Original Research The Effect of Health Education on Knowledge and Self-Care Among Arabic Schoolgirls With Primary Dysmenorrhea in Malaysia Latifa Yahya Al Ajeel, Mei Chan Chong, Li Yoong Tang, Li Ping Wong, Abdulaziz Mansoor Al Raimi Keywords: health education knowledge primary dysmenorrhea self-care abstract The purpose of this study was to evaluate the effect of health education on knowledge and self-care among Arabic schoolgirls with primary dysmenorrhea. A quasi-experimental intervention with a non-equivalent pre-test and post-test control group design. The KoPD and ADSCS questionnaires were used. A health edu- cation program regarding primary dysmenorrhea was provided after the pre-test for the experimental group. The post-test was conducted after two months for both groups. Results revealed a significant increase in the experimental group related knowledge and self-care. The study's indicated that the health education program in this study was useful to enhance schoolgirls' knowledge and self-care. © 2020 Elsevier Inc. All rights reserved. Primary dysmenorrhea (PD) is one of the common problems experienced by many adolescent girls, and it is defined as painful menstruation in the absence of pelvic pathology. PD characteristi- cally begins when adolescents attain ovulatory cycles, usually within 6 to 12 months of menarche. 1 The major symptoms asso- ciated with PD are menstrual pain, nausea, vomiting, loss of appetite, backaches, leg aches, weakness, diarrhea, headaches, depression, irritability, fatigue, and dizziness. 2 When the history of girls indicates PD, clinical therapy should be undertaken; medical treatments as well as traditional and natural treatments are alternative treatment choices for pain relief. These treatments include nonsteroidal anti-inflammatory drugs and hormonal contraceptives. 1 However, other studies have testified about the use of nonpharmacologic sources of pain relief, such as heat or sleep. 3 In a qualitative study involving female students in Egypt, Abdelhameed 4 reported the use of herbal medications, rest or relaxation, diet therapy, and home remedies in handling their dysmenorrhea. Globally, 50% to 91% of women of reproductive age suffer from PD. 5 Its prevalence increases through the adolescent years and decreases with increases in age and parity. 6 According to studies conducted in some Arabic countries, the prevalence of PD has been reported to be 55.8% in Jordan, 7 70.6% in Saudi Arabia, 7 72.4% in Yemen, 8 74.3% in Lebanon, 9 and 94.4% in Egypt. 10 Menstruation is widely seen as polluting and shameful in many countries, and it remains a taboo to discuss problems related to menstruation. Many do not have the means for self-care and do not get the support they need when they face problems, which hinders their ability to carry on with everyday activities and may also establish a foundation for lifelong disempowerment. 11 Many girls lack appropriate and adequate information regarding the physiological and pathologic origin of PD. Primary dysmenor- rhea may be poorly understood and has resulted in anxiety, fear, anger, confusion, shame, disgust, and even depression in girls during their first menstrual experience. 7, 12 Studies conducted in Arab countries also revealed that adoles- cents have a knowledge and self-care deficit regarding menstrua- tion and PD. This may be due to feelings of shame and reluctance to report dysmenorrhea; thus, they do not seek medical advice. 13-15 Moreover, cultural taboos add to the girls’ difficulties, prevent- ing them from seeking help and imposing restrictions on their diet and activities when menstruating. 16 Moawed 17 revealed that nearly two thirds of Saudi girls avoided certain foods, drinks, and activities and practiced several indigenous rituals during menstruation. On the other hand, it was found that mothers, religious books, and sisters were the main sources of information for the girls. Globally, PD is known to have a severe impact on health and social costs, and it causes not only physiological discomfort but also affects the overall quality of life and the ability to take part in daily activities. 18 Therefore, it is highly recommended that the school curriculum incorporates reproductive health education even at an early stage. This would prepare the girls for menstruation and offer the options available to them to acquire the necessary experience and knowl- edge to manage dysmenorrhea. 19-21 Hence, the development of educational programs is beneficial to the girls because it may improve their consciousness about issues associated with man- aging menstrual pain and enhance their social relations as well as their school performance. 13,21,22 To the researchers’ knowledge, there was no literature informing the implementation of health Contents lists available at ScienceDirect The Journal for Nurse Practitioners journal homepage: www.npjournal.org https://doi.org/10.1016/j.nurpra.2020.07.025 1555-4155/© 2020 Elsevier Inc. All rights reserved. The Journal for Nurse Practitioners xxx (xxxx) xxx