School-based Interventions of Menstrual Hygiene Management in Indonesia: Systematic Literature Review

School-based Interventions of Menstrual Hygiene Management in Indonesia: Systematic Literature Review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review School-based Interventions of Menstrual Hygiene Management in Indonesia: Systematic Literature Review Aldilia Wyasti Pratama, Erni Rosita Dewi, Kusmayra Ambarwati This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7238223/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Adolescence marks a critical phase in which menstrual hygiene management (MHM) significantly affects the health, education, and psychosocial development of girls. In Indonesia, poor MHM is prevalent due to limited knowledge, cultural taboos, inadequate school-based education, and insufficient Water, Sanitation and Hygiene (WASH) facilities. Although various school-based MHM interventions have been introduced, their designs and outcomes are heterogeneous, and a comprehensive synthesis of their effectiveness is lacking. Schools represent a strategic platform for implementing health education and promoting behavioural change. However, evidence specific to Indonesia, as this country has its cultural diversity, educational system, and national health policies, has not been systematically reviewed. This review aims to synthesise current evidence on school-based MHM interventions in Indonesia, focusing on their impact on adolescent girls’ knowledge, attitudes and behaviours related to menstruation. Methods This systematic review is registered with PROSPERO (ID: CRD420251082789) and follows the PRISMA 2020 reporting guidelines. A manual search was conducted across three Indonesian national journal databases: Garuda, Perpusnas, and ISJD, from June 15 to July 2, 2025. Eligible studies were peer-reviewed, full-text original articles in Bahasa Indonesia or English, published between 2019 and 2024, with quantitative experimental designs. Inclusion criteria focused on MHM interventions conducted in formal educational settings targeting girls aged 10–19. Studies not conducted in Indonesia, not school-based, or lacking an experimental design were excluded. Titles and abstracts were manually screened, followed by independent full-text review and quality appraisal by multiple reviewers to ensure the rigorous selection and minimise bias. Results Out of 687 initially identified articles from three Indonesian national databases, to include a total of 13 articles were included in this review. The educational level of participants in the included studies was junior high school (9), senior high school (2), and primary school (1), with an age range from 10 to 18 years old, and the total sample was 960 students. The studies were conducted in most areas of Java (10), and the other three were from Bengkulu, Maluku, and South Sulawesi, respectively. The interventions in the included studies were experimental designs, with 7 studies being pre-experimental and 6 being quasi-experimental. The significant improvement was found concerning knowledge, attitude and behaviour. Conclussions The review suggests the potential effectiveness of school-based interventions in improving knowledge, attitude and behaviour of adolescents regarding menstrual hygiene practice. However, a thorough evaluation of these studies revealed significant methodological limitations that must be acknowledged in interpreting these results. Future studies could explore the other effective interventions of MHM and use more rigorous instrument methods. Systematic review registration PROSPERO registration number: CRD420251082789 Menstrual Hygiene Management Menstrual health school-based interventions Health education Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Adolescence is a critical period of physical, psychological, and social transformation, marked notably by the onset of menstruation in females( 1 , 2 ). During this transitional phase, menstrual hygiene management (MHM) becomes a crucial determinant of adolescent girls’ reproductive health and overall well-being. Proper MHM entails access to sanitary products, adequate knowledge, clean and safe facilities, and supportive social environments. However, in many low- and middle-income countries, these conditions are often unmet due to socio-cultural taboos, misinformation, limited health education, and inadequate water, sanitation, and hygiene (WASH) infrastructure( 3 – 5 ). Indonesia, the world’s fourth most populous country, is home to over 25 million adolescent girls( 6 ). Despite national policy efforts to support adolescent reproductive health, evidence shows that many young Indonesian girls lack basic knowledge and appropriate practices related to menstrual hygiene( 7 , 8 ). Poor MHM has been associated with increased risk of reproductive tract infections (RTIs), school absenteeism, psychological distress, and long-term health consequences( 7 ). According to the Indonesian Ministry of Health (Kemenkes RI, 2018), millions of girls report discomfort, itching, and reproductive tract complications directly linked to improper menstrual hygiene. In response to these challenges, various health education interventions have been introduced in Indonesia, aiming to improve adolescent girls’ awareness, attitudes, and behaviours regarding menstrual hygiene( 6 ). These interventions utilise diverse delivery methods including lectures, printed materials (leaflets, booklets), audiovisual content, and participatory learning such as small group discussions or peer-led sessions( 9 ). While individual studies have reported encouraging outcomes, the intervention models, target populations, and evaluation designs vary widely, making it difficult to derive generalizable lessons for policy and programming. This systematic review focuses specifically on menstrual hygiene education interventions delivered within formal educational institutions, such as schools. Schools are not only one of the most consistent and equitable entry points for reaching large populations of adolescents, but also serve as structured environments for behaviour change, life-skills development, and psychosocial support( 10 , 11 ). According to the Ministry of Education and Culture (Kemendikbud, 2022), Indonesia has over 150,000 primary and secondary schools and more than 27,000 madrasahs under the Ministry of Religious Affairs, providing an expansive platform for health education delivery across diverse regions and populations. Furthermore, the Government of Indonesia has established several policies and guidelines to support adolescent reproductive health in school settings. These include the Guidelines for the Implementation of School Health Units (UKS), the Permenkes No. 25 Year 2014 on Maternal and Child Health, and the National Strategy on Adolescent Health (2017–2030)( 12 ). These policies emphasize the integration of reproductive health, including menstrual hygiene into the school health curriculum, and encourage intersectoral collaboration among schools, health centers, and families. However, implementation remains inconsistent due to lack of capacity, limited teacher training, and insufficient monitoring and evaluation( 6 , 13 ). Despite the increase in intervention studies over the past decade, no published systematic review has comprehensively synthesized evidence from educational settings in Indonesia regarding menstrual hygiene interventions for adolescent girls. Most global reviews tend to generalise findings across countries and settings, often overlooking the socio-cultural complexities and infrastructural disparities specific to Indonesia. This creates a significant knowledge gap, especially in understanding which educational strategies are most context-appropriate and scalable within the national school system. This review aims to critically examine school-based intervention studies focused on improving menstrual hygiene among Indonesian adolescents. By consolidating current evidence and identifying methodological trends, this study will inform the design of more targeted, equitable, and sustainable MHM programs in schools. Moreover, its findings will serve as a valuable reference for policymakers, educators, and researchers in other low- and middle-income countries seeking to strengthen adolescent reproductive health through the education sector. Methods The review has been registered with the International Prospective Register of Systematic Reviews in 2025 (PROSPERO ID :CRD420251082789). Our reporting conforms to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) ( 14 ) Search strategy A systematic search was conducted from June 15 to July 2, 2025, using Indonesia's national databases: Garuda, Perpustakaan National Republik Indonesia (PERPUSNAS), and the Indonesian Scientific Journal Database (ISJD). The mentioned databases were chosen due to their legitimate reputation and indexing by Science and Technology Index (SIINTA), a national indexing system administered by the Indonesian Ministry of Research and Technology that classifies journals based on quality and citation performance with comprehensive coverage of science and technology literature. The search was peer reviewed and explored literature from 2019 to 2024. All the databases mentioned are not equipped with an advanced search feature for using the Boolean strategy. Instead, researchers use a manual search strategy that includes each keyword: “menstrual hygiene,” “menstrual health,” “ manajemen kebersihan menstruasi ,” and “ kebersihan menstruasi .” The search was conducted in Bahasa and English to draw articles written in those languages. As all the identified records could not be downloaded or imported into the BibTeX version, the author read the titles and abstracts of studies to manually exclude irrelevant findings and then remove the duplicates. After that, to minimise bias, all the authors independently screened the studies based on the inclusion and exclusion criteria. The irrelevant and duplicate articles were rechecked and removed, while the relevant studies with full text were further screened for the quality appraisal. Inclusion and exclusion criteria The full texts of all refined studies were selected if they were experimental design studies conducted in formal educational institutions or schools with interventions related to menstrual hygiene management in Indonesia. The target of the studies was students aged 10–19 years old. A peer-reviewed and original article with full text published in Bahasa Indonesia or English between 2019 and 2024. However, the studies were excluded if they were not conducted in Indonesia, were not based on formal educational institution interventions, were not experimental design studies, or involved adolescents who did not attend school. Data extraction and synthesis Data from each included article was extracted into a table that included the study title, authors, year of publication, study aim(s), place, the participants’ characteristics (number, age, and educational level), method (design, study, data collection, and data analysis), results, and theoretical framework. The tabulated data were analysed to explore the study design, intervention types, data analysis, outcome of the study, and limitations. The interventions of menstrual hygiene practice include providing access to menstrual hygiene products, improving and maintaining sanitation/hygiene facilities, and health education ( 15 ). The outcomes of the experiment measured improvements in either knowledge or attitude using standardised instruments and assessments with reliable and appropriate statistical analysis. Quality assessment All authors looked at the quality of the studies on their own using the JBI Systematic Reviews for experimental study, which includes nine assessment points: whether the effect is caused, how similar the participants