Attitude as a Complete Mediator: Unraveling the Knowledge-Practice Paradox in Adolescent Menstrual Hygiene Management in Urban Ghana

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DOI: 10.21522/TIJAR.2014.13.02.Art007

Authors : Aba Appiah-Mensah Ampem, Hubert Amu

Abstract:

This study investigated the knowledge-attitude-practice relationships in menstrual hygiene management among 386 adolescent girls aged 10-19 years in the Greater Accra Region of Ghana, employing structural equation modeling to test mediating and moderating mechanisms. Results revealed substantial knowledge deficits with only 47.2 percent demonstrating good knowledge (mean score 10.8/20, 54.0 percent), while 56.7 percent exhibited good practices (mean 15.9/20, 79.5 percent) and 52.3 percent held positive attitudes (mean 3.97/5, 79.5 percent). Structural equation modeling demonstrated that knowledge did not directly predict practices (β equals 0.091, p equals 0.573) but influenced them indirectly through attitudes as a complete mediator (β equals 0.316, p less than 0.001), challenging traditional knowledge-deficit models. Parental guidance significantly moderated the knowledge-practice relationship (β equals 0.693, p equals 0.001), while age and education showed no moderation effects. These findings validate Social Cognitive Theory reciprocal determinism and Theory of Planned Behaviour attitude-behaviour pathways, supporting family-centered interventions that address attitude formation and environmental support systems rather than isolated knowledge transfer for improving adolescent menstrual health management in urban Ghana.

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