Effectiveness of a participatory educational intervention on menstrual health and hygiene knowledge, attitudes, and practices among nursing and midwifery students in Bangladesh
4 affiliations
- 1Graduate School of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan.
- 2Directorate General of Nursing and Midwifery, Ministry of Health and Family Welfare, Dhaka, Bangladesh.
- 3Global Station for Indigenous Studies and Cultural Diversity, Hokkaido University, Sapporo, Hokkaido, Japan.
- 4Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan.
Abstract
Background: Menstrual Health and Hygiene (MHH) is fundamental to women’s well-being but remains underprioritized in professional health education. In Bangladesh, nursing and midwifery students, future frontline health workers, rarely receive structured menstrual health curricula. This study assessed the effectiveness of a Participatory Educational (PE) intervention in improving menstrual Knowledge, Attitudes, and Practices (KAP) among nursing students. Methods: A quasi-experimental pre-test–post-test study was conducted among 384 female nursing and midwifery students in Rajshahi, Bangladesh, with 192 students each in the intervention and control groups. The four-week PE intervention, adapted from WaterAid’s Menstrual Hygiene Matters guide, covered menstrual physiology, hygiene practices, stigma reduction, and Water, Sanitation and Hygiene (WASH) management. The post-intervention evaluation was conducted six months after the intervention. Data were collected using a pre-tested structured questionnaire. Knowledge and practice indicators were analyzed using McNemar’s and chi-square tests, while attitude subscale scores were analyzed using paired and independent samples t-tests, with p < 0.05 considered statistically significant. Results: Baseline socio-demographic characteristics were broadly comparable between groups. At endline, the intervention group showed greater improvement than the control group in several knowledge indicators, including correct identification of average menstrual cycle length (78% vs. 34%, p < 0.001) and reproductive organs (65% vs. 28%, p < 0.001). Attitudes toward menstruation also improved, particularly in perceiving menstruation as a natural event (mean 5.9 vs. 5.1, p < 0.001) and for preparedness and predictability of menstruation (mean 6.0 vs. 4.8, p < 0.001); both were measured on a 1–7 scale. Several practices improved in the intervention group, including consistent use of disposable sanitary pads (88% vs. 58%, p < 0.001), changing menstrual materials at least three times daily (65% vs. 39%, p < 0.001), and handwashing before changing materials (76% vs. 55%, p < 0.001). Conclusion: A short PE intervention, improved selected MHH-related KAP among nursing and midwifery students. Given the single-site quasi-experimental design and the use of only one post-intervention evaluation at six months, the sustainability and trajectory of these changes over time remain uncertain. Multi-site studies with repeated follow-up assessments are needed to confirm these findings and assess their broader applicability to tertiary nursing and midwifery education.
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BibTeX
@article{zaman2026effectiveness,
title = {{Effectiveness of a participatory educational intervention on menstrual health and hygiene knowledge, attitudes, and practices among nursing and midwifery students in Bangladesh}},
author = {Md Nahid Uz Zaman and Akira Sai and Taro Yamauchi},
journal = {PLOS One},
year = {2026},
month = nov,
doi = {10.1371/journal.pone.0362603},
url = {https://doi.org/10.1371/journal.pone.0362603},
note = {CC BY},
}
RIS
TY - JOUR
TI - Effectiveness of a participatory educational intervention on menstrual health and hygiene knowledge, attitudes, and practices among nursing and midwifery students in Bangladesh
AU - Md Nahid Uz Zaman
AU - Akira Sai
AU - Taro Yamauchi
PY - 2026
DA - 2026/11/10
JO - PLOS One
DO - 10.1371/journal.pone.0362603
UR - https://doi.org/10.1371/journal.pone.0362603
AB - Background: Menstrual Health and Hygiene (MHH) is fundamental to women’s well-being but remains underprioritized in professional health education. In Bangladesh, nursing and midwifery students, future frontline health workers, rarely receive structured menstrual health curricula. This study assessed the effectiveness of a Participatory Educational (PE) intervention in improving menstrual Knowledge, Attitudes, and Practices (KAP) among nursing students. Methods: A quasi-experimental pre-test–post-test study was conducted among 384 female nursing and midwifery students in Rajshahi, Bangladesh, with 192 students each in the intervention and control groups. The four-week PE intervention, adapted from WaterAid’s Menstrual Hygiene Matters guide, covered menstrual physiology, hygiene practices, stigma reduction, and Water, Sanitation and Hygiene (WASH) management. The post-intervention evaluation was conducted six months after the intervention. Data were collected using a pre-tested structured questionnaire. Knowledge and practice indicators were analyzed using McNemar’s and chi-square tests, while attitude subscale scores were analyzed using paired and independent samples t-tests, with p < 0.05 considered statistically significant. Results: Baseline socio-demographic characteristics were broadly comparable between groups. At endline, the intervention group showed greater improvement than the control group in several knowledge indicators, including correct identification of average menstrual cycle length (78% vs. 34%, p < 0.001) and reproductive organs (65% vs. 28%, p < 0.001). Attitudes toward menstruation also improved, particularly in perceiving menstruation as a natural event (mean 5.9 vs. 5.1, p < 0.001) and for preparedness and predictability of menstruation (mean 6.0 vs. 4.8, p < 0.001); both were measured on a 1–7 scale. Several practices improved in the intervention group, including consistent use of disposable sanitary pads (88% vs. 58%, p < 0.001), changing menstrual materials at least three times daily (65% vs. 39%, p < 0.001), and handwashing before changing materials (76% vs. 55%, p < 0.001). Conclusion: A short PE intervention, improved selected MHH-related KAP among nursing and midwifery students. Given the single-site quasi-experimental design and the use of only one post-intervention evaluation at six months, the sustainability and trajectory of these changes over time remain uncertain. Multi-site studies with repeated follow-up assessments are needed to confirm these findings and assess their broader applicability to tertiary nursing and midwifery education.
SN - 1932-6203
ER -