are in the comparison groups, the treatments given to each group, the presence of a control group, the chance of measuring multiple exposures and follow-ups, how the outcomes are measured, and the statistical methods used. Each element was independently rated as yes, no, unclear, or not applicable ( 16 ). An overall quality assessment for each study was rated as including, excluding, or seeking further information. Studies that indicated a “yes” for causality, demonstrated similarity among the groups, and provided precise statistical measurements and analysis for the outcomes were included and considered for systematic review and meta-analysis. To ensure consistency, the authors cross-check the quality of the included studies. Any disagreements among the authors were discussed until a consensus was achieved. Results Study Selection As illustrated in Fig. 1 , a total of 687 studies were retrieved from Indonesia’s national databases, Garuda (n = 549), Perpusnas (n = 79), and ISJD (n = 59). The titles, abstracts, and full texts of the studies were screened. There were 604 articles with irrelevant titles and abstracts excluded, 13 duplicate articles, 5 articles not specifically related to menstrual hygiene, 8 articles not conducted in schools or formal educational institutions, and 4 articles not targeting adolescence that were also removed. There were 53 studies assessed for the quality appraisal, and 13 of them were selected to be included. Quality appraisal All the included studies conformed to the JBI systematic review’s criteria for experimental studies in terms of causability, group background similarity, precise measurements, and reliable statistical analysis. There were two types of experimental studies identified: pre-experimental and quasi-experimental. Pre-experimental design relies on no random assignment; the control group is usually absent, and only one group is observed for the intervention, while the quasi-experimental design provides multiple groups for comparison. The included studies were assessed according to the principles of the identified design ( 17 )( 18 ). The details of the critical appraisal of the included studies are shown in Table 1 . Table 1 Quality appraisal of included studies based on the Joanna Briggs Institute (JBI) critical appraisal tools in Indonesia, 2025 Author / Reference Q1 Q2 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Total Rahmawati, Andin Ajeng & Hariastuti ( 19 ) Yes No No No Yes No No Yes Yes Yes:4 No:5 Hasanah, April ZR; Hartini, Lela & Efriani, Rolita ( 20 ) Yes Yes No Yes No No Yes Yes Yes Yes:6; No:3 Hartoyo & Susanto ( 21 ) Yes No No No Yes No No Yes Yes Yes: 4; No:5 Pramesti, Hasna Dian; Suherni; Djanah, Nur ( 22 ) Yes Yes No No Yes Yes Yes Yes Yes Yes:7, No2 Putri, Heldalia Faiza; Sulistiani, Ardiani, Wijayanti, Titik ( 23 ) Yes No No No Yes No No Yes Yes Yes:4 No:5 Mustikarani, Innez Karunia; Wulandari, Yunita & Widiaswati, Yunita( 24 ) Yes No No No Yes No No Yes Yes Yes:4 No:5 Jubaedah, Entin; Yuhandini, Diyah Sri & Sriyatin ( 25 ) Yes Yes No Yes No No Yes Yes Yes Yes:6; No:3 Latifah & Linggardini ( 26 ) Yes Not Applicable Not Applicable No No No Yes Yes Yes Yes:4, Not Applicable:2, No:3 Dolang & Kiriwenno ( 27 ) Yes Yes Yes No Yes Not Applicable Not Applicable Yes Yes Yes:6;Not Applicable:2, No;1 Rizki hasanah, a., hartini, l., & efriani ( 28 ) Yes Unclear No Yes No No Yes Yes Yes Yes:5, Unclear:1; No;3 Salsabilah et al ( 29 ) Yes Yes Yes No Yes Not Applicable Yes Yes Yes Yes:7; Not Applicable:1; No:1 Kas & Darlis ( 30 ) Yes Yes No Yes Yes Yes Yes Yes Yes Yes: 8; No:1 Nisman et al ( 31 ) Yes Yes Yes Yes Yes Unclear Yes Yes Yes Yes:8; Unclear:1 Study characteristics The final systematic review included thirteen experimental studies, seven pre-experimental ( 27 )( 21 )( 26 )( 24 )( 23 )( 19 )( 29 ), and six quasi-experimental ( 25 )( 20 )( 30 )( 31 ) ( 22 ) ( 20 ), totalling 960 participants. The studies were published between 2019 and 2024 in different regions of Indonesia. Ten of the studies were conducted in Sekolah Menengah Pertama (SMP) , or junior high school, while two studies were conducted at the senior high level and one study at the primary level. The details of participants' characteristics of these included studies are displayed in Table 2 . Participant characteristics and settings As the Fig. 2 presented, from13 studies included, the majority of studies ( 3 ) were conducted in Central Java, followed by ( 2 ) studies each in Yogyakarta, Banten, and East Java. There was also one study each in West Java, Central Maluku, and South Sulawesi. Based on the geographical perspective, the locations represent the regions of Indonesia, from West to East Indonesia, there are studies that have been conducted. Table 2 Summary Characteristics of studies included in the systematic review of school-based interventions of MHM in Indonesia, 2025 Authors Year Place Variable Assesment Study Design Intervention tools Sample Participant Characteristic Age Level Of Educa-tion Menarche Age Parents' Educa-tion Parents Occupa-tion Informa-tion Sources Dolang & Kiriwenno ( 27 ) 2019 Masohi, Maluku Knowladge, Attitude and Practice Pre-Experiment Not Provided 35 13–15 y Junior high school Not Provided Provided Provided Not Provided Jubaedah, Entin; Yuhandini, Diyah Sri & Sriyatin ( 25 ) 2019 Cirebon, Jawa Barat Knowladge Quasi-Experiment Video& Leaflets 63 11–13 y Junior high school Provided Provided Not Provided Provided Hartoyo & Susanto ( 21 ) 2021 Banten, Jawa Barat Knowladge, behavior Pre-Experiment Leaflets 104 10–15 y junior high school Not Provided Not Provided Not Provided Provided Hasanah,April ZR; Hartini,Lela & Efriani, Rolita ( 20 ) 2024 Bengkulu Knowladge Quasi-Experiment leaflets & PPT Slides 48 11–16 y Junior high school Provided Provided Not Provided Not Provided Kas & Darlis ( 30 ) 2024 Sopeng, Sulawesi Selatan Attitude Quasi-Experiment Audio Visual Media; PPT Slides 60 12–16 y Senior high school Not Provided Provided Not Provided Not Provided Latifah & Linggardini ( 26 ) 2023 Banyumas, Jawa tengah Knowladge Pre-Experiment Domino card 63 10–13 y Elementary school Provided Not Provided Not Provided Not Provided Mustikarani, Innez Karunia; Wulandari, Yunita & Widiaswati, Yunita ( 24 ) 2021 Surakarta, Jawa Tengah Perception Pre-Experiment Magis Booklet 43 12–14 y Junior high school Provided Not Provided Not Provided Not Provided Nisman et al ( 31 ) 2019 Yogyakarta Knowladge & Practice Quasi-Experiment Booklet 194 12–16 y Junior high school Provided Not Provided Not Provided Provided Pramesti, Hasna Dian; Suherni; Djanah, Nur ( 22 ) 2020 Bantul, Yogyakarta Knowladge Quasi-Experiment Booklet & Leaflets 70 12–13 y Junior high school Not Provided Provided Not Provided Provided Putri, Heldalia Faiza; Sulistiani, Ardiani, Wijayanti, Titik ( 23 ) 2024 Boyolali, Jawa Tengah Knowladge Pre-Experiment Leaflets 83 13–15 y Junior high school Not Provided Provided Provided Not Provided Andin Ajeng Rahmawati & Hariastuti ( 19 ) 2024 Bojonegoro, Jawa Timur Knowladge &Atitude Pre-Experiment Small Group Disscusion 112 12–13 y Junior high school Not Provided Not Provided Not Provided Provided Rizki hasanah, a., hartini, l., & efriani ( 28 ) 2024 Banten Knowladge &Atitude Quasi-Experiment Media Hygenic 38 10–13 y Elementary school Not Provided Provided Provided Not Provided Salsabilah et al ( 28 ) 2024 Surabaya Knowladge, Attitude and Practice Pre-Experiment Web Site 50 16–18 y Senior high school Not Provided Not Provided Not Provided Not Provided Intervention components The details of the intervention components of the included studies are demonstrated in Table 2 , and the distribution of the intervention tools is shown in Fig. 3 . All the included articles provided health education on menstrual hygiene aimed at adolescents in school, but none specified a duration for the intervention. These interventions used various delivery methods, including printed materials (leaflets and booklets), audiovisual content, group discussion and games ( 19 ) ( 20 ) ( 21 ) ( 22 ) ( 23 ) ( 24 ) ( 25 ) ( 26 ) ( 27 ) ( 28 ) ( 29 ) ( 30 )( 31 ). The above graphic presents the distribution of media intervention. Leaflets were the most media used medium (33%), followed by booklets and video media for 20%, respectively. The PowerPoint presentation, website, discussion and domino card accounted for 7%. Intervention outcomes The outcomes of the interventions were demonstrated a change in knowledge, attitude, or behaviour related to menstrual hygiene among adolescents. As it can be seen from Table 3 , all studies reported the improvements in knowledge, while six studies reported on attitudes and one on behaviour, with all demonstrating a p-value of 0.000. Table 3 Intervention components and outcome of included studies in Indonesia, 2025 No Reference Intervention Components Main Findings 1 Jubaedah, Entin; Yuhandini, Diyah Sri & Sriyatin (2020) ( 25 ) Education : Health education on menstrual personal hygiene through video and leaflet delivered in 15-minute sessions. Knowledge : Significant increase in knowledge post-intervention in both groups (video: pre 80.19 → post 93.85; leaflet: pre 81.92 → post 90.58). Comparison : Video more effective than leaflet (mean rank: 13.65 vs 8.65; p = 0.021). 2 Latifah & Linggardini (2023) ( 26 ) Education : Health education using a Domino Card game to teach menstrual hygiene. Delivered in a pre-post one group design in elementary school children. Knowledge : Significant increase in knowledge from 54.70 to 91.29. Wilcoxon test : p < 0.005. 3 Rizki hasanah, a., hartini, l., & efriani (2024) ( 28 ) Education : Health education using Hygenic media (visual/interactive tools). Knowledge : Increased from 28.9–84.2% with good knowledge (p = 0.000). Attitude : Positive attitude increased from 47.4–86.8% (p = 0.000). Between-group difference : Knowledge (p = 0.017), Attitude (p = 0.027). 4 Hasanah,April ZR; Hartini,Lela & Efriani, Rolita (2024) ( 20 ) Education : Health education on genital hygiene using leaflet and PowerPoint. Quasi-experimental design with control group. Knowledge : Leaflet group increased from 5.00 to 9.00; PowerPoint group from 4.67 to 7.71. Attitude : Leaflet more effective (p = 0.013). 5 Hartoyo & Susanto (2021) ( 21 ) Education : Health education through leaflet on menstrual external genital hygiene. Delivered via pre-post format using one group pretest-posttest design. Knowledge : Good knowledge increased from 51.9–78.8%. Behavior : Good hygiene behavior increased from 67.3–88.5%. Wilcoxon test : Significant (p < 0.001). 6 Putri, Heldalia Faiza; Sulistiani, Ardiani, Wijayanti, Titik (2024) ( 23 ) Education : Health education using leaflet on menstrual personal hygiene. One-group pre-post design. Knowledge : Good knowledge increased from 10.8–86.7%. Wilcoxon test : p = 0.000. 7 Mustikarani et al. (2021) ( 24 ) Education : Health education using MAGIS (Menstrual Hygine Sehat) booklet to improve menstrual hygiene perception. One-group pre-post design. Perception : Good perception increased from 48.8–97.7%. Wilcoxon test : p = 0.000. 8 Rahmawati (2024) ( 19 ) Education : Provided health education using Small Group Discussion (SGD) method. Discussions were designed to actively engage students, increase participation, and encourage questions. Knowledge : Significant improvement — majority shifted from "poor" to "adequate" knowledge (66.1%). Attitude : Significant increase — positive attitudes rose from 60.7–84.8%. Wilcoxon test : p = 0.000. 9 Nisman et al. (2019) ( 31 ) Education : Booklet-based health education provided in boarding schools in rural and urban areas. Design: Quasi-experimental (pre-test and post-test). Knowledge : Significant increase in both rural ( p = 0.000) and urban ( p = 0.000) schools. Practice : Rural group improved significantly ( p = 0.000), urban group had a slight decrease ( p = 0.082). Difference: Urban students showed higher overall mean scores. 