Visual ImpairmentNCT06490016
Menstrual Health Education for Visually Impaired Adolescent
A study testing web based education and Face to face in people with Visual Impairment and Menstrual Problem, run by Cukurova University at 1 site in Turkey (Türkiye).
Trial summary
This study was planned as a two-group randomized controlled interventional study to determine the effect of face-to-face and web-based menstrual health education given to visually impaired adolescent girls on menstrual attitude, menstrual symptoms and anxiety. Read more about this study
- Who is it for?
- Ages 11 to 19 years, women onlyHealthy volunteers can take part
- Conditions the study is for
- Visual Impairment, Menstrual Problem
- What is being tested?
- web based education and Face to face
- Type of treatment
- Medical device, Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 35 participants
- Where
- 1 siteTurkey (Türkiye)
- Study dates
- 20 Oct 2024to 15 Feb 2026
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 11 to 19 years
- Women only
- Healthy volunteers accepted
- Child, Adult
Who may be able to join
- For face-to-face education:
- Be between the ages of 11-19
- Ability to read and write
- Menstruation
- Having at least 60% vision loss (those with congenital or acquired vision loss)
- For web-based training:
Show all 11Show fewer
- Be between the ages of 11-19
- Ability to read and write
- Menstruation
- Having at least 60% vision loss (those with congenital or acquired vision loss)
- Having a computer or mobile phone compatible with a screen reader program and internet access.
Who cannot join
- Not attending face-to-face or web-based training for at least 1 week.
Trial locations and contacts
1 site in 1 country.
Turkey (Türkiye)1 site
Çukurova University
Adana, Sarıçam, 01330
Hatice Güdül Öz, MSc, RN, 05075104883, haticegudul@gmail.com
About this study
Official title: Effect of Web Based Menstrual Health Education on Menstrual Attitude, Menstrual Symptoms and Anxiety Among Visually Impaired Adolescent
This study was planned as a two-group randomized controlled interventional study to determine the effect of face-to-face and web-based menstrual health education given to visually impaired adolescent girls on menstrual attitude, menstrual symptoms and anxiety.
Read the detailed description
Menstruation is a physiological and natural process of the reproductive system. It is reported that more than 300 million individuals menstruate every day worldwide. On average, a woman menstruates for approximately 3,000 days, or 8 years, between the ages of 11 and 49. Therefore, menstruation is an important issue that requires physical, spiritual and social adaptation for women. It is known that the majority of menstruating individuals have serious problems in managing their monthly menstrual cycles healthily and effectively. However, the menstrual needs of girls and women with different types of disabilities vary compared to individuals without disabilities.
Since the sense of sight has an important place in performing daily activities, visually impaired girls and women are one of the disabled groups that experience various difficulties during the menstrual process. In the literature, it is seen that visually impaired individuals have negative myths and beliefs about the menstrual period, have difficulties with self-care, do not comply with hygiene rules during the menstrual period, and talk about menstrual hygiene management with their mothers, sisters, friends, etc. It is emphasized that there are deficiencies in their knowledge and practices regarding menstrual hygiene, that they see the menstrual period as a shame, and that they experience difficulties such as social isolation and forced sterilization. In this context, the menstrual period emerges as an important global public health problem for visually impaired girls and women.
Menstrual health/hygiene management is important in order to cope with the problems experienced during menstruation. United Nations International Children\'s Emergency Fund underlines that menstrual health and hygiene management should be addressed within a broader framework, reconciling health, well-being, gender equality, education, social equality, individual empowerment policies and human rights. The only point that distinguishes visually impaired women from sighted women regarding menstruation is menstrual hygiene management. Menstrual management in visually impaired women; It varies depending on the use of materials such as pads and tampons, hygiene training, degree of social support, disability status of the person and symptoms related to menstruation. Different methods and tools can be used in training for visually impaired individuals. When providing education to visually impaired individuals, changes should be made in the tools used rather than the content of the education. Because lack of vision does not constitute an obstacle to their education. Training can be provided using models, printed brochures containing the Braille alphabet, voice recordings and assistive technologies.
