Evaluation of a web-based resource to improve menstrual health literacy and self-management in young women

Evaluation of a web-based resource to improve menstrual health literacy and self-management in young women | 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 Research Article Evaluation of a web-based resource to improve menstrual health literacy and self-management in young women Mike Armour, Kelly Parry, Christina Curry, Tania Ferfolja, Melissa Parker, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1247940/v2 This work is licensed under a CC BY 4.0 License Status: Posted Version 2 posted You are reading this latest preprint version Show more versions Abstract Objective: Menstrual cycle-related conditions, such as dysmenorrhea and heavy bleeding, are common amongst those under 25 years. Despite having significant impact on work, education, and social activities, most do not seek medical advice, preferring to self-manage their symptoms. We aimed to determine if access to a web-based resource could improve health literacy, reduce menstrual symptoms, and encourage health-seeking behavior in those at risk of conditions, such as endometriosis. Methods: People were eligible to participate if they were currently living in Australia, aged 14-25 years, and had menstruated for at least 12 months. Access to the resource, comprising evidence-based information on the menstrual cycle, the Period ImPact and Pain Assessment (PIPPA) tool, and guidance on self-care options, was provided for three menstrual cycles. Results: Seventy-five participants with a mean age of 20.4 years enrolled to use the web-based resource. Forty-three percent visited their doctor regarding their menstrual symptoms during the study period, with 84% indicating that they made the appointment due to the resource; over half (56%) who visited their doctor received a referral to a gynecologist. There were clinically relevant improvements in health literacy reflecting improved confidence of participants regarding having both adequate information and skills to manage their symptoms. Almost half (48.8%) said the resource had changed what they thought was a ‘normal’ period, and 94% could now identify symptoms of endometriosis. Conclusion: A low-cost, web-based resource can improve health literacy, provide effective options for self-management of menstrual cycle-related conditions, and motivate young people to seek medical advice. Health Economics & Outcomes Research Dysmenorrhea health literacy internet menstruation self-care endometriosis Introduction Menstrual conditions, such as dysmenorrhea (period pain) and heavy menstrual bleeding (HMB), are common in young women worldwide (1, 2). Dysmenorrhea is common in young Australian women, with research showing over 90% of those under 25 years reporting regular dysmenorrhea (3, 4). Despite the significant impact menstrual symptoms, such as dysmenorrhea, have on academic attendance and performance (3-5) many women, regardless of age, consider pain a ‘normal’ part of being a woman (6). Most women do not seek medical help, but rather, use self-management (7). However, they are often unsure which self-management strategies are effective and report only partial symptom relief (7, 8) . The Institute of Medicine defines health literacy as “the degree to which individuals have the capacity to obtain, process, and understand basic health-related decisions” (9). In an educational context, the Australian Health and Physical Education (HPE) curriculum (10) focuses on developing knowledge, understanding, and skills related to the three dimensions of health literacy: functional, interactive and critical, where health literacy is considered a personal and community asset to be developed, evaluated, enriched, and communicated. With a specific focus on menstrual health literacy, the HPE curriculum includes sexuality and sexual and reproductive health, puberty, and access to health services. However, almost 50% of Australian teachers report that they are under-prepared to discuss menstruation as part of the normal curriculum (11). This unpreparedness from teachers may explain why young women and their parents in Australia consistently report low menstrual health literacy (7, 12, 13), and why young women often rate their period as ‘normal’ despite significant related absenteeism and regular non-cyclical pelvic pain symptoms (7). This is especially concerning when combined with low rates of seeking medical attention as almost half of young women cannot identify the signs of secondary dysmenorrhea ,such as endometriosis (7). A significant issue is that menstruation is often explained only insofar as women understand enough to protect themselves from unwanted pregnancy rather than empowering them to understand how it affects their lives (14). Increasing health literacy through menstrual education can assist women’s understanding, positively affecting their ability to engage in self-care, and help identify symptoms that require further investigation (15, 16) 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In addition, there are various effective, non-pharmacological interventions that can reduce menstrual symptoms including heat, low intensity exercise, such as yoga or stretching, and acupressure (17-20) 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; however, most young women appear unaware of these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trategies to raise awareness of these interventions are required. This study aimed to evaluate a web-based resource delivering menstrual education, self-screening for menstrual disturbance and evidence-based self-care, to determine if it was acceptable and feasible for young people and if this resource could increase their menstrual health literacy, improve engagement with health professionals, change their management strategies, and reduce menstrual pain. Methods 2 .1 Study design Ethical approval for this study was provided by the Western Sydney University Human Ethics Committee (H12599 – March 2018). All research complied with the relevant guidelines and regulations outlined in the National Statement on Ethical Conduct in Human Research (2018) (21). All participants (and their legal guardians if aged <18yrs) provided written informed consent prior to the start of the study. The web-based resource was hosted by Western Sydney University and was developed based on the results of our national survey on menstrual health literacy (7), as well as our team’s previous work on exploring effective non-pharmacological self-management strategies for dysmenorrhea and other menstrual symptoms, such as premenstrual syndrome (PMS) (17-19). The resource was co-created with an expert steering group comprising the research team, two gynecologists, two general practitioners (GPs), two secondary HPE teachers, a sexual and reproductive health curriculum expert, and five young women (16-25yrs) from diverse backgrounds. The steering group met twice, first to discuss content and format of information that should be included in the resource, and again, approximately four weeks later to assess suitability of the resource content developed by the research team. Minor changes were made in response to feedback from the steering group. The resource was developed with two main sections: Section one was evidence-based information on the menstrual cycle, covering hormonal changes during the menstrual cycle, signs, symptoms, and suspected causes of dysmenorrhea (both primary and secondary), PMS, and HMB. Emphasis was placed on the range of symptoms that could be considered ‘normal’ and those that were likely to require further medical investigation, encouraging participants to speak to their doctor. The second section contained immediate self-care options including guidance on how to use heat effectively, information on usage of over-the-counter medications, such as ibuprofen, and a range of medium- to long-term self-care options including acupressure points, a yoga sequence (Yoga Nidra), and dietary guidance. Upon advice of the steering group, self-management information was delivered as a mixture of text, instructional video clips, and audio recordings. Once developed, the resource was pilot tested with four young women under the age of 21, with further editorial changes made to the content to ensure it was clear and understandable for this age group. 2 .2 Participants, recruitment, and study flow People were eligible to participate if they were currently living in Australia, aged 14-25 years, had menstruated for at least 12 months, had regular periods (within 21 to 35 days), and had internet access on their computer, tablet, or smartphone. Participants were recruited using a variety of methods. These included paid Facebook and Instagram advertising and social media promotion by Family Planning NSW, Endometriosis Australia, ACHPER, and Kimberly-Clark Australia, as well as via social media networks (both personal and professional) of the research team. Potential participants lodged their interest via a web-portal and a member of the research team (K.P.) contacted them via email. A phone call was undertaken (if under 18yrs including the parents/guardians) to get consent and screen participants. Participants completed baseline measures after their next menstrual period and were subsequently provided with web-resource login and password. The Period ImPact and Pain Assessment (PIPPA) tool was previously developed to assist young women determine normal from atypical period pain and interference (4, 22). At baseline, all participants filled in an online version of the PIPPA tool, which asked five Y/N questions regarding the impact of their menstrual symptoms. If they answered “Yes” to either four or five of the PIPPA questions, they received an email with a personalized letter advising them to make an appointment and take this letter to their doctor. The letter contained an explanation of the PIPPA tool and the related questions they had answered “Yes” to and requested that further investigations be made if the doctor felt it was appropriate. Access to the resource covered three menstrual cycles. They were asked to log in to the resource at least twice in the first month to read the information section and familiarize themselves with the self-management options, and at least once per month for the next two months. Participants were encouraged to use as many or few self-management techniques as they preferred. Regular automated reminders, either via email or SMS/text messages (based on participant preference), were sent twice per month to remind participants to use their self-management method(s) of choice. The total duration was approximately four months, with three menstrual cycles, using the resource with a one-month follow-up period. 2 .3 Sample size As this was an evaluation study with a single arm no formal sample size calculation was undertaken. Given the lack of previous data on the effectiveness of such web-based interventions, a decision was made to include 75 participants to ensure that rare events and/or small effect sizes would be captured (23) . 2 .4 Outcome measures and data analysis Table 1 outlines the outcome measures and collection timepoints. All data were captured using Castor EDC (24). Descriptive statistics, including frequencies and percentages, means and standard deviations, or median and interquartile range (IQR), were used to report recruitment and dropout rates and demographics information. All outcomes were determined a priori, and as this was a pilot study, all p -values are considered exploratory. All parametric outcomes were compared using paired t-tests while non-parametric outcomes, such as PIPPA scores, were compared using the Wilcoxon signed-rank test. Missing data were dealt with via last observation carried forward (LOCF) on the assumption that those who dropped out of the trial were non-responders. [INSERT TABLE 1] Results Two hundred and seventy-four young people expressed interest in using the resource over a three-month recruitment period. The most common reasons for exclusion were lack of response to screening phone calls (n=124, 45%) and being outside the age range for eligibility (n=35, 13%). Seventy-five (27%) were eligible to participate, consented and entered the study, with 56 (75%) using the resource for the full three menstrual cycles. The most common reasons for non-completion were lack of time (n=9, 47%), lost to follow up (n=6, 32%) (defined as no response after three weeks of attempted contact), pregnancy (n=2, 11%), or menstrual suppression due to contraceptive use (n=2, 11%). Table 2 outlines the demographics and menstrual characteristics of the participants. Participants had a mean age of 20 (3.4) years, and the majority were currently at school or university (60%). Eighteen participants (24%) had a confirmed diagnosis of endometriosis. Almost three-quarters (73%) of the participants had previously seen a doctor for menstrual symptoms. However, only 16% were happy with the advice they received from their health professional. Eighty percent of participants were at or had attended co-educational schools, with just over half currently attending or had attended a public school (52%), while under one-quarter (22.5%) attended a religiously affiliated school or a private school (17.5%). Only 40% reported they had learned about menstrual health in their HPE classes. Those with a diagnosis of endometriosis (n=18) had a median PIPPA score of 5, while those without (n=57) had a significantly lower median score of 3 ( P =.04). Thirty-eight participants (51%) had a PIPPA score of 4 or greater and received a referral letter for their GP. Half of those who received the referral letter subsequently made an appointment with their GP. Just under half (n=32, 43%) of the participants visited their doctor regarding their menstrual symptoms during the study period. Of those who visited their doctor, 27 participants (84%) indicated that they made the appointment due to being involved in the study, either due to information they received on the website (n=8, 30%) or the referral letter they received (n=19, 70%). Of the 32 participants who visited their GP, over half (56%) had received a referral to a gynecologist by the end of the one-month follow-up period. [INSERT TABLE 2] 3 .1 Menstrual management Table 3 outlines the changes in specific self-management strategies that were part of the study between baseline and the third menstrual period. Of the 84% of participants using analgesics, the most common analgesics used prior to the study were ibuprofen (33%), paracetamol (33%), and mefenamic acid (18%). There were no significant changes ( P =.67) in the type of analgesic used or the dosage used ( P =.72) between baseline and the third menstrual period. Overall, use of self-management for menstrual symptoms increased from 65% of participants at baseline to 86% at the third menstrual period. At the end of the one-month follow up, 60% of participants reported that the resource changed the way they managed their menstrual symptoms, and 85% would keep using at least one of the self-care practices they had learned. [INSERT TABLE 3] 3 .2 Menstrual pain and symptoms Those with a diagnosis of endometriosis (n=18) had a significantly ( P =.005) higher menstrual pain score at baseline (7.7) compared to those without (n=57) a diagnosis of endometriosis (5.6). Overall, there was a small, non-significant ( P =.22) decrease in menstrual pain from 6.1 (1.9) at baseline to 5.3 (2.2) at the end of the three months. At one-month follow up, 4% said their menstrual symptoms were ‘very much better’, 1 in 5 (20%) said their menstrual symptoms were ‘much better’ than before they started, almost half (46%) said ‘a little better’, and just over one-quarter (28.6%) said no change. 