Effect of a creative drama-based educational ıntervention on menstrual attitudes and genital hygiene behaviors in adolescent girls: a randomized controlled trial

Background: This study aimed to determine the effect of training with creative drama techniques on menstrual attitudes and genital hygiene behaviors of early adolescents. Methods: We conducted a parallel-group randomized controlled trial at a public Science and Art Center among girls aged 10–14 (drama n = 32; control n = 32). The intervention comprised four weekly 60–75-min creative-drama sessions delivered by a certified facilitator using a pre-specified manual and fidelity checklists. Primary outcomes were the Genital Hygiene Behaviors Scale (GHB-S) and the Menstruation Attitude Scale (MAS). Post-test group differences were analyzed using independent samples t-tests, while within-group changes were assessed with paired t-tests. Logistic regression was conducted to examine the predictive effect of the intervention on outcomes. Results: At baseline, groups were similar across all measures (p > 0.05). After the intervention, the drama group showed significantly higher posttest scores. Genital Hygiene Behaviors improved from 81.06 ± 14.39 to 92.19 ± 10.66 (p = 0.001; d = 0.654), while the control group showed no significant change (p > 0.05). Menstruation attitudes also improved significantly in the intervention group (95.16 ± 11.89 → 107.91 ± 19.76, p = 0.042; d = 0.374), with no significant change in controls. Logistic regression showed that the intervention predicted improvements in both genital hygiene (OR = 0.958, p = 0.042) and menstruation attitudes (OR = 0.971, p = 0.033). Conclusions: Creative drama education effectively increases hygiene awareness, positively changing attitudes towards menstruation and developing correct hygiene behaviors. It also shows that it is a powerful educational tool that can support long-term behavioral changes related to hygiene. Trial registration: ClinicalTrials.gov NCT07026396; retrospectively registered on June 10, 2025, after data collection was completed due to administrative delays in obtaining institutional approval for trial registration.