Evaluation of the Effects of Planned Trainings Given to Obese Adolescent Girls on Healthy Lifestyle Behaviors and Menstrual Symptoms
Condition: Obesity, Adolescent; Menstrual Problem; Health Behavior
MeSH terms: Pediatric Obesity; Menstruation Disturbances
Study type: Observational

Summary: 
      The aim of this study is to evaluate the effects of training given to obese female students
      in mid-adolescence period for improving nutrition, physical activity, and menstrual symptoms
      on the improvement of their healthy lifestyle behaviors and menstrual symptoms. The research
      sample consisted of 128 obese female students divided into groups as intervention and
      control. In this randomized controlled trial, pretest-posttest control group and random
      process were used. In the first stage of the study, total of 12 hours of training, 120
      minutes for each course per week, was provided. In the second stage, 120 minutes of
      reinforcement training were given every month for three months. The study lasted 16 weeks
      totally. Personal Information Form, Healthy Lifestyle Behavior Scale II (HLBS-II), Menstrual
      Symptom Questionnaire (MSQ) and Student Follow-up Schedule were used as data collection
      tools. Statistical analysis was performed using SPSS Statistics 23 Version. Hypotheses were
      (i) there was a difference between the total HLBS-II and MSQ scores of the students before
      and after the training and (ii) there was a correlation between the scales.
    

Detailed description: 
      Method The research was carried out as a randomized controlled trial to identify menstrual
      symptoms and healthy lifestyle behaviors of obese adolescent girls and to determine the
      effects of planned trainings given to them for improving nutrition, physical activity, and
      menstrual symptoms on the improvement of their healthy lifestyle behaviors and menstrual
      symptoms.

      Research Hypotheses: H1: There is a difference between the mean scores of Healthy Lifestyle
      Behavior Scale II (HLBS-II) and H2: Menstrual Symptom Questionnaire (MSQ) before and after
      the trainings given to obese adolescent girls. H3: There is a correlation between the mean
      scores of HLBS-II and MSQ.

      Study population and data collection tools: The study was carried out in three state high
      schools providing full-time education in a district of Ankara on September 1, 2017-January
      21, 2018 and included 128 obese female students who accepted to participate voluntarily.
      These schools were chosen because the number of students was high and there were students
      from different socioeconomic levels. The study was approved by Yıldırım Beyazıt University
      Ethics Committee (decision numbered 12.04.2017/15 and coded 522). We obtained corporate
      permission from Ankara Provincial Directorate of National Education and informed consents of
      the students and their parents. Personal Information Form, HLBS-II, MSQ, and Student
      Follow-up Schedule, which were created by the researcher in accordance with the literature,
      were used as data collection tools.

      Personal Information Form was prepared by examining the literature on the relevant age group
      to examine the demographic, nutritional, physical activity, and menstrual characteristics of
      the participants.10,11,14,16-19,22,23 Student Follow-up Schedule was developed for the
      students to record their menstrual pain and symptoms, weight and body mass index (BMI)
      measurements during the specified periods.

      Menstrual Symptom Questionnaire was developed by Chesney and Tasto to assess menstrual pain
      and symptoms in 1975, and the usability of the questionnaire on adolescents was assessed by
      Negriff et al.24 and they updated the questionnaire in 2009. In 2013, Güvenç et al.24
      conducted the reliability and validity study. Following the adaptation process, the
      questionnaire was prepared as 5-point Likert type and to involve 22 items. The MSQ score is
      calculated by taking the average of the total scores of the items in the scale. The increase
      in the mean score indicates that the severity of menstrual symptoms increases. The Cronbach's
      Alpha value of the scale is 0.86. In our study, it was found to be 0.91 and 0.92 before and
      after the trainings, respectively.

      Healthy Lifestyle Behavior Scale II (HLSB-II): The scale was developed by Walker et al.25 in
      1987 and updated in 1996 and named as Healthy Lifestyle Behavior Scale II. Bahar et al.26
      studied the validity and reliability of its Turkish version in 2008. The 4-point Likert type
      scale consists of 52 items. Cronbach's Alpha value of the scale is 0.92. In our study, the
      Cronbach's Alpha value of the scale was found to be 0.91 and 0.92 before and after the
      trainings, respectively.