3 .3 Internal health locus of control There was a small, non-significant ( P =.24) increase in mean internal health locus of control (IHLoC) scores from 29.19 (3.39) at baseline to 29.96 (3.25) at one-month follow up. 3 .4 Health literacy measures Table 4 outlines the changes in Pam Activation Measure (PAM) levels and Health Literacy Questionnaire (HLQ) scores. Table 5 details the percentage of reliable change in the Health Education Impact Questionnaire (heiQ) scores. [INSERT TABLES 4 AND 5] 3 .5 Menstrual health literacy Prior to beginning the study at baseline, only one-quarter of the participants (25%) felt that they had sufficient information about their period and its symptoms, with just over half (53%) reporting that they had some information but felt unsure about a number of aspects, with 15% being unsure if they had enough information at all. At the end of the follow-up period, 59% of participants indicated that they felt they had sufficient information about their period and its symptoms, 35% reported that they had some information but felt unsure about a number of aspects, with 6% being unsure if they had enough information at all. At baseline, when asked about specific aspects of menstrual health, 60% of the participants indicated that they knew the signs of HMB, and 69% could identify the symptoms of endometriosis. At follow up, 87% could identify the signs of HMB, and 94% could identify the symptoms of endometriosis. At the end of the follow up, just under half of the participants (48.8%) said the resource had changed what they thought was a ‘normal’ period, and over one-third (35%) said it corrected previous misunderstandings they had about periods and the menstrual cycle. After using the resource, 65% said they were now ‘very comfortable’ talking about periods to others . 3 .6 Participant satisfaction Eighty-five percent of the participants found the web-based resource easy to use, and 90% found the information provided ‘very helpful’. One-quarter of the participants (25%) were ‘very satisfied’ with the changes in their symptoms, and over one-third (34%) were moderately satisfied. Only one participant was unsatisfied. Discussion Our study found that access to an online resource for three menstrual cycles could improve some key aspects of menstrual health literacy, encourage engagement with medical professionals, and provide improved understanding of both a ‘normal’ menstrual cycle and how to identify problematic menstrual conditions, such as endometriosis and HMB. There was an increased uptake of self-care measures over the course of the study, especially in breathing/meditation exercises and acupressure, which were low at baseline. There is some preliminary evidence that mindfulness-style interventions reduce menstrual pain (25, 26), and there is evidence for both mindfulness and acupressure for reducing PMS symptoms (19, 27). Exercise has the most significant reduction in pain compared to other self-care measures, such as heat (17), but uptake was lower than other forms of self-care. This may be because our resource aimed to increase health literacy; content was not included to support behavior change. Incorporating behavior change theory-based content, such as stepping individuals through use of behavior change techniques (28, 29) (e.g., using self-monitoring, setting goals, social support, and/or adding behavior change support intervention methods in addition to the online platform, e.g., face-to-face methods), could further enhance efficacy of the resource in regards to changing behaviors of seeking health care and using self-management strategies, such as exercise. Our team are working to develop such support, including testing of a menstrual pain behavior app (30). Despite the increased uptake of these self-care measures, we did not find evidence of a clinically significant reduction in menstrual pain; however, it is important to note that this study was not powered to detect any such change if it did exist. The pain score itself is also unlikely to capture the complete spectrum of bothersome menstrual symptoms, such as emotional changes (6) , which may explain why, despite lack of a significant pain reduction, over half of the participants rated their menstrual symptoms as at least slightly improved. The addition of a menstrual disturbance self-screening tool (PIPPA) to menstrual education in this study demonstrated health-seeking behavior by women to GPs and reported action by GPs to refer some participants to gynecologists. Young women commonly report GPs’ dismission of pain and interference-related menstrual disturbance (31, 32), which can cause reluctance to engage with health-care professionals (6). In this study, the addition of a letter to GPs with PIPPA scores and explanation of relevance may have provided reverse education of GPs to take seriously young women’s reports of menstrual disturbance. The action by GPs to refer women to gynecologists may have been facilitated by the combination of a high PIPPA score, providing external validation of pain and interference, and women’s increased menstrual health literacy and confidence to present to GPs. Given that over half of young Australian women report symptoms of non-cyclical pelvic pain but also normalize these symptoms (3), ensuring that these young women are advised and empowered to seek medical advice is vital so that lengthy diagnostic delays are reduced (33, 34) . Certain aspects of health literacy related to agency, empowerment, and improved health management skills all increased during the study period. The significant improvement in the “Having sufficient information to manage my health” domain of the HLQ corresponds to “Feel(ing) confident that they have all the information that they need to live with, and manage, their condition and to make decisions” (35). Several domains of the heiQ also showed reliable improvement, with the largest improvement in the skills and technique acquisition domain; improvement in this domain relates to “highly developed skills in symptom relief and techniques to manage own health” (36). The proportion of reliable positive change in our participants was similar across most domains to previous research on the impact of chronic disease management programs in Australia between 2007-2013 (37), suggesting that, despite the online nature and minimal interaction between the research team and participants, or between participants themselves, it was similarly effective to more ‘traditional’ programs. Interestingly, despite these improvements there was no corresponding improvement in the IHLoC scores over the course of the trial, but the IHLoC scores both at baseline and the end of study were similar to previous data on those with and without a chronic health condition (38) , suggesting that these scores were already in the normal range. These findings illustrate that a relatively large number of young people are not receiving accurate information in schools (from neither parents nor health-care professionals), information is not being delivered in a suitable manner, or they are missing the information they need. Previous research in Australia has shown that when discussing a condition, such as endometriosis, young women wanted to know specific symptoms rather than vague or general information (39). Focusing on high schools, the HPE syllabus does not directly address menstrual health education. Content covered in the later years is linked to sexual and reproductive health through the focus area ‘Relationships and Sexuality’, which aims to explore resources and strategies to manage personal, physical and social changes, and transitions associated with puberty as they grow older (10) . In the later years (years 9 and 10), the focus of this content shifts to sexuality and sexual health education, leaving it to the teacher’s discretion to incorporate this content at all or in an effective manner beyond personal experience or from a biological lens. Given the significant number of participants attending co-educational schools (80%), the findings of this study reveal gaps in the HPE curriculum between the menstrual health education delivered in school and what information is needed to develop young people’s menstrual health literacy. We recommend a whole-school approach to develop menstrual health literacy and strategies to support students, teachers, and school staff to promote menstrual health and well-being. This research indicates the need for greater emphasis on menstrual health in HPE classes. Menstrual health education needs to focus on correcting mistaken assumptions about a ‘normal’ period or menstrual cycle and provide sufficient information about periods, their symptoms, and menstrual management, including self-care options and when to consult a doctor. To develop young peoples' menstrual health literacy within the critical dimension, the HPE curriculum needs to provide menstrual health education that empowers students to selectively access, and critically analyze, menstrual health information and take action to promote their menstrual health (10) . Such information could potentially help to alleviate not only dysmenorrhea and related menstrual symptoms but could, by extension, increase their ability to engage fully in the classroom and extra-curricular activities. The provision of an online resource, such as the one reported in this paper, offers young people and teachers additional information that they could access autonomously. Providing such a resource would ensure critical information was more broadly disseminated and independent of individual teacher capacity. Furthermore, such a tool provides young women with the knowledge to take charge of their health. Ideally, use of such a resource would be accompanied by professional learning for teachers and potentially parents and carers of young women to ensure that the health literacy messages received by young women are aligned. Translational capacity of interventions is essential to consider when designing and evaluating health interventions to ensure follow through to sustainable policy and practice change from research settings. The Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework (40) is one of the most commonly used implementation science frameworks. Regarding the current study, reach into the intended target population (e.g., total number of eligible women that were exposed to the intervention invite), adoption of the intervention (e.g., number of women out of the total potential eligible sample who joined the study) and implementation of the intervention (e.g., how the intervention was used, such as number of hours of engagement and with which elements of the online resource) were not determined. A range of social media sources were used to recruit women making it challenging to identify the total potential sample, and the online platform used for resource delivery did not capture analytics to inform use and engagement with the resource. This study was a short evaluation study, thus, long-term engagement with the resource (maintenance) was not explored. Our evaluation tools did, however, detect meaningful changes in some outcomes suggesting that further testing is warranted to explore full scale, long-term effectiveness, and implementation processes in a rigorous trial. Future work should also collect in-depth, qualitative data from resource users (e.g., women) and stakeholders (e.g., teachers) to explore how and why outcomes changed the way they did over time (41) . We have suggested that high schools may be an appropriate place to reach young women. However, consideration of other settings to promote the resource in women, and important influencers of women beyond high school, should also be considered (e.g., through universities, pharmacies, health-care settings, community groups, and other social marketing strategies). We did not collect data on ethnicity, educational level, or socio-economic status, which are associated with health disparities, potentially through health literacy(42, 43). It may be that our resources would require tailoring to particular groups, which will need exploration in the future. For example, peer support (support from someone with similar characteristics to the individual and with experiential knowledge) has been shown to be particularly effective for lifestyle behavior change in culturally diverse communities (44) ; thus, expanding on our current resource to add an element of peer support may be necessary to engage with such communities. There are several strengths to this study including the use of validated health literacy questionnaires and the previously validated PIPPA tool to encourage engagement with health professionals. However, some important limitations must be acknowledged. Firstly, this is a pilot study and, therefore, was not powered to detect small, even if clinically relevant, changes between baseline to end of trial. Secondly, due to budget constraints and internal University policy, the web-based resource was hosted on the University web platform. This platform lacks many of the features of the “modern” Web 2.0 and, therefore, data on which pages were interacted with, for how long, and what video clips received the most views, was not able to be retrieved. Therefore, we are unable to determine how much actual engagement with the material there was. Future versions of this content will be hosted on modern platforms that will allow the research team to use analytics to help optimize content. Finally, outcomes of the visit to GPs or gynecologists are unknown; therefore, we are unsure about how many participants, if any, received a further diagnosis, such as endometriosis, for their symptoms. Conclusions A web-based resource, with minimal setup and ongoing costs, can provide clinically relevant improvements in health literacy, remedy previous misconceptions about menstruation, and increase awareness and up-take of evidence-based self-care methods. The PIPPA tool was a simple, but effective, means of empowering and encouraging visits to health professionals. Future research should explore the most acceptable way to deliver this information, and to ensure that not only young people, but their teachers and parents/guardians, have access to accurate, evidence-based information on menstruation and its management. References 1. Armour M, Parry K, Manohar N, Holmes K, Ferfolja T, Curry C, et al. 