10 Dolang & Kiriwenno (2019) ( 27 ) Education : Health education through lectures, booklets, and leaflets for students. One-group pre-post test design. Improvements : Knowledge (20.03 → 24.86), Attitude (54.57 → 60.00), Practice (4.63 → 5.77). p = 0.000 for all. 11 Pramesti et al. (2019) ( 22 ) Education : Compared booklet vs. leaflet media for menstrual hygiene education. Design: Quasi-experimental with control group.T ools: Pre- and post-questionnaires. Knowledge : Both groups improved significantly ( p = 0.000). Effectiveness : Booklet group had a greater mean improvement (14.09) compared to leaflet group (7.83). Statistical comparison: p = 0.000 (independent t-test). 12 Salsabilah et al. (2024)( 29 ) Education : Website-based educational program. Delivered digitally to adolescent girls. Knowledge : 18% → 90% “Good”; Attitude : 2% → 88% “Positive”; Practice : 12% → 90% “Very Supportive”. All p = 0.000. 13 Kas & Darlis (2024) ( 30 ) Education : One-time counseling using audiovisual and PowerPoint slide media in schools and Islamic boarding schools. Design: Non-randomized pre-test and post-test with control group. Attitude : Significant improvement in both intervention ( mean : 5.83 → 8.67) and control groups ( mean : 6.50 → 9.67 ). Audiovisual education is effective in improving menstrual hygiene attitudes. Wilcoxon test : p = 0.000. Meta Analysis Meta-analysis was performed to identify findings from multiple independent studies to produce a single, more robust estimate of an effect or relationship ( 32 ). In this review, we conducted a forest plot for meta-analysis as shown in Fig. 4 . Four studies can be analysed, involving 191 subjects. Based on the analysis performed using a random effects model with the inverse variance method, the summarised raw means (MRAW) are 51.41 with a 95% confidence interval of 17.02–85.80. A significant heterogeneity was detected (p < 0.01), suggesting inconsistent effects in magnitude and/or direction. The I2 value indicates that 100% of the variability among studies arises from heterogeneity rather than random chance. The funnel plot shows asymmetry (Fig. 5 ), suggesting the possibility of publication bias. Large effects seem to appear more frequently in smaller studies (which are more prone to bias). The study by Mustikarani, Innez Karunia, Wulandari, Yunita & Widiaswati, and Widiaswati in 2021, with a very small standard error but a mean close to zero, appears striking and may significantly affect the overall results. Discussion This systematic review aimed to explore school-based interventions that improve either knowledge or behaviour change among students regarding menstrual health practices. Menstrual hygiene significantly affects females' reproductive health, which is also associated with the well-being of adolescents. Providing good healthcare facilities and proper sanitary/hygiene infrastructure at schools not only improves the academic performance of schoolgirls but also aligns with Indonesia's government commitment and Sustainable Development Goals (SDGs) target, particularly those related to health, gender equality, and quality education ( 33 ) ( 34 ). Indonesia's Ministry of Education has launched the three pillars of health, named Unit Kesehatan Sekolah , which is responsible for ensuring the WASH facilities and providing information on menstrual health ( 35 ). Further, menstrual health has been acknowledged as a global commitment to supporting gender equity and human rights ( 36 ). To the best of our knowledge, no systematic review or meta-analysis has explored school-based interventions for menstrual hygiene among adolescents in Indonesia. Therefore, this study will help policymakers, programmers, planners and researchers, particularly in academic institutions, to design appropriate strategies. In this study, the interventions employed in an academic setting is health education with various delivery methods; presentations, audiovisual, printed materials, games and discussion, aiming to knowledge, attitude and behavioural improvement of menstrual hygiene practice ( 19 ) ( 20 ) ( 21 ) ( 22 ) ( 23 ) ( 24 ) ( 25 ) ( 26 ) ( 27 ) ( 29 ) ( 30 )( 31 ). This aligns with studies in Nepal and Uganda, which highlight the health education intervention in promoting menstrual hygiene knowledge and changing the behaviour of adolescents ( 37 )( 38 ). The school settings were junior high school ( 10 ), while only two were senior high school, and one was an elementary school. The majority of schoolgirls experience their first menstruation ( menarche ) between the ages of 10–16 years old, when they are in junior high school. This was the crucial phase for the girls to have a comprehensive understanding of menstrual health and hygiene, and therefore, the interventions conducted at formal education institutions play a pivotal role in improving the aimed outcomes ( 39 ) ( 40 ). Despite the interventions appearing effective at raising knowledge, and many reported favourable attitude or behaviour changes, improvements in actual behaviour (e.g. frequency of pad changing, toileting practices) were unclear in measurements. Most studies used author-designed questionnaires with unclear validation, relying on self-reports. The sample sizes were generally small it as found in studies conducted by Rindani et al. (2024) and Hasanah et al. (2024 ( 20 )( 28 ). There was an argument that a minimum sample size of 30 respondents would be sufficient to assess the reliability of the questionnaire for an experimental design study, while another argued that the size determination should be based on power analysis that considers the research question, expected effect size, desired significance level and acceptable margin of error ( 41 ) ( 42 ). This review has the following limitations. The studies included used an experimental design, which includes both quasi-experimental and pre-experimental designs. Despite the similar principle for investigating cause-and-effect between variables with the lack of randomness, they still differ in their complexity and the control and intervention groups ( 17 )( 18 ). The quality assessment and tools of the method should be different. However, as it was only limited findings on this issue, we decided to use this kind of experimental design in the review. Moreover, Indonesia's national databases were found lacking in an advanced search feature, which enables researchers to input keywords manually rather than using a Boolean strategy. We highly recommend that the stakeholders improve the Database Management Systems (DBMS) to reduce the omission of relevant studies. The keywords we used might not find all the articles related to MHM interventions at school. Despite the limitations, we performed a comprehensive search of studies and grey literature to include all relevant studies. Conclusions The Indonesian school-based interventions reviewed generally succeeded in improving girls’ menstrual knowledge and often showed promising shifts in attitudes and reported hygiene practices. The diversity of methods (media, peer education, printed materials) suggests multiple feasible strategies, but the evidence is limited by study design and measurement issues. Key limitations include non-validated assessment tools. Future research should employ more rigorous designs and validated outcome measures. Programs must also expand to other school-based interventions and involve schoolboys, teachers and other school members. Aligning with national and global priorities (SDGs, WHO / WASH-in-schools targets), sustainable MHM programs in Indonesia will require coupling education with infrastructure upgrades (private toilets, water and disposal bins) as well as robust monitoring. By addressing these gaps, stakeholders can build on the strong knowledge gains seen in these trials to achieve lasting improvements in girls’ menstrual health and school participation. Abbreviations PROSPERO International Prospective Register of Systematic Reviews MHM Menstrual hygiene management PRISMA The Preferred Reporting Items for Systematic review and Meta-analysis SDGs Sustainable Development Goals WHO World Health Organisation Declarations Ethical approval and consent to participate Not applicable. Competing Interest The authors declare that they have no competing interests. Funding Declaration Not Applicable Availability of data and materials All data supporting the findings of this study are available within the manuscript. No additional datasets or supplementary materials were generated or analysed. References (WHO) WHO (2014) Adolescent Health. WHO, Geneva (UNFPA) UNPF (2014) Menstrual Hygiene Management: Operational Guidelines. UNFPA Asia-Pacific Regional Office Joshi D, Buit G, González-Botero D (2015) Menstrual hygiene management: education and empowerment for girls? Waterlines 34(1):51–67 Upashe SP, Tekelab T, Mekonnen J (2015) Assessment of knowledge and practice of menstrual hygiene among high school girls in Western Ethiopia. BMC women’s health 15(1):84 Yalew M et al (2021) Menstrual hygiene practice among female adolescents and its association with knowledge in Ethiopia: A systematic review and meta-analysis. 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Available from: https://methods.sagepub.com/ency/edvol/encyc-of-research-design/chpt/preexperimental-designs Rahmawati AA, Hariastuti FP, SMALL GROUP DISCUSSION SEBAGAI UPAYA PENINGKATAN PENGETAHUAN DAN SIKAP REMAJA TENTANG MENSTRUAL HYGIENE DI SMP, PLUS AL FATIMAH BOJONEGORO (2024) Small Group Discussion as an Effort to Increase Knowledge and Behaviour in Teenagers About Menstrual Hygiene at Al Fatimah Junior High School Bojonegoro. Jurnal Ilmiah Keperawatan (Scientific J Nursing) 10(3):614–618 Hasanah AYR, Hartini L, Efriani R, PENGARUH MEDIA EDUKASI TERHADAP PENGETAHUAN DAN, SIKAP REMAJA PUTRI TENTANG HYGIENE GENITALIA SAAT MENSTRUASI DI SMP NEGERI 2 KOTA BENGKULU (2024) J Nurs Public Health 12(1):61–71 Hartoyo ED, Susanto BNA, PENGARUH MEDIA LEAFLET TENTANG PERSONAL HYGIENE, GENITALIA PADA SAAT MENSTRUASI TERHADAP PENGETAHUAN DAN PERILAKU REMAJA (2021) Jurnal Ilmu Kesehatan Masyarakat 17(1):46–51 Pramesti HD, Suherni S, Djanah N (2019) Effectiveness menstrual hygiene knowledge using booklet and leaflet media for adolescent girl: (Studied in An-Nur Islamic Boarding School, Bantul). Jurnal Kesehatan Ibu dan Anak 13(1):61–68 Putri HF, Sulistiani A, Wijayanti T, PDF) PENGARUH PENDIDIKAN KESEHATAN MELALUI MEDIA LEAFLET TERHADAP PENGETAHUAN PERSONAL HYGIENE MASA MENSTRUASI PADA REMAJA PUTRI DI SMP N 3 MOJOSONGO BOYOLALI (2025) (. ResearchGate [Internet]. Jan 26 [cited 2025 Jul 22]; Available from: https://www.researchgate.net/publication/388328127 _PENGARUH_PENDIDIKAN_KESEHATAN_MELALUI_MEDIA_LEAFLET _TERHADAP_PENGETAHUAN_PERSONAL_HYGIENE_MASA_MENSTRUASI_PADA_ REMAJA_PUTRI_DI_SMP_N_3_MOJOSONGO_BOYOLALI Mustikarani IK, Wulandari Y, Widiaswati A (2021) Health Education Using MAGIS Booklet to Increasing Menstrual Hygiene Perception of Teenage Girls. Jurnal Kebidanan dan Kesehatan Tradisional. ;53–58 Jubaedah E, Yuhandini DS, Sriyatin -, PENDIDIKAN KESEHATAN MELALUI MEDIA VIDEO DAN LEAFLET TERHADAP PENGETAHUAN PERSONAL HYGIENE MENSTRUASI REMAJA PUTRI KELAS VII TAHUN 2019, Pharmacist Analyst, Nurse, Nutrition, Midwivery, Environment, Dentist). [cited 2025 Jul 22]; Available from: https://ojs.poltekkes-medan.ac.id/pannmed/article/view/645 Latifah LS, Linggardini K (2023) Pengaruh permainan edukatif domino card terhadap pengetahuan anak usia sekolah dasar tentang manajemen kebersihan diri saat menstruasi. J Nurs Pract Educ 4(1):50–57 Dolang MW, Kiriwenno E (2020) Pengaruh Pendidikan Kesehatan Tentang Higiene Menstruasi Terhadap Pengetahuan Remaja Putri. Biosel Biology Sci Educ 9(1):101–108 Rindiani P, Marsiwi AR, Kurniawan R, PENGARUH EDUKASI MEDIA, HYGENIC TERHADAP PENGETAHUAN DAN SIKAP TENTANG PERSONAL HYGIENE GENITALIA SELAMA MENSTRUASI PADA SISWI SEKOLAH DASAR (2024). ;5(1) Salsabilah PN, Wulan DW, Pratami E, Latip A (2024) The Influence of Website-based Education on Adolescent Girls’ Behavior Regarding Personal Hygiene During Menstruation. J Midwifery Jurusan Kebidanan Politeknik Kesehatan Gorontalo 10(2):228–239 Kas SR, Darlis I (2024) Pengaruh Penyuluhan terhadap Perilaku Higiene Menstruasi pada Remaja Pondok Pesantren Yasrib dan SMA Negeri 1 Kabupaten Soppeng. Jurnal Keolahragaan JUARA 4(1):119–126 Nisman WA, Mutiawati DF, Nugraheni M, Milasari I The Influence of Health Education Through Booklet on Knowledge and Practice of Menstrual Hygiene. Jurnal Keperawatan Soedirman [Internet]. 