Menstruation is a natural process in girls, but sometimes it is accompanied by beliefs and behaviors with cultural roots that result in poor health consequences; this study aimed to consider perceptions of individual, families and community to current cultural beliefs, and to determine the effect of education based on the PEN-3 cultural model on students' menstrual health behaviors in Iran. Study had a mixed method design. In the qualitative phase, data were collected from students, their mothers and teachers through focused group discussion and in-depth interviews. In the quantitative phase, training was done in four 2-h sessions for intervention group. The data were collected immediately and 2 months after the training by a questionnaire and they were analyzed by Friedman and Wilcoxon non-parametric tests. Training was effective on all of the model structures and significantly increased mean score of the health behavior after training and 2 months later by 8.74 and 13.86, respectively, in intervention group (P<0.05). The perception and behavior of the others and access to sanitary services and products, especially cultural factors affect girls’' menstrual health behaviors, therefore, it is necessary to design the health plans regarding each of these factors, and the cultural context of each community.

中文翻译：

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基于PEN-3文化模型的教育对学生月经健康行为的影响：混合方法研究

月经是女孩的自然过程，但有时伴随着具有文化根源的信仰和行为，导致不良的健康后果；这项研究旨在考虑个人，家庭和社区对当前文化信仰的看法，并确定基于PEN-3文化模型的教育对伊朗学生月经健康行为的影响。研究采用了混合方法设计。在定性阶段，通过重点小组讨论和深入访谈从学生，他们的母亲和老师那里收集数据。在定量阶段，对干预组进行了四个为时2小时的培训。训练后和训练后两个月立即收集数据，并通过Friedman和Wilcoxon非参数检验进行分析。P <0.05）。他人的观念和行为以及获得卫生服务和产品的机会，尤其是文化因素，都会影响女孩的月经健康行为，因此，有必要针对这些因素以及每个社区的文化背景制定保健计划。