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Declarations Acknowledgments Funding for this study was provided as part of a WSU partnership grant between Western Sydney University and Kimberly-Clark Australia. The sponsor of the study had no role in the data collection, analysis, or interpretation of the manuscript. Thank you to all those organisations who promoted this on their social media including Family Planning NSW, Endometriosis Australia, ACHPER, and Kimberly-Clark Australia. Author Contributions All authors contributed significantly to this work. MA, CC, TF, CS, KH and FM designed the study. MA and KP performed the data collection and statistical analysis, MA, CC, TF, CS, MP, KH and FM interpreted the data. MA and TF drafted the article. KP, CC, TF, CS, KH, MP, TF and FM all contributed to critical revisions on the manuscript. All authors reviewed the manuscript and approved the final draft. Competing Interests The authors have no competing interests to report. Data Availability The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request. Tables Timepoint: Baseline and at the conclusion of each of the three menstrual periods during the study. Menstrual pain/dysmenorrhea severity A single 0-10 numeric rating scale (NRS) for overall menstrual pain. Analgesic usage Type of analgesic and dosage catagorised as ‘more than recommended on box’, ‘same as recommended on box’. Self-management Types of self-management used during the most recent menstrual period. Timepoint: Baseline and end of study. Internal Health Locus of Control (IHLoC) IHLoC is a measure of how much control individuals feel that they can exert over their own health was collected at baseline and end of trial (45) . Patient Activation Measure (PAM) PAM draws on concepts such as health locus of control, self-efficacy in managing health behaviours and readiness to change health behaviours, but is not condition or behaviour specific (46) . PAM scores are used to generate one of four levels, in order of increasing levels of activation; from Level 1 suggesting that the person does not yet understand their role in health care up to Level 4 indicating that the person is proactive and engaged in recommended health behaviours. Health Literacy Questionnaire (HLQ) The Health Literacy Questionnaire (HLQ) consists of 44 questions and can be either self-administered or orally administered. The HLQ identifies the specific health literacy strengths and limitations of people and communities. It examines nine areas of health literacy. Research has shown the HLQ is a robust independent measure of each of the nine identified health literacy dimensions (35) . Health Education Impact Questionnaire (heiQ) The Health Education Impact Questionnaire (heiQ) is a perception- and evaluation-based measure that was developed to be a user-friendly, relevant and psychometrically sound instrument for the comprehensive evaluation of patient education programs and activities (36) . Timepoint: At one-month follow up. Trial Exit Questionaaire The trial exit questionnaire collected participant satisfaction, use of self-care, changes in understanding of menstruation, and information on visits to medical practitioners. Timepoint: Baseline. Period ImPact and Pain Assessment Tool (PIPPA) A 5-item dichotomous Yes/No survey to measure pain and interference related menstrual disturbance (4, 22) . Table 1. Outcome measures by timepoint. N = 75 Mean (SD) Age (y) 20 (3.4) Age at menarche (y) 12 (1.7) N (%) Occupation At school or university 45 (60%) Working for pay 26 (34.7%) Other 4 (5.3%) Response to “I think my periods are normal” Yes 48 (64%) No 21 (28%) Unsure 6 (8%) Regular Dysmenorrhea Yes 74 (98.7%) No 1 (1.3%) Current pain management Analgesic medication 63 (84%) Contraceptives 22 (29.3%) Rest 63 (84%) Heat 66 (88%) Yoga 9 (12%) Acupressure 4 (5.3%) Pilates 0 Low intensity exercise 22 (29.3%) Resistance exercise 4 (5.3%) High intensity exercise 8 (10.7%) Meditation 12 (16%) Herbal medicine 14 (18.7%) Prayer 4 (5.3%) Dietary changes 11 (14.7%) Other 3 (4%) Sources of information on menstruation Mum 57 (76%) Dad 1 (1.3%) Female relatives 26 (34.7%) HPE teacher a 15 (20%) Doctor 34 (45.3%) Friends 32 (42.7%) Social media 17 (22.7%) Magazines 14 (18.7%) Google search 36 (48%) Other 7 (9.3%) a Health and Physical Education teacher PIPPA scores and medical visits: Table 2. Demographics and menstrual characteristics. Modality Baseline (n=73) Cycle 1 (n=67) Cycle 2 (n=59) Cycle 3 (n=56) N (%) Heat 42 (57.5%) 43 (64.2%) 36 (61%) 37 (66.1%) Exercise (low intensity e.g., yoga) 22 (30.1%) 40 (59.7%) 33 (55.9%) 23 (41.1%) Exercise (high intensity e.g., running) 6 (8.2%) 12 (17.9%) 8 (13.6%) 11 (19.6%) Meditation/breathing exercises 11 (15.1%) 20 (29.9%) 25 (42.4%) 28 (50%) Acupressure 1 (1.4%) 17 (25.4%) 13 (22%) 11 (19.6%) Table 3. Usage of self-management strategies over time. Baseline End of trial Median (IQR) Median (IQR) Patient Activation Measure (PAM) Level 3 (2-4) 3 (2-4) Health Literacy Questionnaire (HLQ) Mean (SD) Mean (SD) Feeling understood and supported by health-care providers (HPS) 3.05 (0.41) 3.12 (0.30) Having sufficient information to manage my health (HSI) 2.79 (0.47) 3.09 (0.21) a Actively managing my health (AMH) 3.01 (0.38) 3.05 (0.35) Social support for health (SS) 3.10 (0.55) 3.09 (0.43) Appraisal of health information (CA) 2.89 (0.55) 3.04 (0.44) Ability to actively engage with health-care providers (AE) 3.64 (0.59) 3.74 (0.50) Navigating the health-care system (NHS) 3.58 (0.65) 3.69 (0.57) Ability to find good health information (FHI) 3.78 (0.62) 3.89 (0.44) Understand health information well enough to know what to do (UHI) 4.14 (0.52) 4.14 (0.49) a P =.02 Table 4: Health literacy outcomes. Percentage of participants with reliable positive change between baseline and end of trial a Health-directed Behaviour 12.7 Positive & Active Engagement in Life 10.9 Self-monitoring and Insight 14.5 Constructive Attitudes & Approaches 16.4 Skill and Technique Acquisition 40.0 Social Integration & Support 14.5 Health Services Navigation 20.0 Emotional Distress 21.8 a reliable positive change is based on an effect size of 0.5 or greater. Table 5: Health education impact questionnaire outcome (heiQ). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 2 posted You are reading this latest preprint version Show more versions 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. 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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-1247940","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":78051404,"identity":"741b3dcb-a4b8-4574-ad8e-6ea35839deee","order_by":0,"name":"Mike Armour","email":"data:image/png;base64,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","orcid":"","institution":"NICM Health Research Institute, Western Sydney University","correspondingAuthor":true,"prefix":"","firstName":"Mike","middleName":"","lastName":"Armour","suffix":""},{"id":78051405,"identity":"24af6e75-e58c-4e1b-8ff7-6123e00f6cd6","order_by":1,"name":"Kelly Parry","email":"","orcid":"","institution":"NICM Health Research Institute, Western Sydney University","correspondingAuthor":false,"prefix":"","firstName":"Kelly","middleName":"","lastName":"Parry","suffix":""},{"id":78051406,"identity":"edca6153-8050-4d62-ad09-5743ff8e6499","order_by":2,"name":"Christina Curry","email":"","orcid":"","institution":"Western Sydney University","correspondingAuthor":false,"prefix":"","firstName":"Christina","middleName":"","lastName":"Curry","suffix":""},{"id":78051407,"identity":"8534464a-ddd9-4230-80eb-8b1b1e47502c","order_by":3,"name":"Tania Ferfolja","email":"","orcid":"","institution":"Western Sydney University","correspondingAuthor":false,"prefix":"","firstName":"Tania","middleName":"","lastName":"Ferfolja","suffix":""},{"id":78051408,"identity":"4c13d386-bf9a-435d-9d81-ccb7cbcd1fdb","order_by":4,"name":"Melissa Parker","email":"","orcid":"","institution":"ACT Health","correspondingAuthor":false,"prefix":"","firstName":"Melissa","middleName":"","lastName":"Parker","suffix":""},{"id":78051409,"identity":"77c12cbf-c292-4647-8a22-3c8ca8b26f61","order_by":5,"name":"Toobah Farooqi","email":"","orcid":"","institution":"UNSW Sydney","correspondingAuthor":false,"prefix":"","firstName":"Toobah","middleName":"","lastName":"Farooqi","suffix":""},{"id":78051410,"identity":"ae071560-bcaa-4e6e-99c6-a185110a29ca","order_by":6,"name":"Freya MacMillan","email":"","orcid":"","institution":"Translational Health Research Institute (THRI), Western Sydney University","correspondingAuthor":false,"prefix":"","firstName":"Freya","middleName":"","lastName":"MacMillan","suffix":""},{"id":78051411,"identity":"6228fc43-1245-457e-bc90-536988611af8","order_by":7,"name":"Caroline A Smith","email":"","orcid":"","institution":"NICM Health Research Institute, Western Sydney University","correspondingAuthor":false,"prefix":"","firstName":"Caroline","middleName":"A","lastName":"Smith","suffix":""},{"id":78051412,"identity":"87eee786-b6a6-440b-8b59-478d8720d141","order_by":8,"name":"Kathryn Holmes","email":"","orcid":"","institution":"Western Sydney University","correspondingAuthor":false,"prefix":"","firstName":"Kathryn","middleName":"","lastName":"Holmes","suffix":""}],"badges":[],"createdAt":"2022-01-10 23:59:05","currentVersionCode":2,"declarations":"","doi":"10.21203/rs.3.rs-1247940/v2","doiUrl":"https://doi.org/10.21203/rs.3.rs-1247940/v2","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":19803356,"identity":"99530277-9def-41cc-b90c-28be116ac2ca","added_by":"auto","created_at":"2022-03-31 03:46:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":473279,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1247940/v2/8983cda9-b263-4d19-b357-705932373f8d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eEvaluation of a web-based resource to improve menstrual health literacy and self-management in young women\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMenstrual conditions, such as dysmenorrhea (period pain) and heavy menstrual bleeding (HMB), are common in young women worldwide\u0026nbsp;(1, 2). Dysmenorrhea is common in young Australian women, with research showing over 90% of those under 25 years reporting regular dysmenorrhea\u0026nbsp;(3, 4). Despite the significant impact menstrual symptoms, such as dysmenorrhea, have on academic attendance and performance\u0026nbsp;(3-5)\u0026nbsp;many women, regardless of age, consider pain a \u0026lsquo;normal\u0026rsquo; part of being a woman\u0026nbsp;(6). Most women do not seek medical help, but rather, use self-management\u0026nbsp;(7). However, they are often unsure which self-management strategies are effective and report only partial symptom relief\u0026nbsp;(7, 8)\u003cspan lang=\"EN-AU\"\u003e.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eThe Institute of Medicine defines \u003cem\u003ehealth literacy\u003c/em\u003e as \u003cem\u003e\u0026ldquo;the degree to which individuals have the capacity to obtain, process, and understand basic health-related decisions\u0026rdquo;\u003c/em\u003e (9). In an educational context, the Australian Health and Physical Education (HPE) curriculum\u0026nbsp;(10)\u0026nbsp;focuses on developing knowledge, understanding, and skills related to the three dimensions of health literacy: functional, interactive and critical, where health literacy is considered a personal and community asset to be developed, evaluated, enriched, and communicated. With a specific focus on menstrual health literacy,\u0026nbsp;the HPE curriculum includes sexuality and sexual and reproductive health, puberty, and access to health services. However,\u0026nbsp;almost 50% of Australian teachers report that they are under-prepared to discuss menstruation as part of the normal curriculum\u0026nbsp;(11).\u0026nbsp;This unpreparedness from teachers may explain why young women and their parents in Australia consistently report low menstrual health literacy\u0026nbsp;(7, 12, 13), and why young women often rate their period as \u0026lsquo;normal\u0026rsquo; despite significant related absenteeism and regular non-cyclical pelvic pain symptoms\u0026nbsp;(7). This is especially concerning when combined with low rates of seeking medical attention as almost half of young women cannot identify the signs of secondary dysmenorrhea ,such as endometriosis\u0026nbsp;(7).\u0026nbsp;A significant issue is that menstruation is often explained only insofar as women understand enough to protect themselves from unwanted pregnancy rather than empowering them to understand how it affects their lives\u0026nbsp;(14).\u003c/p\u003e\n\u003cp\u003e\u003cspan lang=\"EN-AU\"\u003eIncreasing health literacy through menstrual education can assist women\u0026rsquo;s understanding, positively affecting their ability to engage in self-care, and help identify symptoms that require further investigation\u0026nbsp;\u003c/span\u003e\u003cspan lang=\"EN-AU\"\u003e(15, 16)\n \u003c!--[if gte mso 9]\u003e\u003cxml\u003e\n 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lang=\"EN-AU\"\u003e. In addition, there are various effective, non-pharmacological interventions that can reduce menstrual symptoms including heat, low intensity exercise, such as yoga or stretching, and acupressure\u0026nbsp;\u003c/span\u003e\u003cspan lang=\"EN-AU\"\u003e(17-20)\n \u003c!--[if gte mso 9]\u003e\u003cxml\u003e\n 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lang=\"EN-AU\"\u003e; however, most young women appear unaware of these\u0026nbsp;\u003c/span\u003e\u003cspan lang=\"EN-AU\"\u003e(8)\n \u003c!--[if gte mso 9]\u003e\u003cxml\u003e\n 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lang=\"EN-AU\"\u003e. Strategies to raise awareness of these interventions are required.\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eThis study aimed to evaluate a web-based resource delivering menstrual education, self-screening for menstrual disturbance and evidence-based self-care, to determine if it was acceptable and feasible for young people and if this resource could increase their menstrual health literacy, improve engagement with health professionals, change their management strategies, and reduce menstrual pain.\u003c/p\u003e"},{"header":"Methods","content":"\u003ch3\u003e2\u003cem\u003e.1 \u0026nbsp;\u003c/em\u003eStudy design\u003c/h3\u003e\n\u003cp\u003eEthical approval for this study was provided by the Western Sydney University Human Ethics Committee (H12599 \u0026ndash; March 2018). All research complied with the relevant guidelines and regulations outlined in the National Statement on Ethical Conduct in Human Research (2018)\u0026nbsp;(21). All participants (and their legal guardians if aged \u0026lt;18yrs) provided written informed consent prior to the start of the study. The web-based resource was hosted by Western Sydney University and was developed based on the results of our national survey on menstrual health literacy\u0026nbsp;(7), as well as our team\u0026rsquo;s previous work on exploring effective non-pharmacological self-management strategies for dysmenorrhea and other menstrual symptoms, such as premenstrual syndrome (PMS)\u0026nbsp;(17-19). The resource was co-created with an expert steering group comprising the research team, two\u0026nbsp;gynecologists, two general practitioners (GPs), two secondary HPE teachers, a sexual and reproductive health curriculum expert, and five young women (16-25yrs) from diverse backgrounds. The steering group met twice, first to discuss content and format of information that should be included in the resource, and again, approximately four weeks later to assess suitability of the resource content developed by the research team. Minor changes were made in response to feedback from the steering group. The resource was developed with two main sections: Section one was evidence-based information on the menstrual cycle, covering hormonal changes during the menstrual cycle, signs, symptoms, and suspected causes of dysmenorrhea (both primary and secondary), PMS, and HMB. Emphasis was placed on the range of symptoms that could be considered \u0026lsquo;normal\u0026rsquo; and those that were likely to require further medical investigation, encouraging participants to speak to their doctor. The second section contained immediate self-care options including guidance on how to use heat effectively, information on usage of over-the-counter medications, such as ibuprofen, and a range of medium- to long-term self-care options including acupressure points, a yoga sequence (Yoga Nidra), and dietary guidance. Upon advice of the steering group, self-management information was delivered as a mixture of text, instructional video clips, and audio recordings. Once developed, the resource was pilot tested with four young women under the age of 21, with further editorial changes made to the content to ensure it was clear and understandable for this age group.