small
sample size of include studies as well as small size of
participants.
CONCLUSION
Regarding the average knowledge of the participants
in puberty health and also the effectiveness of family
variables in the knowledge of the participants and also
regarding that mothers are the most preferred and the
rst source of information about puberty health and
menstruation-related issues, more attention should be
paid to increasing parents’ knowledge especially moth-
ers, the how-about of information transfer and commu-
nication with the girls. In addition to training mothers,
other proper and specialized educational sources such as
health care providers, health care providers of schools,
and the media by considering cultural and educational
sensitivities.
The present article was extracted from MSc. thesis
approved and sponsored by Tabriz University of Medi-
cal Sciences, Iran (ID Code: 9381). Hereby, the authors
would like to thank the mothers and all the individuals
who helped in conducting the study. The assistance of
the head of ce of the Education Ministry of Tabriz City,
the personnel from the girls’ secondary schools, and par-
ticipating students this study was greatly appreciated.
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