The Effectiveness of Health Education Using Comic Media on Knowledge and Attitudes Toward Menarche Among Female Students in Grades Iv–V At SDN 2 Kayuambon, West Bandung Regency, 2026

Abstract

Background: Menarche is an important reproductive milestone that may be accompanied by fear, embarrassment,
anxiety, and confusion when girls have insufficient prior information. Preliminary findings at SDN 2 Kayuambon
indicated that many girls had not received specific education about menarche and several still lacked basic knowledge and
felt afraid or embarrassed about menstruation (Dewi, 2023; Nadila et al., 2024).
Purpose: This study aimed to determine the effectiveness of health education using comic media on knowledge and
attitudes toward menarche among female students in grades IV–V at SDN 2 Kayuambon, West Bandung Regency, in
2026 (Notoatmodjo, 2018).
Materials and methods: A quasi-experimental study using a pretest–posttest control group design was conducted among
48 female students who had not experienced menarche. Twenty-four students received health education using comic
media and 24 received health education using leaflet media. Data were collected using knowledge and attitude
questionnaires before and after the intervention. The Wilcoxon Signed Rank Test was used for paired comparisons with
α=0.05; the study protocol also specified Mann–Whitney testing for comparisons between independent groups (Nursalam,
2020; Sugiyono, 2020).
Results: In the comic group, knowledge changed from 19 students (79.2%) in the poor category and 5 (20.8%) in the
sufficient category before intervention to 18 (75.0%) in the good category and 6 (25.0%) in the sufficient category after
intervention. The Wilcoxon test showed p<0.001. Attitudes changed from 18 students (75.0%) with negative attitudes
and 6 (25.0%) with positive attitudes before intervention to 15 (62.5%) with positive attitudes and 9 (37.5%) with negative
attitudes after intervention; the tabulated Wilcoxon result was p=0.020. In the leaflet group, knowledge changed to 16
(66.7%) poor, 5 (20.8%) sufficient, and 3 (12.5%) good, with p=0.100, while attitudes changed to 15 (62.5%) negative and
9 (37.5%) positive, with p=0.527 (Primary data, 2026).
Conclusions: Health education using comic media was associated with significant improvements in knowledge and
attitudes toward menarche in the intervention group. The comic approach may therefore be considered an appropriate
educational medium for elementary-school girls, particularly because visual and story-based materials can make health
information more concrete and engaging for children (Daryanto, 2016; Sari et al., 2025)..