\u003c/p\u003e\n\u003ch3\u003e2\u003cem\u003e.2 \u0026nbsp;\u003c/em\u003eParticipants, recruitment, and study flow\u003c/h3\u003e\n\u003cp\u003ePeople were eligible to participate if they were currently living in Australia, aged 14-25 years, had menstruated for at least 12 months, had regular periods (within 21 to 35 days), and had internet access on their computer, tablet, or smartphone.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eParticipants were recruited using a variety of methods. These included paid Facebook and Instagram advertising and social media promotion by Family Planning NSW, Endometriosis Australia, ACHPER, and Kimberly-Clark Australia, as well as via social media networks (both personal and professional) of the research team. Potential participants lodged their interest via a web-portal and a member of the research team (K.P.) contacted them via email. A phone call was undertaken (if under 18yrs including the parents/guardians) to get consent and screen participants.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eParticipants completed baseline measures after their next menstrual period and were subsequently provided with web-resource login and password.\u0026nbsp;The\u0026nbsp;Period ImPact and Pain Assessment (PIPPA)\u0026nbsp;tool was previously developed to assist young women determine normal from atypical period pain and interference\u0026nbsp;(4, 22).\u0026nbsp;At baseline, all participants filled in an online version of the PIPPA tool, which asked five Y/N questions regarding the impact of their menstrual symptoms. If they answered \u0026ldquo;Yes\u0026rdquo; to either four or five of the PIPPA questions, they received an email with a personalized letter advising them to make an appointment and take this letter to their doctor. The letter contained an explanation of the PIPPA tool and the related questions they had answered \u0026ldquo;Yes\u0026rdquo; to and requested that further investigations be made if the doctor felt it was appropriate. Access to the resource covered three menstrual cycles. They were asked to log in to the resource at least twice in the first month to read the information section and familiarize themselves with the self-management options, and at least once per month for the next two months. Participants were encouraged to use as many or few self-management techniques as they preferred. Regular automated reminders, either via email or SMS/text messages (based on participant preference), were sent twice per month to remind participants to use their self-management method(s) of choice. The total duration was approximately four months, with three menstrual cycles, using the resource with a one-month follow-up period.\u003c/p\u003e\n\u003ch3\u003e2\u003cem\u003e.3 \u0026nbsp;\u003c/em\u003eSample size\u003c/h3\u003e\n\u003cp\u003eAs this was an evaluation study with a single arm no formal sample size calculation was undertaken. Given the lack of previous data on the effectiveness of such web-based interventions, a decision was made to include 75 participants to ensure that rare events and/or small effect sizes would be captured\u0026nbsp;(23)\u003cspan lang=\"EN-AU\"\u003e.\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003ch3\u003e2\u003cem\u003e.4 \u0026nbsp;\u003c/em\u003eOutcome measures and data analysis\u003c/h3\u003e\n\u003cp\u003eTable 1 outlines the outcome measures and collection timepoints. All data were captured using Castor EDC (24). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDescriptive statistics, including frequencies and percentages, means and standard deviations, or median and interquartile range (IQR), were used to report recruitment and dropout rates and demographics information. All outcomes were determined \u003cem\u003ea priori,\u003c/em\u003e and as this was a pilot study, all \u003cem\u003ep\u003c/em\u003e-values are considered exploratory. All parametric outcomes were compared using paired t-tests while non-parametric outcomes, such as PIPPA scores, were compared using the Wilcoxon signed-rank test. Missing data were dealt with via last observation carried forward (LOCF) on the assumption that those who dropped out of the trial were non-responders.\u003c/p\u003e\n\u003cp\u003e[INSERT TABLE 1]\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cspan lang=\"EN-AU\"\u003eTwo hundred and seventy-four young people expressed interest in using the resource over a three-month recruitment period. The most common reasons for exclusion were lack of response to screening phone calls (n=124, 45%) and being outside the age range for eligibility (n=35, 13%). Seventy-five (27%) were eligible to participate, consented and entered the study, with 56 (75%) using the resource for the full three menstrual cycles. The most common reasons for non-completion were lack of time (n=9, 47%), lost to follow up (n=6, 32%) (defined as no response after three weeks of attempted contact), pregnancy (n=2, 11%), or menstrual suppression due to contraceptive use (n=2, 11%).\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan lang=\"EN-AU\"\u003eTable 2 outlines the demographics and menstrual characteristics of the participants. Participants had a mean age of 20 (3.4) years, and the majority were currently at school or university (60%). Eighteen participants (24%) had a confirmed diagnosis of endometriosis. Almost three-quarters (73%) of the participants had previously seen a doctor for menstrual symptoms. However, only 16% were happy with the advice they received from their health professional. Eighty percent of participants were at or had attended co-educational schools, with just over half currently attending or had attended a public school (52%), while under one-quarter (22.5%) attended a religiously affiliated school or a private school (17.5%). Only 40% reported they had learned about menstrual health in their HPE classes.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan lang=\"EN-AU\"\u003eThose with a diagnosis of endometriosis (n=18) had a median PIPPA score of 5, while those without (n=57) had a significantly lower median score of 3 (\u003cem\u003eP\u003c/em\u003e=.04). Thirty-eight participants (51%) had a PIPPA score of 4 or greater and received a referral letter for their GP. Half of those who received the referral letter subsequently made an appointment with their GP.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan lang=\"EN-AU\"\u003eJust under half (n=32, 43%) of the participants visited their doctor regarding their menstrual symptoms during the study period. Of those who visited their doctor, 27 participants (84%) indicated that they made the appointment due to being involved in the study, either due to information they received on the website (n=8, 30%) or the referral letter they received (n=19, 70%). Of the 32 participants who visited their GP, over half (56%) had received a referral to a gynecologist by the end of the one-month follow-up period.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan lang=\"EN-AU\"\u003e[INSERT TABLE 2]\u003c/span\u003e\u003c/p\u003e\n\u003ch3\u003e3\u003cem\u003e.1 \u0026nbsp;\u003c/em\u003eMenstrual management\u003c/h3\u003e\n\u003cp\u003e\u003cspan lang=\"EN-AU\"\u003eTable 3 outlines the changes in specific self-management strategies that were part of the study between baseline and the third menstrual period. Of the 84% of participants using analgesics, the most common analgesics used prior to the study were ibuprofen (33%), paracetamol (33%), and mefenamic acid (18%). There were no significant changes (\u003cem\u003eP\u003c/em\u003e=.67) in the type of analgesic used or the dosage used (\u003cem\u003eP\u003c/em\u003e=.72) between baseline and the third menstrual period. Overall, use of self-management for menstrual symptoms increased from 65% of participants at baseline to 86% at the third menstrual period.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan lang=\"EN-AU\"\u003eAt the end of the one-month follow up, 60% of participants reported that the resource changed the way they managed their menstrual symptoms, and 85% would keep using at least one of the self-care practices they had learned.\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan lang=\"EN-AU\"\u003e[INSERT TABLE 3]\u003c/span\u003e\u003c/p\u003e\n\u003ch3\u003e3\u003cem\u003e.2 \u0026nbsp;\u003c/em\u003eMenstrual pain and symptoms\u003c/h3\u003e\n\u003cp\u003e\u003cspan lang=\"EN-AU\"\u003eThose with a diagnosis of endometriosis (n=18) had a significantly (\u003cem\u003eP\u003c/em\u003e=.005) higher menstrual pain score at baseline (7.7) compared to those without (n=57) a diagnosis of endometriosis (5.6). Overall, there was a small, non-significant (\u003cem\u003eP\u003c/em\u003e=.22) decrease in menstrual pain from 6.1 (1.9) at baseline to 5.3 (2.2) at the end of the three months. At one-month follow up, 4% said their menstrual symptoms were \u0026lsquo;very much better\u0026rsquo;, 1 in 5 (20%) said their menstrual symptoms were \u0026lsquo;much better\u0026rsquo; than before they started, almost half (46%) said \u0026lsquo;a little better\u0026rsquo;, and just over one-quarter (28.6%) said no change.\u003c/span\u003e\u003c/p\u003e\n\u003ch3\u003e3\u003cem\u003e.3 \u0026nbsp;\u003c/em\u003eInternal health locus of control\u003c/h3\u003e\n\u003cp\u003e\u003cspan lang=\"EN-AU\"\u003eThere was a small, non-significant (\u003cem\u003eP\u003c/em\u003e=.24) increase in mean internal health locus of control (IHLoC) scores from 29.19 (3.39) at baseline to 29.96 (3.25) at one-month follow up.\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003ch3\u003e3\u003cem\u003e.4 \u0026nbsp;\u003c/em\u003eHealth literacy measures\u003c/h3\u003e\n\u003cp\u003e\u003cspan lang=\"EN-AU\"\u003eTable 4 outlines the changes in Pam Activation Measure (PAM) levels and Health Literacy Questionnaire (HLQ) scores. Table 5 details the percentage of reliable change in the Health Education Impact Questionnaire (heiQ) scores.\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan lang=\"EN-AU\"\u003e[INSERT TABLES 4 AND 5]\u003c/span\u003e\u003c/p\u003e\n\u003ch3\u003e3\u003cem\u003e.5 \u0026nbsp;\u003c/em\u003eMenstrual health literacy\u003c/h3\u003e\n\u003cp\u003e\u003cspan lang=\"EN-AU\"\u003ePrior to beginning the study at baseline, only one-quarter of the participants (25%) felt that they had sufficient information about their period and its symptoms, with just over half (53%) reporting that they had some information but felt unsure about a number of aspects, with 15% being unsure if they had enough information at all. At the end of the follow-up period, 59% of participants indicated that they felt they had sufficient information about their period and its symptoms, 35% reported that they had some information but felt unsure about a number of aspects, with 6% being unsure if they had enough information at all.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan lang=\"EN-AU\"\u003eAt baseline, when asked about specific aspects of menstrual health, 60% of the participants indicated that they knew the signs of HMB, and 69% could identify the symptoms of endometriosis. At follow up, 87% could identify the signs of HMB, and 94% could identify the symptoms of endometriosis.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eAt the end of the follow up, just under half of the participants (48.8%) said the resource had changed what they thought was a \u0026lsquo;normal\u0026rsquo; period, and over one-third (35%) said it corrected previous misunderstandings they had about periods and the menstrual cycle.\u0026nbsp;After using the resource, 65% said they were now \u0026lsquo;very comfortable\u0026rsquo; talking about periods to others\u003cspan lang=\"EN-AU\"\u003e.\u003c/span\u003e\u003c/p\u003e\n\u003ch3\u003e3\u003cem\u003e.6 \u0026nbsp;\u003c/em\u003eParticipant satisfaction\u003c/h3\u003e\n\u003cp\u003e\u003cspan lang=\"EN-AU\"\u003eEighty-five percent of the participants found the web-based resource easy to use, and 90% found the information provided \u0026lsquo;very helpful\u0026rsquo;. One-quarter of the participants (25%) were \u0026lsquo;very satisfied\u0026rsquo; with the changes in their symptoms, and over one-third (34%) were moderately satisfied. Only one participant was unsatisfied.\u0026nbsp;\u003c/span\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cspan lang=\"EN-AU\"\u003eOur study found that access to an online resource for three menstrual cycles could improve some key aspects of menstrual health literacy, encourage engagement with medical professionals, and provide improved understanding of both a \u0026lsquo;normal\u0026rsquo; menstrual cycle and how to identify problematic menstrual conditions, such as endometriosis and HMB.\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eThere was an increased uptake of self-care measures over the course of the study, especially in breathing/meditation exercises and acupressure, which were low at baseline. There is some preliminary evidence that mindfulness-style interventions reduce menstrual pain\u0026nbsp;(25, 26), and there is evidence for both mindfulness and acupressure for reducing PMS symptoms\u0026nbsp;(19, 27). Exercise has the most significant reduction in pain compared to other self-care measures, such as heat\u0026nbsp;(17), but uptake was lower than other forms of self-care. This may be because our resource aimed to increase health literacy; content was not included to support behavior change. Incorporating behavior change theory-based content, such as stepping individuals through use of behavior change techniques\u0026nbsp;(28, 29)\u0026nbsp;(e.g., using self-monitoring, setting goals, social support, and/or adding behavior change support intervention methods in addition to the online platform, e.g., face-to-face methods), could further enhance efficacy of the resource in regards to changing behaviors of seeking health care and using self-management strategies, such as exercise. Our team are working to develop such support, including testing of a menstrual pain behavior app\u0026nbsp;(30). Despite the increased uptake of these self-care measures, we did not find evidence of a clinically significant reduction in menstrual pain; however, it is important to note that this study was not powered to detect any such change if it did exist. The pain score itself is also unlikely to capture the complete spectrum of bothersome menstrual symptoms, such as emotional changes\u0026nbsp;(6)\u003cspan lang=\"EN-AU\"\u003e, which may explain why, despite lack of a significant pain reduction, over half of the participants rated their menstrual symptoms as at least slightly improved.