2019 Jul 10 [cited 2025 Jul 22];14(2). Available from: https://jks.fikes.unsoed.ac.id/index.php/jks/article/view/844 Whittemore R, Chao A, Jang M, Minges KE, Park C (2014) Methods for knowledge synthesis: An overview. Heart Lung 43(5):453–461 Sharma MK, Adhikari R, Khanal SP, Acharya D, van Teijlingen E (2024) Do school Water, Sanitation, and Hygiene facilities affect students’ health status, attendance, and educational achievements? A qualitative study in Nepal. Health Sci Rep 7(8):e2293 THE 17 GOALS | Sustainable Development [Internet]. [cited 2025 Jul 23]. Available from: https://sdgs.un.org/goals Database Peraturan | JDIH BPK [Internet] [cited 2025 Jul 18]. Permenkes No. 25 Tahun 2014. Available from: http://peraturan.bpk.go.id/Details/117562/permenkes-no-25-tahun-2014 WHO statement on menstrual health and rights [Internet]. [cited 2025 Jul 23]. Available from: https://www.who.int/news/item/22-06-2022-who-statement-on-menstrual-health-and-rights Ghimire S, Gahatraj NR, Shrestha N, Manandhar S, Dhital SR (2024) Effects of health education intervention on menstrual hygiene knowledge and practices among the adolescent girls of Pokhara Metropolitan, Nepal. PLoS ONE 19(9):e0291884 Yang YT, Chen DR (2023) Effectiveness of a menstrual health education program on psychological well-being and behavioral change among adolescent girls in rural Uganda. J Public Health Afr 14(3):1971 Lacroix AE, Gondal H, Shumway KR, Langaker MD Physiology, Menarche. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 [cited 2025 Jul 23]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK470216/ Deshpande TN, Patil SS, Gharai SB, Patil SR, Durgawale PM (2018) Menstrual hygiene among adolescent girls – A study from urban slum area. J Family Med Prim Care 7(6):1439–1445 Indrayan A, Mishra A (2021) The importance of small samples in medical research. J Postgrad Med 67(4):219–223 Bujang MA, Omar ED, Foo DHP, Hon YK (2024) Sample size determination for conducting a pilot study to assess reliability of a questionnaire. Restor Dent Endod 49(1):e3 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7238223","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":492292297,"identity":"f0ae7887-84f6-450d-acb8-eec142c78bd3","order_by":0,"name":"Aldilia Wyasti 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02:50:48","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-7238223/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7238223/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87901472,"identity":"e3b175c9-b62c-45e0-ba25-d1e9e00159e1","added_by":"auto","created_at":"2025-07-30 08:18:45","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":122070,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of the study selection for systematic review of school-based intreventions of menstrual hygiene management in Indonesia, 2025\u003c/p\u003e","description":"","filename":"image1.png","url":"https://assets-eu.researchsquare.com/files/rs-7238223/v1/1f37f03347e5f3c4a17eef3a.png"},{"id":87901477,"identity":"3dcd1028-673b-4eb6-ac97-d6235832f1b8","added_by":"auto","created_at":"2025-07-30 08:18:46","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":77080,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of included studies research sites in Indonesia, 2025\u003c/p\u003e","description":"","filename":"image2.png","url":"https://assets-eu.researchsquare.com/files/rs-7238223/v1/90629a4f01dba8f0fc687418.png"},{"id":87902977,"identity":"fe5c351a-1254-438c-ad65-389de51bb634","added_by":"auto","created_at":"2025-07-30 08:26:46","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":75374,"visible":true,"origin":"","legend":"\u003cp\u003eThe distribution of intervention delivery methods of the included studies in Indonesia, 2025\u003c/p\u003e","description":"","filename":"image3.png","url":"https://assets-eu.researchsquare.com/files/rs-7238223/v1/c1abcffb50d15a1449fd4fa8.png"},{"id":87901476,"identity":"64b4c8d6-53b8-4e89-a7d3-bac1e1316aa5","added_by":"auto","created_at":"2025-07-30 08:18:46","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":109564,"visible":true,"origin":"","legend":"\u003cp\u003eThe forest plot of the included studies' results in Indonesia, 2025\u003c/p\u003e","description":"","filename":"image4.png","url":"https://assets-eu.researchsquare.com/files/rs-7238223/v1/5a517d2e71c57670924353ec.png"},{"id":87901479,"identity":"3e7cacc7-920e-4360-a72e-845e01af439d","added_by":"auto","created_at":"2025-07-30 08:18:46","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":97117,"visible":true,"origin":"","legend":"\u003cp\u003eThe asymmetry funnel plot of the included studies in Indonesia, 2025\u003c/p\u003e","description":"","filename":"image5.png","url":"https://assets-eu.researchsquare.com/files/rs-7238223/v1/ce7e5bb158d658245612844e.png"},{"id":87905044,"identity":"6f52e391-c986-4aa7-83df-9647616fc881","added_by":"auto","created_at":"2025-07-30 08:42:46","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1482677,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7238223/v1/c59d08dc-c342-4912-aafe-953258fddb29.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eSchool-based Interventions of Menstrual Hygiene Management in Indonesia: Systematic Literature Review\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAdolescence is a critical period of physical, psychological, and social transformation, marked notably by the onset of menstruation in females(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). During this transitional phase, menstrual hygiene management (MHM) becomes a crucial determinant of adolescent girls’ reproductive health and overall well-being. Proper MHM entails access to sanitary products, adequate knowledge, clean and safe facilities, and supportive social environments. However, in many low- and middle-income countries, these conditions are often unmet due to socio-cultural taboos, misinformation, limited health education, and inadequate water, sanitation, and hygiene (WASH) infrastructure(\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e–\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIndonesia, the world’s fourth most populous country, is home to over 25\u0026nbsp;million adolescent girls(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Despite national policy efforts to support adolescent reproductive health, evidence shows that many young Indonesian girls lack basic knowledge and appropriate practices related to menstrual hygiene(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Poor MHM has been associated with increased risk of reproductive tract infections (RTIs), school absenteeism, psychological distress, and long-term health consequences(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). According to the Indonesian Ministry of Health (Kemenkes RI, 2018), millions of girls report discomfort, itching, and reproductive tract complications directly linked to improper menstrual hygiene.\u003c/p\u003e\u003cp\u003eIn response to these challenges, various health education interventions have been introduced in Indonesia, aiming to improve adolescent girls’ awareness, attitudes, and behaviours regarding menstrual hygiene(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). These interventions utilise diverse delivery methods including lectures, printed materials (leaflets, booklets), audiovisual content, and participatory learning such as small group discussions or peer-led sessions(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). While individual studies have reported encouraging outcomes, the intervention models, target populations, and evaluation designs vary widely, making it difficult to derive generalizable lessons for policy and programming.\u003c/p\u003e\u003cp\u003eThis systematic review focuses specifically on menstrual hygiene education interventions delivered within formal educational institutions, such as schools. Schools are not only one of the most consistent and equitable entry points for reaching large populations of adolescents, but also serve as structured environments for behaviour change, life-skills development, and psychosocial support(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). According to the Ministry of Education and Culture (Kemendikbud, 2022), Indonesia has over 150,000 primary and secondary schools and more than 27,000 madrasahs under the Ministry of Religious Affairs, providing an expansive platform for health education delivery across diverse regions and populations.\u003c/p\u003e\u003cp\u003eFurthermore, the Government of Indonesia has established several policies and guidelines to support adolescent reproductive health in school settings. These include the Guidelines for the Implementation of School Health Units (UKS), the Permenkes No. 25 Year 2014 on Maternal and Child Health, and the National Strategy on Adolescent Health (2017–2030)(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). These policies emphasize the integration of reproductive health, including menstrual hygiene into the school health curriculum, and encourage intersectoral collaboration among schools, health centers, and families. However, implementation remains inconsistent due to lack of capacity, limited teacher training, and insufficient monitoring and evaluation(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eDespite the increase in intervention studies over the past decade, no published systematic review has comprehensively synthesized evidence from educational settings in Indonesia regarding menstrual hygiene interventions for adolescent girls. Most global reviews tend to generalise findings across countries and settings, often overlooking the socio-cultural complexities and infrastructural disparities specific to Indonesia. This creates a significant knowledge gap, especially in understanding which educational strategies are most context-appropriate and scalable within the national school system.\u003c/p\u003e\u003cp\u003eThis review aims to critically examine school-based intervention studies focused on improving menstrual hygiene among Indonesian adolescents. By consolidating current evidence and identifying methodological trends, this study will inform the design of more targeted, equitable, and sustainable MHM programs in schools. Moreover, its findings will serve as a valuable reference for policymakers, educators, and researchers in other low- and middle-income countries seeking to strengthen adolescent reproductive health through the education sector.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe review has been registered with the International Prospective Register of Systematic Reviews in 2025 (PROSPERO ID :CRD420251082789). Our reporting conforms to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cb\u003eSearch strategy\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA systematic search was conducted from June 15 to July 2, 2025, using Indonesia's national databases: Garuda, \u003cem\u003ePerpustakaan National Republik Indonesia\u003c/em\u003e (PERPUSNAS), and the Indonesian Scientific Journal Database (ISJD). The mentioned databases were chosen due to their legitimate reputation and indexing by Science and Technology Index (SIINTA), a national indexing system administered by the Indonesian Ministry of Research and Technology that classifies journals based on quality and citation performance with comprehensive coverage of science and technology literature. The search was peer reviewed and explored literature from 2019 to 2024.