Relationship Between Metacognitive Beliefs and Body Image Concerns in Primary Dysmenorrhea Intensity: The Mediating Role of Pain Self-Efficacy in Iranian Students

Background: Given that primary dysmenorrhea can affect individuals' course of life and social activities, it is necessary to consider the role of related variables in its incidence and conduct more studies to take effective measures to reduce this pain. Objectives: This study aims to model the structural equations of the relationship between metacognitive beliefs and body image concerns with the mediating role of pain self-efficacy on the severity of primary dysmenorrhea. Methods: This study adopted a cross-sectional, descriptive correlational research design. A structural equation modeling method was conducted on 724 students studying in the first semester of 2021 - 2022. Questionnaires assessed menstrual pain severity, body image concern, pain self-efficacy, and metacognitive beliefs. Data were analyzed using structural equation modeling, SPSS.25, and AMOS 24. Results: According to data analysis, all indices of fit were appropriate after modifications, and the model had a very good fit at the significance level (χ2/df = 3.619, CFI = 0.931, TLI = 0.910, NFI = 0.907, RMSEA = 0.060, 90%CI [0.053, 0.068], SRMR = 0.077). In examining direct pathways, metacognitive beliefs showed a direct effect on and a negative correlation with the severity of dysmenorrhea. The investigation of indirect pathways also confirmed the effect of metacognitive beliefs on the severity of primary dysmenorrhea with the mediating role of pain self-efficacy. The effect of the direct pathway of body image concern on the severity of primary dysmenorrhea was not significant and was removed from the model. On the other hand, as the examination of the indirect path showed, the effect of body image concerns on the severity of primary dysmenorrhea was mediated by pain self-efficacy. Conclusions: According to the findings, the promotion of mental health was effective in controlling primary dysmenorrhea. Hence, more attention to psychological issues is required through effective practical protocols to provide an introduction to menstrual health and the grounds for performance improvement in girls.