The comprehensive menstrual hygiene management training to be prepared will guide health professionals, special education teachers and institutions. Studies have reported that nurses have difficulty and experience communication problems while providing care to disabled individuals. It is believed that it will guide nurses regarding the educational methods and needs of visually impaired individuals. In addition, it is a study that can support healthcare personnel who may be inadequate in consultancy and training roles due to the insufficient number of healthcare personnel in our country and their high workload. In particular, the widespread use of web-based training in the education of disabled individuals can be an opportunity for many disabled individuals who have economic, transportation and material problems, regardless of time and place.
Hypotheses of the research:
Ho: Between groups; Ho1: There is no difference between menstrual attitude scale scores in web-based and face-to-face menstrual health education.
Ho2: There is no difference between menstrual symptom scale scores in web-based and face-to-face menstrual health education.
Ho3: There is no difference between anxiety scores in web-based and face-to-face menstrual health education.
H1: Between groups:
H11: There is a difference between menstrual attitude scale scores in web-based and face-to-face menstrual health education.
H12: There is a difference between menstrual symptom scale scores in web-based and face-to-face menstrual health education.
H13: There is a difference between anxiety scores in web-based and face-to-face menstrual health education.
- Conditions
- Visual Impairment, Menstrual Problem
- Being tested
- web based education, Face to face
- Keywords
- anxiety, health education, nurse, menstruation, visually impaired adolescent
- Medical subject headings
- Vision Disorders, Menstruation Disturbances, Anxiety Disorders, Health Education
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
web based educationDevice
The web page will be prepared with professional support in line with the guidelines of the Web Content Accessibility Guide (WCAG / WIEK 2.1) developed by W3C.
- st meeting: online "Informed Consent" will be obtained. After the meeting, the Personal Information Form, Menstrual Attitude Scale, Menstrual Symptom Scale, State and Trait Anxiety Scale will be filled out online.
- nd interview: Module 1-2.
- rd interview: Module 3 -4.
- th meeting: Module 5.They will be asked to fill out the System Usability Scale.
- th interview: During the first menstrual period after the training, the Menstrual Attitude Scale, Menstrual Symptom Scale, and State Anxiety Scale will be completed online.
- th interview: During the second menstrual period after the training, the Menstrual Attitude Scale, Menstrual Symptom Scale, and State Anxiety Scale will be completed online.
Face to faceBehavioural
In face-to-face training, "female internal reproductive organ models", "female external reproductive organ models", "training content prepared with Braille alphabet", "menstrual hygiene management kit (underwear, pads, napkins, calendar)" materials will be used. Pictures and audio descriptions will be used in web-based training.
- st interview: "Informed Consent" . After the meeting, the Personal Information Form, Menstrual Attitude Scale, Menstrual Symptom Scale, State and Trait Anxiety Scale will be filled out.
- nd meeting: Module 1-2
- rd meeting: Module 3- 4
- th meeting: Module 5.
- th interview: Menstrual Attitude Scale, Menstrual Symptom Scale, State Anxiety Scale will be completed.
- th interview: Menstrual Attitude Scale, Menstrual Symptom Scale, State Anxiety Scale will be completed.
| Study group | Role | What they receive |
|---|---|---|
| Intervention group that given face to face education | Experimental | 6 face-to-face meetings will be held with adolescent disabled girls. Training will be held collectively at school or in an association. The training modules will last 3 weeks and 5 modules will be used in the training. (1st Meeting and Survey collection, 2nd week: 1st and 2nd module, 3rd week: 3 modules and 4th week: 5 modules, 6th interview: after training). Training modules will be given every week at a determined place and time. Following the training, the effect of the training will be investigated by repeating the data collection forms twice at 1-month intervals during the menstrual periods of the participants. Receives: Behavioral: Face to face |
| Intervention group that given web-based education | Experimental | This group will not be met face to face and communication will be provided via the website. A username and password will be defined for each user before entering the web page. Visually impaired adolescent girls will be able to individually enter the relevant modules without assistance, read the module they want, and listen to the depicted pictures and graphics. From the admin section of the website, it will be tracked who attended the training, how many minutes they stayed, and how many times a week they attended. The training modules will last 3 weeks and 5 modules will be used in the training. (1st Meeting and Survey collection, 2nd week: 1st and 2nd module, 3rd week: 3 modules and 4th week: 5 modules, 6th interview: after training). A reminder notification will be sent to the contact section on the website every week for them to attend the training. Receives: Device: web based education |
What is being measured
The primary outcome is the main question the study is designed to answer.