\u003c/p\u003e\u003cp\u003eAll the databases mentioned are not equipped with an advanced search feature for using the Boolean strategy. Instead, researchers use a manual search strategy that includes each keyword: “menstrual hygiene,” “menstrual health,” “\u003cem\u003emanajemen kebersihan menstruasi\u003c/em\u003e,” and “\u003cem\u003ekebersihan menstruasi\u003c/em\u003e.” The search was conducted in Bahasa and English to draw articles written in those languages. As all the identified records could not be downloaded or imported into the BibTeX version, the author read the titles and abstracts of studies to manually exclude irrelevant findings and then remove the duplicates. After that, to minimise bias, all the authors independently screened the studies based on the inclusion and exclusion criteria. The irrelevant and duplicate articles were rechecked and removed, while the relevant studies with full text were further screened for the quality appraisal.\u003c/p\u003e\u003cp\u003e\u003cb\u003eInclusion and exclusion criteria\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe full texts of all refined studies were selected if they were experimental design studies conducted in formal educational institutions or schools with interventions related to menstrual hygiene management in Indonesia. The target of the studies was students aged 10–19 years old. A peer-reviewed and original article with full text published in Bahasa Indonesia or English between 2019 and 2024. However, the studies were excluded if they were not conducted in Indonesia, were not based on formal educational institution interventions, were not experimental design studies, or involved adolescents who did not attend school.\u003c/p\u003e\u003cp\u003e\u003cb\u003eData extraction and synthesis\u003c/b\u003e\u003c/p\u003e\u003cp\u003eData from each included article was extracted into a table that included the study title, authors, year of publication, study aim(s), place, the participants’ characteristics (number, age, and educational level), method (design, study, data collection, and data analysis), results, and theoretical framework. The tabulated data were analysed to explore the study design, intervention types, data analysis, outcome of the study, and limitations. The interventions of menstrual hygiene practice include providing access to menstrual hygiene products, improving and maintaining sanitation/hygiene facilities, and health education (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). The outcomes of the experiment measured improvements in either knowledge or attitude using standardised instruments and assessments with reliable and appropriate statistical analysis.\u003c/p\u003e\u003cp\u003e\u003cb\u003eQuality assessment\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAll authors looked at the quality of the studies on their own using the JBI Systematic Reviews for experimental study, which includes nine assessment points: whether the effect is caused, how similar the participants are in the comparison groups, the treatments given to each group, the presence of a control group, the chance of measuring multiple exposures and follow-ups, how the outcomes are measured, and the statistical methods used. Each element was independently rated as yes, no, unclear, or not applicable (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). An overall quality assessment for each study was rated as including, excluding, or seeking further information. Studies that indicated a “yes” for causality, demonstrated similarity among the groups, and provided precise statistical measurements and analysis for the outcomes were included and considered for systematic review and meta-analysis. To ensure consistency, the authors cross-check the quality of the included studies. Any disagreements among the authors were discussed until a consensus was achieved.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cb\u003eStudy Selection\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAs illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003e, a total of 687 studies were retrieved from Indonesia\u0026rsquo;s national databases, Garuda (n\u0026thinsp;=\u0026thinsp;549), Perpusnas (n\u0026thinsp;=\u0026thinsp;79), and ISJD (n\u0026thinsp;=\u0026thinsp;59). The titles, abstracts, and full texts of the studies were screened. There were 604 articles with irrelevant titles and abstracts excluded, 13 duplicate articles, 5 articles not specifically related to menstrual hygiene, 8 articles not conducted in schools or formal educational institutions, and 4 articles not targeting adolescence that were also removed. There were 53 studies assessed for the quality appraisal, and 13 of them were selected to be included.\u003c/p\u003e\u003cp\u003e\u003cb\u003eQuality appraisal\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAll the included studies conformed to the JBI systematic review\u0026rsquo;s criteria for experimental studies in terms of causability, group background similarity, precise measurements, and reliable statistical analysis. There were two types of experimental studies identified: pre-experimental and quasi-experimental. Pre-experimental design relies on no random assignment; the control group is usually absent, and only one group is observed for the intervention, while the quasi-experimental design provides multiple groups for comparison. The included studies were assessed according to the principles of the identified design (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). The details of the critical appraisal of the included studies are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eQuality appraisal of included studies based on the Joanna Briggs Institute (JBI) critical appraisal tools in Indonesia, 2025\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"11\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAuthor / Reference\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eQ1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eQ2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eQ2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eQ3\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eQ4\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eQ5\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eQ6\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eQ7\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003eQ8\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRahmawati, Andin Ajeng \u0026amp; Hariastuti (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eYes:4 No:5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHasanah, April ZR; Hartini, Lela \u0026amp; Efriani, Rolita (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eYes:6; No:3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHartoyo \u0026amp; Susanto (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eYes: 4; No:5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePramesti, Hasna Dian; Suherni; Djanah, Nur (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eYes:7, No2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePutri, Heldalia Faiza; Sulistiani, Ardiani, Wijayanti, Titik (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eYes:4 No:5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMustikarani, Innez Karunia; Wulandari, Yunita \u0026amp; Widiaswati, Yunita(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eYes:4 No:5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJubaedah, Entin; Yuhandini, Diyah Sri \u0026amp; Sriyatin (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eYes:6; No:3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLatifah \u0026amp; Linggardini (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNot Applicable\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNot Applicable\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eYes:4, Not Applicable:2, No:3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDolang \u0026amp; Kiriwenno (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNot Applicable\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNot Applicable\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eYes:6;Not Applicable:2, No;1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRizki hasanah, a., hartini, l., \u0026amp; efriani (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eUnclear\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eYes:5, Unclear:1; No;3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSalsabilah et al (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNot Applicable\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eYes:7; Not Applicable:1; No:1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKas \u0026amp; Darlis (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eYes: 8; No:1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNisman et al (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eUnclear\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eYes:8; Unclear:1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eStudy characteristics\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe final systematic review included thirteen experimental studies, seven pre-experimental (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e)(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e)(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e)(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e)(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e), and six quasi-experimental (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e)(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e) (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), totalling 960 participants. The studies were published between 2019 and 2024 in different regions of Indonesia. Ten of the studies were conducted in \u003cem\u003eSekolah Menengah Pertama (SMP)\u003c/em\u003e, or junior high school, while two studies were conducted at the senior high level and one study at the primary level. The details of participants' characteristics of these included studies are displayed in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cb\u003eParticipant characteristics and settings\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eAs the Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e2\u003c/span\u003e presented, from13 studies included, the majority of studies (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) were conducted in Central Java, followed by (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) studies each in Yogyakarta, Banten, and East Java. There was also one study each in West Java, Central Maluku, and South Sulawesi. Based on the geographical perspective, the locations represent the regions of Indonesia, from West to East Indonesia, there are studies that have been conducted.