\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eThe addition of a menstrual disturbance self-screening tool (PIPPA) to menstrual education in this study demonstrated health-seeking behavior by women to GPs and reported action by GPs to refer some participants to gynecologists. Young women commonly report GPs\u0026rsquo; dismission of pain and interference-related menstrual disturbance\u0026nbsp;(31, 32), which can cause reluctance to engage with health-care professionals\u0026nbsp;(6). In this study, the addition of a letter to GPs with PIPPA scores and explanation of relevance may have provided reverse education of GPs to take seriously young women\u0026rsquo;s reports of menstrual disturbance. The action by GPs to refer women to gynecologists may have been facilitated by the combination of a high PIPPA score, providing external validation of pain and interference, and women\u0026rsquo;s increased menstrual health literacy and confidence to present to GPs. Given that over half of young Australian women report symptoms of non-cyclical pelvic pain but also normalize these symptoms\u0026nbsp;(3), ensuring that these young women are advised and empowered to seek medical advice is vital so that lengthy diagnostic delays are reduced\u0026nbsp;(33, 34)\u003cspan lang=\"EN-AU\"\u003e.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eCertain aspects of health literacy related to agency, empowerment, and improved health management skills all increased during the study period. The significant improvement in the \u0026ldquo;Having sufficient information to manage my health\u0026rdquo; domain of the HLQ corresponds to \u0026ldquo;Feel(ing) confident that they have all the information that they need to live with, and manage, their condition and to make decisions\u0026rdquo;\u0026nbsp;(35). Several domains of the heiQ also showed reliable improvement, with the largest improvement in the skills and technique acquisition domain; improvement in this domain relates to \u0026ldquo;highly developed skills in symptom relief and techniques to manage own health\u0026rdquo;\u0026nbsp;(36). The proportion of reliable positive change in our participants was similar across most domains to previous research on the impact of chronic disease management programs in Australia between 2007-2013\u0026nbsp;(37), suggesting that, despite the online nature and minimal interaction between the research team and participants, or between participants themselves, it was similarly effective to more \u0026lsquo;traditional\u0026rsquo; programs. Interestingly, despite these improvements there was no corresponding improvement in the IHLoC scores over the course of the trial, but the IHLoC scores both at baseline and the end of study were similar to previous data on those with and without a chronic health condition\u0026nbsp;(38)\u003cspan lang=\"EN-AU\"\u003e, suggesting that these scores were already in the normal range.\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eThese findings illustrate that a relatively large number of young people are not receiving accurate information in schools (from neither parents nor health-care professionals), information is not being delivered in a suitable manner, or they are missing the information they need. Previous research in Australia has shown that when discussing a condition, such as endometriosis, young women wanted to know specific symptoms rather than vague or general information\u0026nbsp;(39). Focusing on high schools, the HPE syllabus does not directly address menstrual health education. Content covered in the later years is linked to sexual and reproductive health through the focus area \u0026lsquo;Relationships and Sexuality\u0026rsquo;, which aims to explore resources and strategies to manage personal, physical and social changes, and transitions associated with puberty as they grow older\u0026nbsp;(10)\u003cspan lang=\"EN-AU\"\u003e. In the later years (years 9 and 10), the focus of this content shifts to sexuality and sexual health education, leaving it to the teacher\u0026rsquo;s discretion to incorporate this content at all or in an effective manner beyond personal experience or from a biological lens. Given the significant number of participants attending co-educational schools (80%), the findings of this study reveal gaps in the HPE curriculum between the menstrual health education delivered in school and what information is needed to develop young people\u0026rsquo;s menstrual health literacy.\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eWe recommend a whole-school approach to develop menstrual health literacy and strategies to support students, teachers, and school staff to promote menstrual health and well-being. This research indicates the need for greater emphasis on menstrual health in HPE classes. Menstrual health education needs to focus on correcting mistaken assumptions about a \u0026lsquo;normal\u0026rsquo; period or menstrual cycle and provide sufficient information about periods, their symptoms, and menstrual management, including self-care options and when to consult a doctor. To develop young peoples\u0026apos; menstrual health literacy within the critical dimension, the HPE curriculum needs to provide menstrual health education that empowers students to selectively access, and critically analyze, menstrual health information and take action to promote their menstrual health\u0026nbsp;(10)\u003cspan lang=\"EN-AU\"\u003e. Such information could potentially help to alleviate not only dysmenorrhea and related menstrual symptoms but could, by extension, increase their ability to engage fully in the classroom and extra-curricular activities. The provision of an online resource, such as the one reported in this paper, offers young people and teachers additional information that they could access autonomously. Providing such a resource would ensure critical information was more broadly disseminated and independent of individual teacher capacity. Furthermore, such a tool provides young women with the knowledge to take charge of their health. Ideally, use of such a resource would be accompanied by professional learning for teachers and potentially parents and carers of young women to ensure that the health literacy messages received by young women are aligned.\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eTranslational capacity of interventions is essential to consider when designing and evaluating health interventions to ensure follow through to sustainable policy and practice change from research settings. The Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework\u0026nbsp;(40)\u0026nbsp;is one of the most commonly used implementation science frameworks. Regarding the current study, reach into the intended target population (e.g., total number of eligible women that were exposed to the intervention invite), adoption of the intervention (e.g., number of women out of the total potential eligible sample who joined the study) and implementation of the intervention (e.g., how the intervention was used, such as number of hours of engagement and with which elements of the online resource) were not determined. A range of social media sources were used to recruit women making it challenging to identify the total potential sample, and the online platform used for resource delivery did not capture analytics to inform use and engagement with the resource. This study was a short evaluation study, thus, long-term engagement with the resource (maintenance) was not explored. Our evaluation tools did, however, detect meaningful changes in some outcomes suggesting that further testing is warranted to explore full scale, long-term effectiveness, and implementation processes in a rigorous trial. Future work should also collect in-depth, qualitative data from resource users (e.g., women) and stakeholders (e.g., teachers) to explore how and why outcomes changed the way they did over time\u0026nbsp;(41)\u003cspan lang=\"EN-AU\"\u003e.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eWe have suggested that high schools may be an appropriate place to reach young women. However, consideration of other settings to promote the resource in women, and important influencers of women beyond high school, should also be considered (e.g., through universities, pharmacies, health-care settings, community groups, and other social marketing strategies). We did not collect data on ethnicity, educational level, or socio-economic status, which are associated with health disparities, potentially through health literacy(42, 43). It may be that our resources would require tailoring to particular groups, which will need exploration in the future. For example, peer support (support from someone with similar characteristics to the individual and with experiential knowledge) has been shown to be particularly effective for lifestyle behavior change in culturally diverse communities\u0026nbsp;(44)\u003cspan lang=\"EN-AU\"\u003e; thus, expanding on our current resource to add an element of peer support may be necessary to engage with such communities.\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan lang=\"EN-AU\"\u003eThere are several strengths to this study including the use of validated health literacy questionnaires and the previously validated PIPPA tool to encourage engagement with health professionals. However, some important limitations must be acknowledged. Firstly, this is a pilot study and, therefore, was not powered to detect small, even if clinically relevant, changes between baseline to end of trial. Secondly, due to budget constraints and internal University policy, the web-based resource was hosted on the University web platform. This platform lacks many of the features of the \u0026ldquo;modern\u0026rdquo; Web 2.0 and, therefore, data on which pages were interacted with, for how long, and what video clips received the most views, was not able to be retrieved. Therefore, we are unable to determine how much actual engagement with the material there was. Future versions of this content will be hosted on modern platforms that will allow the research team to use analytics to help optimize content. Finally, outcomes of the visit to GPs or gynecologists are unknown; therefore, we are unsure about how many participants, if any, received a further diagnosis, such as endometriosis, for their symptoms.\u0026nbsp;\u003c/span\u003e\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003e\u003cspan lang=\"EN-AU\"\u003eA web-based resource, with minimal setup and ongoing costs, can provide clinically relevant improvements in health literacy, remedy previous misconceptions about menstruation, and increase awareness and up-take of evidence-based self-care methods. The PIPPA tool was a simple, but effective, means of empowering and encouraging visits to health professionals. Future research should explore the most acceptable way to deliver this information, and to ensure that not only young people, but their teachers and parents/guardians, have access to accurate, evidence-based information on menstruation and its management.\u0026nbsp;\u003c/span\u003e\u003c/p\u003e"},{"header":"References","content":"\u003cp\u003e1.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Armour M, Parry K, Manohar N, Holmes K, Ferfolja T, Curry C, et al. The Prevalence and Academic Impact of Dysmenorrhea in 21,573 Young Women: A Systematic Review and Meta-Analysis. J Womens Health (Larchmt). 2019;28(8):1161-71. Epub 2019/06/07. doi: 10.1089/jwh.2018.7615. PubMed PMID: 31170024.\u003c/p\u003e\n\u003cp\u003e2.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Friberg B, Orno AK, Lindgren A, Lethagen S. Bleeding disorders among young women: a population-based prevalence study. Acta Obstet Gynecol Scand. 2006;85(2):200-6. 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PubMed PMID: 30107564.\u003c/p\u003e\n\u003cp\u003e44.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Fisher EB, Boothroyd RI, Coufal MM, Baumann LC, Mbanya JC, Rotheram-Borus MJ, et al. Peer support for self-management of diabetes improved outcomes in international settings. Health Aff (Millwood). 2012;31(1):130-9. doi: 10.1377/hlthaff.2011.0914. PubMed PMID: 22232103.\u003c/p\u003e\n\u003cp\u003e45.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Wallston KA, Wallston BS, DeVellis R. Development of the Multidimensional Health Locus of Control (MHLC) Scales. Health Educ Monogr. 1978;6(2):160-70. Epub 1978/01/01. doi: 10.1177/109019817800600107. PubMed PMID: 689890.\u003c/p\u003e\n\u003cp\u003e46. \u0026nbsp; \u0026nbsp; \u0026nbsp; Hibbard JH, Stockard J, Mahoney ER, Tusler M. Development of the Patient Activation Measure (PAM): conceptualizing and measuring activation in patients and consumers. Health services research. 2004;39(4p1):1005-26.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cspan lang=\"EN-AU\"\u003eAcknowledgments\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFunding for this study was provided as part of a WSU partnership grant between Western Sydney University and Kimberly-Clark Australia.\u0026nbsp;The sponsor of the study had no role in the data collection, analysis, or interpretation of the manuscript.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThank you to all those organisations who promoted this on their social media including\u0026nbsp;Family Planning NSW, Endometriosis Australia, ACHPER, and Kimberly-Clark Australia.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan lang=\"EN-AU\"\u003eAll authors contributed significantly to this work. MA, CC, TF, CS, KH and FM designed the study. MA and KP performed the data collection and statistical analysis, MA, CC, TF, CS, MP, KH and FM interpreted the data. MA and TF drafted the article. KP, CC, TF, CS, KH, MP, TF and FM all contributed to critical revisions on the manuscript. All authors reviewed the manuscript and approved the final draft.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cspan lang=\"EN-AU\"\u003eCompeting Interests\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no competing interests to report.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan lang=\"EN-AU\"\u003eThe datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/span\u003e\u003c/p\u003e"},{"header":"Tables","content":"\u003ctable style=\"border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd bgcolor=\"#FFFF00\" colspan=\"2\" style=\"width: 467.5pt;border: 1pt solid windowtext;background: rgb(231, 230, 230) none repeat scroll 0% 0%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003eTimepoint:\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003cspan style='font-size:13px;line-height: 115%;font-family:\"Arial\",sans-serif;color:black;'\u003eBaseline and at the conclusion of each of the three menstrual periods during the study.