Primary Outcome Measure 1
Menstrual Attitude Scale will be used to score the menstrual attitude level. The scale consists of 33 items. MBI consists of five subscales that question the positive and negative aspects of menstruation.
- Menstruation as a debilitating phenomenon,
- Menstruation as a disturbing phenomenon,
- Menstruation as a natural phenomenon,
- Noticing/anticipating that menstruation will occur
- Deny the effects of menstruation. The scale is Likert type and evaluated between 1-7. The reliability coefficient of the original scale is 0.95-0.97. A high average of the scores obtained from the items, subgroups or the entire scale in the Menstruation Attitude Scale indicates that the attitude towards menstruation is "positive". As the scores of the scale increase, the positive attitude towards menstruation increases.
At the same time, it is planned to increase the scale score by providing planned training.
Measured: during 6 week
Primary Outcome Measure 2
The Menstrual Symptom Scale will be used to score menstrual symptom level.
The Menstruation Symptom Scale evaluates menstrual pain and symptoms. Participants are asked to give a number between 1 (never) and 5 (always) to the symptoms they experience regarding menstruation. 1-13. Items belong to the "Negative effects/somatic complaints" subscale, items 14-19. The items refer to the "Menstrual pain symptoms" subscale and items 20-22. The items belong to the "Coping methods" sub-dimension. Cronbach's Alpha value is 0.86. It is a five-point Likert type scale consisting of 22 items. The score obtained from the sub-dimensions is calculated by taking the total score average of the items in the sub-dimensions. An increase in the mean score for sub-dimensions indicates that the severity of menstrual symptoms related to that sub-dimension has increased.
At the same time, it is planned to reduce the scale score by providing planned training.
Measured: during 6 week
Primary Outcome Measure 3
State and Trait Anxiety Scale will be used to score the state and trait anxiety level.
Each expression in the scale is "Not at all" (1), "Somewhat" (2), "A lot" (3), "Completely" (4). It indicates that 0-19 points obtained from the scale mean no anxiety, 20-39 points mean mild anxiety, 40-59 points mean moderate anxiety, and 60-79 points mean severe anxiety, and individuals with scores of 60 and above need professional help.
At the same time, it is planned to reduce the scale score by providing planned training.
Measured: during 6 week
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted8 Jul 2024
- Study start20 Oct 2024 (estimated)
- Primary completion25 Feb 2025 (estimated)
- Study completion15 Feb 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Visual ImpairmentStudies of the same condition, open and under way.
- More trials run by Cukurova UniversityThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Supportive care
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- There are 2 groups: 2 interventional group
- Masking
- None (open label)
- Enrolment
- 35 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Cukurova University
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, hatice güdül öz, Cukurova University
- Investigators
- Evşen Nazik, PhD,RN, Study director, Cukurova University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06490016
- Sponsor's protocol ID
- 04.02.2023/83
- Other IDs
- 223K208
- Status last verified
- Jun 2024
- First submitted
- 14 Jun 2024
- Last updated
- 8 Jul 2024
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Study at a glance
From the registry record, last updated by the sponsor on 8 Jul 2024. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Effect of Web Based Menstrual Health Education on Menstrual Attitude, Menstrual Symptoms and Anxiety Among Visually Impaired Adolescent
- ClinicalTrials.gov ID
- NCT06490016
- Acronym / sponsor ID
- 04.02.2023/83
- Conditions
- Visual Impairment, Menstrual Problem
- Keywords
- anxiety, health education, nurse, menstruation, visually impaired adolescent
- Study type
- Interventional
- Recruitment status
- Unknown status
- Enrolment
- 35 participants (estimated)
- Lead sponsor
- Cukurova UniversityUniversity, hospital or other
- Study start
- 20 Oct 2024 (estimated)
- Primary completion
- 25 Feb 2025 (estimated)
- Study completion
- 15 Feb 2026 (estimated)
- First posted
- 8 Jul 2024 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This study was planned as a two-group randomized controlled interventional study to determine the effect of face-to-face and web-based menstrual health education given to visually impaired adolescent girls on menstrual attitude, menstrual symptoms and anxiety.