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSummary Characteristics of studies included in the systematic review of school-based interventions of MHM in Indonesia, 2025\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"13\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eAuthors\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eYear\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ePlace\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVariable Assesment\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eStudy Design\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eIntervention tools\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSample\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"6\" nameend=\"c13\" namest=\"c8\"\u003e\u003cp\u003eParticipant Characteristic\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eLevel Of Educa-tion\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003eMenarche Age\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e\u003cp\u003eParents' Educa-tion\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c12\"\u003e\u003cp\u003eParents Occupa-tion\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c13\"\u003e\u003cp\u003eInforma-tion Sources\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDolang \u0026amp; Kiriwenno (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2019\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMasohi, Maluku\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eKnowladge, Attitude and Practice\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePre-Experiment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNot Provided\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e13\u0026ndash;15 y\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eJunior high school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eNot Provided\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eProvided\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eProvided\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003eNot Provided\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJubaedah, Entin; Yuhandini, Diyah Sri \u0026amp; Sriyatin (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2019\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCirebon, Jawa Barat\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eKnowladge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eQuasi-Experiment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eVideo\u0026amp; Leaflets\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e11\u0026ndash;13 y\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eJunior high school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eProvided\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eProvided\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eNot Provided\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003eProvided\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHartoyo \u0026amp; Susanto (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBanten, Jawa Barat\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eKnowladge, behavior\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePre-Experiment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eLeaflets\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e104\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e10\u0026ndash;15 y\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003ejunior high school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eNot Provided\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eNot Provided\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eNot Provided\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003eProvided\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHasanah,April ZR; Hartini,Lela \u0026amp; Efriani, Rolita (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBengkulu\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eKnowladge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eQuasi-Experiment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eleaflets \u0026amp; PPT Slides\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e11\u0026ndash;16 y\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eJunior high school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eProvided\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eProvided\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eNot Provided\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003eNot Provided\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKas \u0026amp; Darlis (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSopeng, Sulawesi Selatan\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAttitude\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eQuasi-Experiment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eAudio Visual Media; PPT Slides\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e12\u0026ndash;16 y\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eSenior high school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eNot Provided\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eProvided\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eNot Provided\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003eNot Provided\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLatifah \u0026amp; Linggardini (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2023\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBanyumas, Jawa tengah\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eKnowladge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePre-Experiment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDomino card\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e10\u0026ndash;13 y\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eElementary school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eProvided\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eNot Provided\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eNot Provided\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003eNot Provided\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMustikarani, Innez Karunia; Wulandari, Yunita \u0026amp; Widiaswati, Yunita (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSurakarta, Jawa Tengah\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePerception\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePre-Experiment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eMagis Booklet\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e12\u0026ndash;14 y\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eJunior high school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eProvided\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eNot Provided\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eNot Provided\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003eNot Provided\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNisman et al (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2019\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYogyakarta\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eKnowladge \u0026amp; Practice\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eQuasi-Experiment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eBooklet\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e194\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e12\u0026ndash;16 y\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eJunior high school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eProvided\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eNot Provided\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eNot Provided\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003eProvided\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePramesti, Hasna Dian; Suherni;\u0026nbsp; Djanah, Nur (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBantul, Yogyakarta\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eKnowladge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eQuasi-Experiment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eBooklet \u0026amp; Leaflets\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e12\u0026ndash;13 y\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eJunior high school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eNot Provided\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eProvided\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eNot Provided\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003eProvided\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePutri, Heldalia Faiza; Sulistiani, Ardiani, Wijayanti, Titik (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBoyolali, Jawa Tengah\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eKnowladge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePre-Experiment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eLeaflets\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e13\u0026ndash;15 y\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eJunior high school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eNot Provided\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eProvided\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eProvided\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003eNot Provided\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAndin Ajeng Rahmawati \u0026amp; Hariastuti (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBojonegoro, Jawa Timur\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eKnowladge \u0026amp;Atitude\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePre-Experiment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSmall Group Disscusion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e112\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e12\u0026ndash;13 y\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eJunior high school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eNot Provided\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eNot Provided\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eNot Provided\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003eProvided\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRizki hasanah, a., hartini, l., \u0026amp; efriani (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBanten\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eKnowladge \u0026amp;Atitude\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eQuasi-Experiment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eMedia Hygenic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e10\u0026ndash;13 y\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eElementary school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eNot Provided\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eProvided\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eProvided\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003eNot Provided\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSalsabilah et al (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSurabaya\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eKnowladge, Attitude and Practice\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePre-Experiment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eWeb Site\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e16\u0026ndash;18 y\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eSenior high school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eNot Provided\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eNot Provided\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eNot Provided\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003eNot Provided\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eIntervention components\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe details of the intervention components of the included studies are demonstrated in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, and the distribution of the intervention tools is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e3\u003c/span\u003e. All the included articles provided health education on menstrual hygiene aimed at adolescents in school, but none specified a duration for the intervention. These interventions used various delivery methods, including printed materials (leaflets and booklets), audiovisual content, group discussion and games (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e) (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e) (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e) (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e)(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe above graphic presents the distribution of media intervention. Leaflets were the most media used medium (33%), followed by booklets and video media for 20%, respectively. The PowerPoint presentation, website, discussion and domino card accounted for 7%.