\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:134.45pt;border:solid windowtext 1.0pt;border-top: none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;font-style:italic;'\u003eMenstrual pain/dysmenorrhea severity\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 333.05pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003eA single 0-10 numeric rating scale (NRS) for overall menstrual pain.\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:134.45pt;border:solid windowtext 1.0pt;border-top: none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;font-style:italic;'\u003eAnalgesic usage\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 333.05pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003eType of analgesic and dosage catagorised as \u0026lsquo;more than recommended on box\u0026rsquo;, \u0026lsquo;same as recommended on box\u0026rsquo;.\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:134.45pt;border:solid windowtext 1.0pt;border-top: none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;font-style:italic;'\u003eSelf-management\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 333.05pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003eTypes of self-management used during the most recent menstrual period.\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd bgcolor=\"#FFFF00\" colspan=\"2\" style=\"width: 467.5pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;background: rgb(231, 230, 230) none repeat scroll 0% 0%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;font-weight: bold;'\u003eTimepoint:\u003c/span\u003e\u003c/strong\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;'\u003e\u0026nbsp;Baseline and end of study.\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:134.45pt;border:solid windowtext 1.0pt;border-top: none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;font-style:italic;'\u003eInternal Health Locus of Control (IHLoC)\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 333.05pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003eIHLoC is a measure of how much control individuals feel that they can exert over their own health was collected at baseline and end of trial\u0026nbsp;\u003c/span\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e(45)\u003c/span\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e.\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:134.45pt;border:solid windowtext 1.0pt;border-top: none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;font-style:italic;'\u003ePatient Activation Measure (PAM)\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 333.05pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003ePAM draws on concepts such as health locus of control, self-efficacy in managing health behaviours and readiness to change health behaviours, but is not condition or behaviour specific\u0026nbsp;\u003c/span\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e(46)\u003c/span\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e. PAM scores are used to generate one of four levels, in order of increasing levels of activation; from Level 1 suggesting that the person does not yet understand their role in health care up to Level 4 indicating that the person is proactive and engaged in recommended health behaviours.\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:134.45pt;border:solid windowtext 1.0pt;border-top: none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003eHealth Literacy Questionnaire (HLQ)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 333.05pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003eThe Health Literacy Questionnaire (HLQ) consists of 44 questions and can be either self-administered or orally administered. The HLQ identifies the specific health literacy strengths and limitations of people and communities. It examines nine areas of health literacy. Research has shown the HLQ is a robust independent measure of each of the nine identified health literacy dimensions\u0026nbsp;\u003c/span\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e(35)\u003c/span\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e.\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:134.45pt;border:solid windowtext 1.0pt;border-top: none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003eHealth Education Impact Questionnaire (heiQ)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 333.05pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003eThe Health Education Impact Questionnaire (heiQ) is a perception- and evaluation-based measure that was developed to be a user-friendly, relevant and psychometrically sound instrument for the comprehensive evaluation of patient education programs and activities\u0026nbsp;\u003c/span\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e(36)\u003c/span\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e.\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd bgcolor=\"#FFFF00\" colspan=\"2\" style=\"width: 467.5pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;background: rgb(231, 230, 230) none repeat scroll 0% 0%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;'\u003e\u003cstrong\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;font-weight:bold;'\u003eTimepoint:\u003c/span\u003e\u003c/strong\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;'\u003e\u0026nbsp;At one-month follow up.\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:134.45pt;border:solid windowtext 1.0pt;border-top: none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003eTrial Exit Questionaaire\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 333.05pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003eThe trial exit questionnaire collected participant satisfaction, use of self-care, changes in understanding of menstruation, and information on visits to medical practitioners.\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd bgcolor=\"#FFFF00\" colspan=\"2\" style=\"width:467.5pt;border:solid windowtext 1.0pt;border-top:none;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;'\u003e\u003cstrong\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;font-weight:bold;'\u003eTimepoint:\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;'\u003eBaseline.\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:134.45pt;border:solid windowtext 1.0pt;border-top: none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003ePeriod ImPact and Pain Assessment Tool (PIPPA)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 333.05pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:115%;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003eA 5-item dichotomous Yes/No survey to measure pain and interference related menstrual disturbance\u0026nbsp;\u003c/span\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e(4, 22)\u003c/span\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e.\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:107%;'\u003e\u003cstrong\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:107%;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:107%;'\u003e\u003cstrong\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:107%;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003eTable 1.\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:107%;font-family:\"Arial\",sans-serif;'\u003eOutcome measures by timepoint.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ctable style=\"border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width:382.5pt;border:solid windowtext 1.0pt;border-bottom:solid windowtext 1.5pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;text-align:center;'\u003e\u003cstrong\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003eN = 75\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.0pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.5pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cstrong\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003eMean (SD)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd bgcolor=\"#FFFF00\" colspan=\"2\" style=\"width:382.5pt;border:solid windowtext 1.0pt;border-top:none;background: #E7E6E6;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;text-align:right;'\u003e\u003cstrong\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;font-weight: bold;'\u003eAge (y)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width:85.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cspan style='font-size:13px;line-height: 115%;font-family:\"Arial\",sans-serif;color:black;'\u003e20 (3.4)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width:382.5pt;border:solid windowtext 1.0pt;border-top:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;text-align:right;'\u003e\u003cstrong\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003eAge at menarche (y)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e12 (1.7)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width:382.5pt;border-top:none;border-left: solid windowtext 1.0pt;border-bottom:solid windowtext 1.5pt;border-right: solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cstrong\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.5pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cstrong\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003eN (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd bgcolor=\"#FFFF00\" rowspan=\"3\" style=\"width:240.75pt;border:solid windowtext 1.0pt;border-top:none;background: #E7E6E6;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;text-align:right;'\u003e\u003cstrong\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;font-weight: bold;'\u003eOccupation\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width:141.75pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;font-style:italic;'\u003eAt school or university\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width:85.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cspan style='font-size:13px;line-height: 115%;font-family:\"Arial\",sans-serif;color:black;'\u003e45 (60%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width:141.75pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;font-style:italic;'\u003eWorking for pay\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width:85.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cspan style='font-size:13px;line-height: 115%;font-family:\"Arial\",sans-serif;color:black;'\u003e26 (34.7%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width:141.75pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;font-style:italic;'\u003eOther\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width:85.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cspan style='font-size:13px;line-height: 115%;font-family:\"Arial\",sans-serif;color:black;'\u003e4 (5.3%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width:240.75pt;border:solid windowtext 1.0pt;border-top:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;text-align:right;'\u003e\u003cstrong\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003eResponse to \u0026ldquo;I think my periods are normal\u0026rdquo;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:141.75pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;font-style:italic;'\u003eYes\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e48 (64%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:141.75pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;font-style:italic;'\u003eNo\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e21 (28%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:141.75pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;font-style:italic;'\u003eUnsure\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e6 (8%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd bgcolor=\"#FFFF00\" rowspan=\"2\" style=\"width:240.75pt;border:solid windowtext 1.0pt;border-top:none;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;text-align:right;'\u003e\u003cstrong\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;font-weight: bold;'\u003eRegular Dysmenorrhea\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width:141.75pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;font-style:italic;'\u003eYes\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width:85.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cspan style='font-size:13px;line-height: 115%;font-family:\"Arial\",sans-serif;color:black;'\u003e74 (98.7%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width:141.75pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;font-style:italic;'\u003eNo\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width:85.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cspan style='font-size:13px;line-height: 115%;font-family:\"Arial\",sans-serif;color:black;'\u003e1 (1.3%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"15\" style=\"width:240.75pt;border:solid windowtext 1.0pt;border-top:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;text-align:right;'\u003e\u003cstrong\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003eCurrent pain management\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:141.75pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;font-style:italic;'\u003eAnalgesic medication\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e63 (84%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:141.75pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;font-style:italic;'\u003eContraceptives\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e22 (29.3%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:141.75pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;font-style:italic;'\u003eRest\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e63 (84%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:141.75pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;font-style:italic;'\u003eHeat\u0026nbsp;\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e66 (88%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:141.75pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;font-style:italic;'\u003eYoga\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e9 (12%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:141.75pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;font-style:italic;'\u003eAcupressure\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e4 (5.3%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:141.75pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;font-style:italic;'\u003ePilates\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:141.75pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;font-style:italic;'\u003eLow intensity exercise\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e22 (29.3%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:141.75pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;font-style:italic;'\u003eResistance exercise\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e4 (5.3%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:141.75pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;font-style:italic;'\u003eHigh intensity exercise\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e8 (10.7%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:141.75pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;font-style:italic;'\u003eMeditation\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e12 (16%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:141.75pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;font-style:italic;'\u003eHerbal medicine\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e14 (18.7%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:141.75pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;font-style:italic;'\u003ePrayer\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e4 (5.3%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:141.75pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;font-style:italic;'\u003eDietary changes\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e11 (14.7%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:141.75pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;font-style:italic;'\u003eOther\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e3 (4%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd bgcolor=\"#FFFF00\" rowspan=\"10\" style=\"width:240.75pt;border:solid windowtext 1.0pt;border-top:none;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;text-align:right;'\u003e\u003cstrong\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;font-weight: bold;'\u003eSources of information on menstruation\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width:141.75pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;font-style:italic;'\u003eMum\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width: 85pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;background: rgb(231, 230, 230) none repeat scroll 0% 0%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cspan style='font-size:13px;line-height: 115%;font-family:\"Arial\",sans-serif;color:black;'\u003e57 (76%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width:141.75pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;font-style:italic;'\u003eDad\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width: 85pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;background: rgb(231, 230, 230) none repeat scroll 0% 0%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cspan style='font-size:13px;line-height: 115%;font-family:\"Arial\",sans-serif;color:black;'\u003e1 (1.3%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width:141.75pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;font-style:italic;'\u003eFemale relatives\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width: 85pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;background: rgb(231, 230, 230) none repeat scroll 0% 0%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cspan style='font-size:13px;line-height: 115%;font-family:\"Arial\",sans-serif;color:black;'\u003e26 (34.7%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width:141.75pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;font-style:italic;'\u003eHPE teacher\u003csup\u003ea\u003c/sup\u003e\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width: 85pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;background: rgb(231, 230, 230) none repeat scroll 0% 0%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cspan style='font-size:13px;line-height: 115%;font-family:\"Arial\",sans-serif;color:black;'\u003e15 (20%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width:141.75pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;font-style:italic;'\u003eDoctor\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width: 85pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;background: rgb(231, 230, 230) none repeat scroll 0% 0%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cspan style='font-size:13px;line-height: 115%;font-family:\"Arial\",sans-serif;color:black;'\u003e34 (45.3%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width:141.75pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;font-style:italic;'\u003eFriends\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width: 85pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;background: rgb(231, 230, 230) none repeat scroll 0% 0%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cspan style='font-size:13px;line-height: 115%;font-family:\"Arial\",sans-serif;color:black;'\u003e32 (42.7%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width:141.75pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;font-style:italic;'\u003eSocial media\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width: 85pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;background: rgb(231, 230, 230) none repeat scroll 0% 0%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cspan style='font-size:13px;line-height: 115%;font-family:\"Arial\",sans-serif;color:black;'\u003e17 (22.7%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width:141.75pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;font-style:italic;'\u003eMagazines\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width: 85pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;background: rgb(231, 230, 230) none repeat scroll 0% 0%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cspan style='font-size:13px;line-height: 115%;font-family:\"Arial\",sans-serif;color:black;'\u003e14 (18.7%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width:141.75pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;font-style:italic;'\u003eGoogle search\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width: 85pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;background: rgb(231, 230, 230) none repeat scroll 0% 0%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cspan style='font-size:13px;line-height: 115%;font-family:\"Arial\",sans-serif;color:black;'\u003e36 (48%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width:141.75pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;font-style:italic;'\u003eOther\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width: 85pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;background: rgb(231, 230, 230) none repeat scroll 0% 0%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cspan style='font-size:13px;line-height: 115%;font-family:\"Arial\",sans-serif;color:black;'\u003e7 (9.3%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:normal;text-align:justify;'\u003e\u003csup\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003ea\u003c/span\u003e\u003c/sup\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;font-family:\"Arial\",sans-serif;'\u003eHealth and Physical Education teacher\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:150%;text-align:justify;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;font-style:italic;'\u003ePIPPA scores and medical visits:\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:150%;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003eTable 2.\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003eDemographics and menstrual characteristics.\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:150%;text-align:justify;'\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ctable style=\"width:109.86%;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:40.0%;border:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;text-align:center;'\u003e\u003cstrong\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003eModality\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:15.18%;border:solid windowtext 1.0pt;border-left:none;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;text-align:center;'\u003e\u003cstrong\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003eBaseline (n=73)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:15.2%;border:solid windowtext 1.0pt;border-left:none;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;text-align:center;'\u003e\u003cstrong\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003eCycle 1\u003cbr\u003e\u0026nbsp;(n=67)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:15.18%;border:solid windowtext 1.0pt;border-left:none;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;text-align:center;'\u003e\u003cstrong\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003eCycle 2\u003cbr\u003e\u0026nbsp;(n=59)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:14.46%;border:solid windowtext 1.0pt;border-left:none;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;text-align:center;'\u003e\u003cstrong\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003eCycle 3\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;text-align:center;'\u003e\u003cstrong\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e(n=56)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:40.0%;border:solid windowtext 1.0pt;border-top:none;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width:60.0%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;text-align:center;'\u003e\u003cstrong\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003eN (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width:40.0%;border:solid windowtext 1.0pt;border-top:none;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;font-style:italic;'\u003eHeat\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width:15.18%;border-top: none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;'\u003e42 (57.5%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width:15.2%;border-top: none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;'\u003e43 (64.2%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width:15.18%;border-top: none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;'\u003e36 (61%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width:14.46%;border-top: none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;'\u003e37 (66.1%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:40.0%;border:solid windowtext 1.0pt;border-top:none;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;font-style:italic;'\u003eExercise (low intensity e.g., yoga)\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:15.18%;border-top:none;border-left: none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;'\u003e22 (30.1%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:15.2%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;'\u003e40 (59.7%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:15.18%;border-top:none;border-left: none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;'\u003e33 (55.9%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:14.46%;border-top:none;border-left: none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;'\u003e23 (41.1%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width:40.0%;border:solid windowtext 1.0pt;border-top:none;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;font-style:italic;'\u003eExercise (high intensity e.g., running)\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width:15.18%;border-top: none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;'\u003e6 (8.2%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width:15.2%;border-top: none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;'\u003e12 (17.9%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width:15.18%;border-top: none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;'\u003e8 (13.6%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width:14.46%;border-top: none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;'\u003e11 (19.6%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:40.0%;border:solid windowtext 1.0pt;border-top:none;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;font-style:italic;'\u003eMeditation/breathing exercises\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:15.18%;border-top:none;border-left: none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;'\u003e11 (15.1%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:15.2%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;'\u003e20 (29.9%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:15.18%;border-top:none;border-left: none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;'\u003e25 (42.4%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:14.46%;border-top:none;border-left: none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;'\u003e28 (50%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width:40.0%;border:solid windowtext 1.0pt;border-top:none;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:115%;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;font-style:italic;'\u003eAcupressure\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width:15.18%;border-top: none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;'\u003e1 (1.4%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width:15.2%;border-top: none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;'\u003e17 (25.4%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width:15.18%;border-top: none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;'\u003e13 (22%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width:14.46%;border-top: none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;'\u003e11 (19.6%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:150%;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:150%;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003eTable 3.\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003eUsage of self-management strategies over time.