Detailed description
Menstruation is a physiological and natural process of the reproductive system. It is reported that more than 300 million individuals menstruate every day worldwide. On average, a woman menstruates for approximately 3,000 days, or 8 years, between the ages of 11 and 49. Therefore, menstruation is an important issue that requires physical, spiritual and social adaptation for women. It is known that the majority of menstruating individuals have serious problems in managing their monthly menstrual cycles healthily and effectively. However, the menstrual needs of girls and women with different types of disabilities vary compared to individuals without disabilities.
Since the sense of sight has an important place in performing daily activities, visually impaired girls and women are one of the disabled groups that experience various difficulties during the menstrual process. In the literature, it is seen that visually impaired individuals have negative myths and beliefs about the menstrual period, have difficulties with self-care, do not comply with hygiene rules during the menstrual period, and talk about menstrual hygiene management with their mothers, sisters, friends, etc. It is emphasized that there are deficiencies in their knowledge and practices regarding menstrual hygiene, that they see the menstrual period as a shame, and that they experience difficulties such as social isolation and forced sterilization. In this context, the menstrual period emerges as an important global public health problem for visually impaired girls and women.
Menstrual health/hygiene management is important in order to cope with the problems experienced during menstruation. United Nations International Children\'s Emergency Fund underlines that menstrual health and hygiene management should be addressed within a broader framework, reconciling health, well-being, gender equality, education, social equality, individual empowerment policies and human rights. The only point that distinguishes visually impaired women from sighted women regarding menstruation is menstrual hygiene management. Menstrual management in visually impaired women; It varies depending on the use of materials such as pads and tampons, hygiene training, degree of social support, disability status of the person and symptoms related to menstruation. Different methods and tools can be used in training for visually impaired individuals. When providing education to visually impaired individuals, changes should be made in the tools used rather than the content of the education. Because lack of vision does not constitute an obstacle to their education. Training can be provided using models, printed brochures containing the Braille alphabet, voice recordings and assistive technologies.
The comprehensive menstrual hygiene management training to be prepared will guide health professionals, special education teachers and institutions. Studies have reported that nurses have difficulty and experience communication problems while providing care to disabled individuals. It is believed that it will guide nurses regarding the educational methods and needs of visually impaired individuals. In addition, it is a study that can support healthcare personnel who may be inadequate in consultancy and training roles due to the insufficient number of healthcare personnel in our country and their high workload. In particular, the widespread use of web-based training in the education of disabled individuals can be an opportunity for many disabled individuals who have economic, transportation and material problems, regardless of time and place.
Hypotheses of the research:
Ho: Between groups; Ho1: There is no difference between menstrual attitude scale scores in web-based and face-to-face menstrual health education.
Ho2: There is no difference between menstrual symptom scale scores in web-based and face-to-face menstrual health education.
Ho3: There is no difference between anxiety scores in web-based and face-to-face menstrual health education.
H1: Between groups:
H11: There is a difference between menstrual attitude scale scores in web-based and face-to-face menstrual health education.
H12: There is a difference between menstrual symptom scale scores in web-based and face-to-face menstrual health education.
H13: There is a difference between anxiety scores in web-based and face-to-face menstrual health education.