\u003c/p\u003e\u003cp\u003e\u003cb\u003eIntervention outcomes\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe outcomes of the interventions were demonstrated a change in knowledge, attitude, or behaviour related to menstrual hygiene among adolescents. As it can be seen from Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, all studies reported the improvements in knowledge, while six studies reported on attitudes and one on behaviour, with all demonstrating a p-value of 0.000.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eIntervention components and outcome of included studies in Indonesia, 2025\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIntervention Components\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMain Findings\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJubaedah, Entin; Yuhandini, Diyah Sri \u0026amp; Sriyatin (2020) (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e: Health education on menstrual personal hygiene through video and leaflet delivered in 15-minute sessions.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eKnowledge\u003c/b\u003e: Significant increase in knowledge post-intervention in both groups (video: pre 80.19 \u0026rarr; post 93.85; leaflet: pre 81.92 \u0026rarr; post 90.58). \u003cb\u003eComparison\u003c/b\u003e: Video more effective than leaflet (mean rank: 13.65 vs 8.65; p\u0026thinsp;=\u0026thinsp;0.021).\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLatifah \u0026amp; Linggardini (2023) (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e: Health education using a Domino Card game to teach menstrual hygiene. Delivered in a pre-post one group design in elementary school children.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eKnowledge\u003c/b\u003e: Significant increase in knowledge from 54.70 to 91.29. \u003cb\u003eWilcoxon test\u003c/b\u003e: p\u0026thinsp;\u0026lt;\u0026thinsp;0.005.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRizki hasanah, a., hartini, l., \u0026amp; efriani (2024) (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e: Health education using Hygenic media (visual/interactive tools).\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eKnowledge\u003c/b\u003e: Increased from 28.9\u0026ndash;84.2% with good knowledge (p\u0026thinsp;=\u0026thinsp;0.000). \u003cb\u003eAttitude\u003c/b\u003e: Positive attitude increased from 47.4\u0026ndash;86.8% (p\u0026thinsp;=\u0026thinsp;0.000). \u003cb\u003eBetween-group difference\u003c/b\u003e: Knowledge (p\u0026thinsp;=\u0026thinsp;0.017), Attitude (p\u0026thinsp;=\u0026thinsp;0.027).\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHasanah,April ZR; Hartini,Lela \u0026amp; Efriani, Rolita (2024) (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e: Health education on genital hygiene using leaflet and PowerPoint. Quasi-experimental design with control group.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eKnowledge\u003c/b\u003e: Leaflet group increased from 5.00 to 9.00; PowerPoint group from 4.67 to 7.71. \u003cb\u003eAttitude\u003c/b\u003e: Leaflet more effective (p\u0026thinsp;=\u0026thinsp;0.013).\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHartoyo \u0026amp; Susanto (2021) (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e: Health education through leaflet on menstrual external genital hygiene. Delivered via pre-post format using one group pretest-posttest design.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eKnowledge\u003c/b\u003e: Good knowledge increased from 51.9\u0026ndash;78.8%. \u003cb\u003eBehavior\u003c/b\u003e: Good hygiene behavior increased from 67.3\u0026ndash;88.5%. \u003cb\u003eWilcoxon test\u003c/b\u003e: Significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e6\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePutri, Heldalia Faiza; Sulistiani, Ardiani, Wijayanti, Titik (2024) (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e: Health education using leaflet on menstrual personal hygiene. One-group pre-post design.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eKnowledge\u003c/b\u003e: Good knowledge increased from 10.8\u0026ndash;86.7%. \u003cb\u003eWilcoxon test\u003c/b\u003e: p\u0026thinsp;=\u0026thinsp;0.000.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e7\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMustikarani et al. (2021) (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e: Health education using MAGIS (Menstrual Hygine Sehat) booklet to improve menstrual hygiene perception. One-group pre-post design.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003ePerception\u003c/b\u003e: Good perception increased from 48.8\u0026ndash;97.7%. \u003cb\u003eWilcoxon test\u003c/b\u003e: p\u0026thinsp;=\u0026thinsp;0.000.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e8\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRahmawati (2024) (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e: Provided health education using Small Group Discussion (SGD) method. Discussions were designed to actively engage students, increase participation, and encourage questions.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eKnowledge\u003c/b\u003e: Significant improvement \u0026mdash; majority shifted from \"poor\" to \"adequate\" knowledge (66.1%). \u003cb\u003eAttitude\u003c/b\u003e: Significant increase \u0026mdash; positive attitudes rose from 60.7\u0026ndash;84.8%.\u003c/p\u003e\u003cp\u003e\u003cb\u003eWilcoxon test\u003c/b\u003e: p\u0026thinsp;=\u0026thinsp;0.000.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e9\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNisman et al. (2019) (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e: Booklet-based health education provided in boarding schools in rural and urban areas. Design: Quasi-experimental (pre-test and post-test).\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eKnowledge\u003c/b\u003e: Significant increase in both rural (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.000) and urban (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.000) schools. \u003cb\u003ePractice\u003c/b\u003e: Rural group improved significantly (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.000), urban group had a slight decrease (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.082). Difference: Urban students showed higher overall mean scores.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e10\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDolang \u0026amp; Kiriwenno (2019) (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e: Health education through lectures, booklets, and leaflets for students. One-group pre-post test design.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eImprovements\u003c/b\u003e: Knowledge (20.03 \u0026rarr; 24.86), \u003cb\u003eAttitude\u003c/b\u003e (54.57 \u0026rarr; 60.00), \u003cb\u003ePractice\u003c/b\u003e (4.63 \u0026rarr; 5.77). p\u0026thinsp;=\u0026thinsp;0.000 for all.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e11\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePramesti et al. (2019) (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e: Compared booklet vs. leaflet media for menstrual hygiene education. Design: Quasi-experimental with control group.T ools: Pre- and post-questionnaires.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eKnowledge\u003c/b\u003e: Both groups improved significantly (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.000). \u003cb\u003eEffectiveness\u003c/b\u003e: Booklet group had a greater mean improvement (14.09) compared to leaflet group (7.83). Statistical comparison: \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.000 \u003cb\u003e(independent t-test).\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e12\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSalsabilah et al. (2024)(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e: Website-based educational program. Delivered digitally to adolescent girls.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eKnowledge\u003c/b\u003e: 18% \u0026rarr; 90% \u0026ldquo;Good\u0026rdquo;; \u003cb\u003eAttitude\u003c/b\u003e: 2% \u0026rarr; 88% \u0026ldquo;Positive\u0026rdquo;; \u003cb\u003ePractice\u003c/b\u003e: 12% \u0026rarr; 90% \u0026ldquo;Very Supportive\u0026rdquo;. All p\u0026thinsp;=\u0026thinsp;0.000.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e13\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eKas \u0026amp; Darlis (2024) (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e: One-time counseling using audiovisual and PowerPoint slide media in schools and Islamic boarding schools. Design: Non-randomized pre-test and post-test with control group.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eAttitude\u003c/b\u003e: Significant improvement in both intervention (\u003cem\u003emean\u003c/em\u003e: 5.83 \u0026rarr; 8.67) and control groups (\u003cem\u003emean\u003c/em\u003e: 6.50 \u0026rarr; 9.67\u003cb\u003e).\u003c/b\u003e Audiovisual education is effective in improving menstrual hygiene attitudes.\u003c/p\u003e\u003cp\u003e\u003cb\u003eWilcoxon test\u003c/b\u003e: p\u0026thinsp;=\u0026thinsp;0.000.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eMeta Analysis\u003c/b\u003e\u003c/p\u003e\u003cp\u003eMeta-analysis was performed to identify findings from multiple independent studies to produce a single, more robust estimate of an effect or relationship (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). In this review, we conducted a forest plot for meta-analysis as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eFour studies can be analysed, involving 191 subjects. Based on the analysis performed using a random effects model with the inverse variance method, the summarised raw means (MRAW) are 51.41 with a 95% confidence interval of 17.02\u0026ndash;85.80. A significant heterogeneity was detected (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), suggesting inconsistent effects in magnitude and/or direction. The I2 value indicates that 100% of the variability among studies arises from heterogeneity rather than random chance.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe funnel plot shows asymmetry (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e5\u003c/span\u003e), suggesting the possibility of publication bias. Large effects seem to appear more frequently in smaller studies (which are more prone to bias). The study by Mustikarani, Innez Karunia, Wulandari, Yunita \u0026amp; Widiaswati, and Widiaswati in 2021, with a very small standard error but a mean close to zero, appears striking and may significantly affect the overall results.