# Adolescent boys’ sociocultural beliefs and attitudes toward menstruation in selected high schools in Ghana: Mediation and moderation effect of knowledge

## TL;DR

This study explores how adolescent boys in Ghana view menstruation and how their knowledge affects their attitudes and sociocultural beliefs.

## Contribution

The study identifies knowledge as a mediator and moderator in shaping adolescent boys' attitudes toward menstruation in Ghana.

## Key findings

- Adolescent boys with low knowledge showed more negative sociocultural beliefs and attitudes toward menstruation.
- Knowledge significantly reduced negative sociocultural beliefs and attitudes among the boys.
- Effective menstrual education can help reduce stigma and improve menstrual health outcomes for girls.

## Abstract

Adolescent boys can reinforce negative societal attitudes towards menstruation and make it difficult for adolescent girls to achieve optimal menstrual health and hygiene (MHH) which defeats Sustainable Development Goals 3, 5.1, 5.2 and 5.6. This study investigated how knowledge mediates/moderates the association between sociocultural beliefs (SB) and attitudes of adolescent boys regarding menstruation in senior high schools in Ghana. A cross-sectional study was conducted in five mix-sex public senior high schools (SHS) in Volta region, Ghana. Probability proportional to size was used to distribute 431 study subjects among the schools, and surveys were conducted using structured questionnaires. Structural equation modeling (SEM) and generalized least square (GLS) modeling were conducted. The mean age of the sample was 17.3 (±1.0). Majority (60.6%) were between 15–17 years old, and Christians (95.4%). Half of them had low knowledge; 38% had moderate, and 11% had high knowledge. Meanwhile, negative SB (55.2%) outweighed positive SB, which reflected in their attitudes towards menstruation with 52.7% exhibiting poor attitudes. The SEM revealed that knowledge had a significant negative effect on SB and attitudes, with coefficients of -0.06 (SE = 0.01, p < 0.001), and -0.28 (SE = 0.06, p < 0.001) respectively. The GLS model indicated that knowledge also moderates the relationship between SB and attitudes. Male students in Ghana have a tendency to stigmatize menstruation among their female counterparts because they have inadequate knowledge about it and this may affect the achievement of optimal MHH by their female colleagues. It is evident that effective menstrual education reduces negative attitudes.