\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:150%;text-align:justify;'\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ctable style=\"border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"border:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 150%;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border:solid windowtext 1.0pt;border-left:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 150%;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003eBaseline\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border:solid windowtext 1.0pt;border-left:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 150%;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003eEnd of trial\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"border:solid windowtext 1.0pt;border-top:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 150%;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 150%;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003eMedian (IQR)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 150%;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003eMedian (IQR)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"border:solid windowtext 1.0pt;border-top:none;padding:0in 5.4pt 0in 5.4pt;height:28.35pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 150%;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003ePatient Activation Measure (PAM) Level\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:28.35pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:150%;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003e3 (2-4)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:28.35pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:150%;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003e3 (2-4)\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"border:solid windowtext 1.0pt;border-top:none;padding:0in 5.4pt 0in 5.4pt;height:33.15pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 150%;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003eHealth Literacy Questionnaire (HLQ)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:33.15pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 150%;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003eMean (SD)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:33.15pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 150%;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003eMean (SD)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"border:solid windowtext 1.0pt;border-top:none;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 150%;text-align:justify;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;color:black;font-style:italic;'\u003eFeeling understood and supported by health-care providers (HPS)\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"border-top:none;border-left:none;border-bottom: solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;color:black;'\u003e3.05 (0.41)\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"border-top:none;border-left:none;border-bottom: solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;color:black;'\u003e3.12 (0.30)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"border:solid windowtext 1.0pt;border-top:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 150%;text-align:justify;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;font-style:italic;'\u003eHaving sufficient information to manage my health (HSI)\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:150%;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003e2.79 (0.47)\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:150%;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003e3.09 (0.21)\u003csup\u003ea\u003c/sup\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"border:solid windowtext 1.0pt;border-top:none;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 150%;text-align:justify;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;color:black;font-style:italic;'\u003eActively managing my health (AMH)\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"border-top:none;border-left:none;border-bottom: solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;color:black;'\u003e3.01 (0.38)\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"border-top:none;border-left:none;border-bottom: solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;color:black;'\u003e3.05 (0.35)\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"border:solid windowtext 1.0pt;border-top:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 150%;text-align:justify;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;font-style:italic;'\u003eSocial support for health (SS)\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:150%;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003e3.10 (0.55)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:150%;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003e3.09 (0.43)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"border:solid windowtext 1.0pt;border-top:none;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 150%;text-align:justify;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;color:black;font-style:italic;'\u003eAppraisal of health information (CA)\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"border-top:none;border-left:none;border-bottom: solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;color:black;'\u003e2.89 (0.55)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"border-top:none;border-left:none;border-bottom: solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;color:black;'\u003e3.04 (0.44)\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"border:solid windowtext 1.0pt;border-top:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 150%;text-align:justify;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;font-style:italic;'\u003eAbility to actively engage with health-care providers (AE)\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:150%;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003e3.64 (0.59)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:150%;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003e3.74 (0.50)\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"border:solid windowtext 1.0pt;border-top:none;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 150%;text-align:justify;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;color:black;font-style:italic;'\u003eNavigating the health-care system (NHS)\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"border-top:none;border-left:none;border-bottom: solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;color:black;'\u003e3.58 (0.65)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"border-top:none;border-left:none;border-bottom: solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;color:black;'\u003e3.69 (0.57)\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"border:solid windowtext 1.0pt;border-top:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 150%;text-align:justify;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;font-style:italic;'\u003eAbility to find good health information (FHI)\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:150%;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003e3.78 (0.62)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:150%;'\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003e3.89 (0.44)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"border:solid windowtext 1.0pt;border-top:none;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 150%;text-align:justify;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;color:black;font-style:italic;'\u003eUnderstand health information well enough to know what to do (UHI)\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"border-top:none;border-left:none;border-bottom: solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;color:black;'\u003e4.14 (0.52)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"border-top:none;border-left:none;border-bottom: solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#E7E6E6;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;color:black;'\u003e4.14 (0.49)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style='margin-right:0in;margin-left:5.0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:150%;text-align:justify;text-indent:.5in;'\u003e\u003csup\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003ea\u003c/span\u003e\u003c/sup\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;font-style:italic;'\u003eP\u003c/span\u003e\u003c/em\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003e=.02\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:150%;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003eTable 4:\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003eHealth literacy outcomes.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ctable style=\"border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:184.05pt;border:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:283.45pt;border:solid windowtext 1.0pt;border-left: none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003ePercentage of participants with reliable positive change\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003ebetween baseline and end of trial\u003csup\u003ea\u003c/sup\u003e\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width: 184.05pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;background: rgb(231, 230, 230) none repeat scroll 0% 0%;padding: 0in 5.4pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;font-style:italic;'\u003eHealth-directed Behaviour\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width: 283.45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;background: rgb(231, 230, 230) none repeat scroll 0% 0%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;'\u003e12.7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 184.05pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;font-style:italic;'\u003ePositive \u0026amp; Active Engagement in Life\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 283.45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;'\u003e10.9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width: 184.05pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;background: rgb(231, 230, 230) none repeat scroll 0% 0%;padding: 0in 5.4pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;font-style:italic;'\u003eSelf-monitoring and Insight\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width: 283.45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;background: rgb(231, 230, 230) none repeat scroll 0% 0%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;'\u003e14.5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 184.05pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;font-style:italic;'\u003eConstructive Attitudes \u0026amp; Approaches\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 283.45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;'\u003e16.4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width: 184.05pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;background: rgb(231, 230, 230) none repeat scroll 0% 0%;padding: 0in 5.4pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;font-style:italic;'\u003eSkill and Technique Acquisition\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width: 283.45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;background: rgb(231, 230, 230) none repeat scroll 0% 0%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;'\u003e40.0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 184.05pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;font-style:italic;'\u003eSocial Integration \u0026amp; Support\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 283.45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;'\u003e14.5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width: 184.05pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;background: rgb(231, 230, 230) none repeat scroll 0% 0%;padding: 0in 5.4pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;font-style:italic;'\u003eHealth Services Navigation\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd bgcolor=\"#FFFF00\" style=\"width: 283.45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;background: rgb(231, 230, 230) none repeat scroll 0% 0%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;'\u003e20.0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 184.05pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cem\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;font-style:italic;'\u003eEmotional Distress\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 283.45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:0in;line-height: 115%;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;color:black;'\u003e21.8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:150%;text-align:justify;'\u003e\u003csup\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003ea\u0026nbsp;\u003c/span\u003e\u003c/sup\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003ereliable positive change is based on an effect size of 0.5 or greater.\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin-right:0in;margin-left:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-bottom:8.0pt;line-height:150%;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;font-weight:bold;'\u003eTable 5:\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003cspan lang=\"EN-AU\" style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003eHealth education impact questionnaire outcome (heiQ).\u003c/span\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","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":"Dysmenorrhea, health literacy, internet, menstruation, self-care, endometriosis","lastPublishedDoi":"10.21203/rs.3.rs-1247940/v2","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1247940/v2","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eMenstrual cycle-related conditions, such as dysmenorrhea and heavy bleeding, are common amongst those under 25 years. Despite having significant impact on work, education, and social activities, most do not seek medical advice, preferring to self-manage their symptoms. We\u003cem\u003e \u003c/em\u003eaimed to determine if access to a web-based resource could improve health literacy, reduce menstrual symptoms, and encourage health-seeking behavior in those at risk of conditions, such as endometriosis. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e People were eligible to participate if they were currently living in Australia, aged 14-25 years, and had menstruated for at least 12 months. Access to the resource, comprising evidence-based information on the menstrual cycle, the Period ImPact and Pain Assessment (PIPPA) tool, and guidance on self-care options, was provided for three menstrual cycles. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Seventy-five participants with a mean age of 20.4 years enrolled to use the web-based resource. Forty-three percent visited their doctor regarding their menstrual symptoms during the study period, with 84% indicating that they made the appointment due to the resource; over half (56%) who visited their doctor received a referral to a gynecologist. There were clinically relevant improvements in health literacy reflecting improved confidence of participants regarding having both adequate information and skills to manage their symptoms. Almost half (48.8%) said the resource had changed what they thought was a ‘normal’ period, and 94% could now identify symptoms of endometriosis. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e \u0026nbsp;A low-cost, web-based resource can improve health literacy, provide effective options for self-management of menstrual cycle-related conditions, and motivate young people to seek medical advice.\u003c/p\u003e","manuscriptTitle":"Evaluation of a web-based resource to improve menstrual health literacy and self-management in young women","msid":"","msnumber":"","nonDraftVersions":[{"code":2,"date":"2022-03-31 03:46:40","doi":"10.21203/rs.3.rs-1247940/v2","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}},{"code":1,"date":"2022-01-20 17:33:19","doi":"10.21203/rs.3.rs-1247940/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":"35baf62d-692d-451d-949e-013cac4ab3f3","owner":[],"postedDate":"March 31st, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":11487985,"name":"Health Economics \u0026 Outcomes Research"}],"tags":[],"updatedAt":"2022-03-28T20:44:16+00:00","versionOfRecord":[],"versionCreatedAt":"2022-03-31 03:46:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v2","identity":"rs-1247940","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1247940","identity":"rs-1247940","version":["v2"]},"buildId":"WvIrzKhiLBfengagbw6Ux","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}