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis systematic review aimed to explore school-based interventions that improve either knowledge or behaviour change among students regarding menstrual health practices. Menstrual hygiene significantly affects females' reproductive health, which is also associated with the well-being of adolescents. Providing good healthcare facilities and proper sanitary/hygiene infrastructure at schools not only improves the academic performance of schoolgirls but also aligns with Indonesia's government commitment and Sustainable Development Goals (SDGs) target, particularly those related to health, gender equality, and quality education (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e) (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Indonesia's Ministry of Education has launched the three pillars of health, named \u003cem\u003eUnit Kesehatan Sekolah\u003c/em\u003e, which is responsible for ensuring the WASH facilities and providing information on menstrual health (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Further, menstrual health has been acknowledged as a global commitment to supporting gender equity and human rights (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). To the best of our knowledge, no systematic review or meta-analysis has explored school-based interventions for menstrual hygiene among adolescents in Indonesia. Therefore, this study will help policymakers, programmers, planners and researchers, particularly in academic institutions, to design appropriate strategies.\u003c/p\u003e\u003cp\u003eIn this study, the interventions employed in an academic setting is health education with various delivery methods; presentations, audiovisual, printed materials, games and discussion, aiming to knowledge, attitude and behavioural improvement of menstrual hygiene practice (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e) (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e) (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e)(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). This aligns with studies in Nepal and Uganda, which highlight the health education intervention in promoting menstrual hygiene knowledge and changing the behaviour of adolescents (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e)(\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). The school settings were junior high school (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), while only two were senior high school, and one was an elementary school. The majority of schoolgirls experience their first menstruation (\u003cem\u003emenarche\u003c/em\u003e) between the ages of 10\u0026ndash;16 years old, when they are in junior high school. This was the crucial phase for the girls to have a comprehensive understanding of menstrual health and hygiene, and therefore, the interventions conducted at formal education institutions play a pivotal role in improving the aimed outcomes (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e) (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). Despite the interventions appearing effective at raising knowledge, and many reported favourable attitude or behaviour changes, improvements in actual behaviour (e.g. frequency of pad changing, toileting practices) were unclear in measurements. Most studies used author-designed questionnaires with unclear validation, relying on self-reports. The sample sizes were generally small it as found in studies conducted by Rindani et al. (2024) and Hasanah et al. (2024 (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). There was an argument that a minimum sample size of 30 respondents would be sufficient to assess the reliability of the questionnaire for an experimental design study, while another argued that the size determination should be based on power analysis that considers the research question, expected effect size, desired significance level and acceptable margin of error (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e) (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis review has the following limitations. The studies included used an experimental design, which includes both quasi-experimental and pre-experimental designs. Despite the similar principle for investigating cause-and-effect between variables with the lack of randomness, they still differ in their complexity and the control and intervention groups (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). The quality assessment and tools of the method should be different. However, as it was only limited findings on this issue, we decided to use this kind of experimental design in the review. Moreover, Indonesia's national databases were found lacking in an advanced search feature, which enables researchers to input keywords manually rather than using a Boolean strategy. We highly recommend that the stakeholders improve the Database Management Systems (DBMS) to reduce the omission of relevant studies. The keywords we used might not find all the articles related to MHM interventions at school. Despite the limitations, we performed a comprehensive search of studies and grey literature to include all relevant studies.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe Indonesian school-based interventions reviewed generally succeeded in improving girls\u0026rsquo; menstrual knowledge and often showed promising shifts in attitudes and reported hygiene practices. The diversity of methods (media, peer education, printed materials) suggests multiple feasible strategies, but the evidence is limited by study design and measurement issues. Key limitations include non-validated assessment tools. Future research should employ more rigorous designs and validated outcome measures. Programs must also expand to other school-based interventions and involve schoolboys, teachers and other school members. Aligning with national and global priorities (SDGs, WHO / WASH-in-schools targets), sustainable MHM programs in Indonesia will require coupling education with infrastructure upgrades (private toilets, water and disposal bins) as well as robust monitoring. By addressing these gaps, stakeholders can build on the strong knowledge gains seen in these trials to achieve lasting improvements in girls\u0026rsquo; menstrual health and school participation.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003ePROSPERO International Prospective Register of Systematic Reviews\u003c/p\u003e\u003cp\u003eMHM Menstrual hygiene management\u003c/p\u003e\u003cp\u003ePRISMA The Preferred Reporting Items for Systematic review and Meta-analysis\u003c/p\u003e\u003cp\u003eSDGs Sustainable Development Goals\u003c/p\u003e\u003cp\u003eWHO World Health Organisation\u003c/p\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eEthical approval and consent to participate\u003c/h2\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eCompeting Interest\u003c/strong\u003e\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\u003ch2\u003eFunding Declaration\u003c/h2\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eNot Applicable\u003c/p\u003e\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e\u003cp\u003eAll data supporting the findings of this study are available within the manuscript. No additional datasets or supplementary materials were generated or analysed.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003e(WHO) WHO (2014) Adolescent Health. WHO, Geneva\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e(UNFPA) UNPF (2014) Menstrual Hygiene Management: Operational Guidelines. UNFPA Asia-Pacific Regional Office\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJoshi D, Buit G, Gonz\u0026aacute;lez-Botero D (2015) Menstrual hygiene management: education and empowerment for girls? Waterlines 34(1):51\u0026ndash;67\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eUpashe SP, Tekelab T, Mekonnen J (2015) Assessment of knowledge and practice of menstrual hygiene among high school girls in Western Ethiopia. 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Restor Dent Endod 49(1):e3\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Yayasan Chonyzamani","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Menstrual Hygiene Management, Menstrual health, school-based interventions, Health education","lastPublishedDoi":"10.21203/rs.3.rs-7238223/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7238223/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAdolescence marks a critical phase in which menstrual hygiene management (MHM) significantly affects the health, education, and psychosocial development of girls. In Indonesia, poor MHM is prevalent due to limited knowledge, cultural taboos, inadequate school-based education, and insufficient Water, Sanitation and Hygiene (WASH) facilities. Although various school-based MHM interventions have been introduced, their designs and outcomes are heterogeneous, and a comprehensive synthesis of their effectiveness is lacking. Schools represent a strategic platform for implementing health education and promoting behavioural change. However, evidence specific to Indonesia, as this country has its cultural diversity, educational system, and national health policies, has not been systematically reviewed. This review aims to synthesise current evidence on school-based MHM interventions in Indonesia, focusing on their impact on adolescent girls’ knowledge, attitudes and behaviours related to menstruation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis systematic review is registered with PROSPERO (ID: CRD420251082789) and follows the PRISMA 2020 reporting guidelines. A manual search was conducted across three Indonesian national journal databases: \u003cem\u003eGaruda, Perpusnas, and ISJD,\u003c/em\u003e from June 15 to July 2, 2025. Eligible studies were peer-reviewed, full-text original articles in Bahasa Indonesia or English, published between 2019 and 2024, with quantitative experimental designs. Inclusion criteria focused on MHM interventions conducted in formal educational settings targeting girls aged 10–19. Studies not conducted in Indonesia, not school-based, or lacking an experimental design were excluded. Titles and abstracts were manually screened, followed by independent full-text review and quality appraisal by multiple reviewers to ensure the rigorous selection and minimise bias.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOut of 687 initially identified articles from three Indonesian national databases, to include a total of 13 articles were included in this review. The educational level of participants in the included studies was junior high school (9), senior high school (2), and primary school (1), with an age range from 10 to 18 years old, and the total sample was 960 students. The studies were conducted in most areas of Java (10), and the other three were from Bengkulu, Maluku, and South Sulawesi, respectively. The interventions in the included studies were experimental designs, with 7 studies being pre-experimental and 6 being quasi-experimental. The significant improvement was found concerning knowledge, attitude and behaviour.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclussions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe review suggests the potential effectiveness of school-based interventions in improving knowledge, attitude and behaviour of adolescents regarding menstrual hygiene practice. However, a thorough evaluation of these studies revealed significant methodological limitations that must be acknowledged in interpreting these results. Future studies could explore the other effective interventions of MHM and use more rigorous instrument methods.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSystematic review registration \u003c/strong\u003ePROSPERO registration number:\u003cstrong\u003e \u003c/strong\u003eCRD420251082789\u003c/p\u003e","manuscriptTitle":"School-based Interventions of Menstrual Hygiene Management in Indonesia: Systematic Literature Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-30 08:18:41","doi":"10.21203/rs.3.rs-7238223/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"06c91fe0-a941-46b2-b26c-7a8780d953ca","owner":[],"postedDate":"July 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-30T08:18:41+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-30 08:18:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7238223","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7238223","identity":"rs-7238223","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}