      Treatment and control groups: The study population covers all female high school students.
      Study sample: In accordance with BMI-for-Age Percentile for Girls (kg/m2) determined by WHO,2
      the study population was determined via two stages and consisted of volunteer female obese
      students aged 14 (BMI 26,7), 15 (BMI> 27,6) and 16 years (BMI> 28,2), who were currently at
      ninth, 10th and 11th grade in high school. In the first stage, BMIs, heights, and weights of
      1300 female students who participated in the study voluntarily were measured and the students
      who met the criteria were included in the study. In the second stage, students, who agreed to
      participate in training and monitoring, were determined and they were, then, randomly divided
      into two groups, namely intervention (n=63) and control (n=65) groups.

      The steps in the Implementation Phase are as follows: a) Sampling: measuring the BMIs,
      heights, and weights of 1300 female students, determining the sample group, and obtaining
      informed consent from them and their parents; b) Before the Training: applying Personal
      Information Form, HLBS-II, and MSQ to the intervention and control groups determined randomly
      and distributing the Student Follow-up Schedules; c) Providing trainings to the intervention
      group; d) Monitoring the weights, BMIs, and menstrual symptoms of intervention and control
      groups; and e) After the Training: Applying HLBS-II and MSQ scales to intervention and
      control groups, collecting the follow-up schedules, and providing training to the control
      group and all other students. Trainings: First stage: 120 minutes basic training per week for
      four weeks (40 minutes on diet, 40 minutes on physical activity, and 40 minutes on menstrual
      symptoms) . Second stage: Reinforcement trainings of 120 minutes were given once a month for
      three months. Periodic follow-up of intervention and control groups was carried out by
      recording their BMIs (Tanita BC 730 branded calibrated professional body analyzer was used to
      determine weight and BMI , which were measured three times in three periods) and menstrual
      symptoms ( participants were asked to mark Menstrual Pain and Symptoms in the first three
      days of menstruation in five periods) .

      Statistical Analysis: Data was analyzed by using SPSS Statistics for Windows, Version 23.0
      (IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp). Descriptive data was
      compared using Chi-Square and Mann-Whitney U tests, while Wilcoxon's and McNemar's tests were
      used to compare the menstruation findings of the students before and after the training.
      Dependent Samples t-Test was used in the intragroup comparison of total HLBS-II, MSQ, and
      sub-dimension scores. Comparison of differences between groups was performed by using the
      Independent Samples t-Test. Pearson's correlation analysis was used to determine the
      relationship between total HLBS-II and MSQ scores.
    

Intervention name(s): Health life style behaviour ,
Intervention type(s): Behavioral
Intervention description(s): Training: applying Personal Information Form, HLBS-II, and MSQ to the intervention and control groups determined randomly and distributing the Student Follow-up Schedules; c) Providing trainings to the intervention group; d) Monitoring the weights, BMIs, and menstrual symptoms of intervention and control groups; and e) After the Training: Applying HLBS-II and MSQ scales to intervention and control groups, collecting the follow-up schedules, and providing training to the control group and all other students. Trainings: First stage: 120 minutes basic training per week for four weeks (40 minutes on diet, 40 minutes on physical activity, and 40 minutes on menstrual symptoms)
Other intervention name(s): menstrual symptoms
Observational model: Other
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        : The study population covers all female high school students. Study sample: In accordance
        with BMI-for-Age Percentile for Girls (kg/m2) determined by WHO,2 the study population was
        determined via two stages and consisted of volunteer female obese students aged 14 (BMI
        26,7), 15 (BMI> 27,6) and 16 years (BMI> 28,2), who were currently at ninth, 10th and 11th
        grade in high school. In the first stage, BMIs, heights, and weights of 1300 female
        students who participated in the study voluntarily were measured and the students who met
        the criteria were included in the study.