Study design
- Primary purpose
- Supportive care
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
- Model description
- There are 2 groups: 2 interventional group
| Arm | Type | Receives |
|---|---|---|
| Intervention group that given face to face education | Experimental | Behavioral: Face to face6 face-to-face meetings will be held with adolescent disabled girls. Training will be held collectively at school or in an association. The training modules will last 3 weeks and 5 modules will be used in the training. (1st Meeting and Survey collection, 2nd week: 1st and 2nd module, 3rd week: 3 modules and 4th week: 5 modules, 6th interview: after training). Training modules will be given every week at a determined place and time. Following the training, the effect of the training will be investigated by repeating the data collection forms twice at 1-month intervals during the menstrual periods of the participants. |
| Intervention group that given web-based education | Experimental | Device: web based educationThis group will not be met face to face and communication will be provided via the website. A username and password will be defined for each user before entering the web page. Visually impaired adolescent girls will be able to individually enter the relevant modules without assistance, read the module they want, and listen to the depicted pictures and graphics. From the admin section of the website, it will be tracked who attended the training, how many minutes they stayed, and how many times a week they attended. The training modules will last 3 weeks and 5 modules will be used in the training. (1st Meeting and Survey collection, 2nd week: 1st and 2nd module, 3rd week: 3 modules and 4th week: 5 modules, 6th interview: after training). A reminder notification will be sent to the contact section on the website every week for them to attend the training. |
Who may qualify
- Ages
- 11 to 19 years
- Sex
- Female only
- Healthy volunteers
- Accepted
- Age groups
- Child, Adult
Key inclusion criteria (11 listed)
- For face-to-face education:
- Be between the ages of 11-19
- Ability to read and write
- Menstruation
- Having at least 60% vision loss (those with congenital or acquired vision loss)
Key exclusion criteria (1 listed)
- Not attending face-to-face or web-based training for at least 1 week.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| web based educationThe web page will be prepared with professional support in line with the guidelines of the Web Content Accessibility Guide (WCAG / WIEK 2.1) developed by W3C. 1. st meeting: online "Informed Consent" will be obtained. After the meeting, the Personal Information Form, Menstrual Attitude Scale, Menstrual Symptom Scale, State and Trait Anxiety Scale will be filled out online. 2. nd interview: Module 1-2. 3. rd interview: Module 3 -4. 4. th meeting: Module 5.They will be asked to fill out the System Usability Scale. 5. th interview: During the first menstrual period after the training, the Menstrual Attitude Scale, Menstrual Symptom Scale, and State Anxiety Scale will be completed online. 6. th interview: During the second menstrual period after the training, the Menstrual Attitude Scale, Menstrual Symptom Scale, and State Anxiety Scale will be completed online. | Device | Intervention group that given web-based education |
| Face to faceIn face-to-face training, "female internal reproductive organ models", "female external reproductive organ models", "training content prepared with Braille alphabet", "menstrual hygiene management kit (underwear, pads, napkins, calendar)" materials will be used. Pictures and audio descriptions will be used in web-based training. 1. st interview: "Informed Consent" . After the meeting, the Personal Information Form, Menstrual Attitude Scale, Menstrual Symptom Scale, State and Trait Anxiety Scale will be filled out. 2. nd meeting: Module 1-2 3. rd meeting: Module 3- 4 4. th meeting: Module 5. 5. th interview: Menstrual Attitude Scale, Menstrual Symptom Scale, State Anxiety Scale will be completed. 6. th interview: Menstrual Attitude Scale, Menstrual Symptom Scale, State Anxiety Scale will be completed. | Behavioural | Intervention group that given face to face education |
Primary outcome
Primary Outcome Measure 1
Time frame: during 6 week
Menstrual Attitude Scale will be used to score the menstrual attitude level. The scale consists of 33 items. MBI consists of five subscales that question the positive and negative aspects of menstruation. 1. Menstruation as a debilitating phenomenon, 2. Menstruation as a disturbing phenomenon, 3. Menstruation as a natural phenomenon, 4. Noticing/anticipating that menstruation will occur 5. Deny the effects of menstruation. The scale is Likert type and evaluated between 1-7. The reliability coefficient of the original scale is 0.95-0.97. A high average of the scores obtained from the items, subgroups or the entire scale in the Menstruation Attitude Scale indicates that the attitude towards menstruation is "positive". As the scores of the scale increase, the positive attitude towards menstruation increases. At the same time, it is planned to increase the scale score by providing planned training.
Primary Outcome Measure 2
Time frame: during 6 week
The Menstrual Symptom Scale will be used to score menstrual symptom level. The Menstruation Symptom Scale evaluates menstrual pain and symptoms. Participants are asked to give a number between 1 (never) and 5 (always) to the symptoms they experience regarding menstruation. 1-13. Items belong to the "Negative effects/somatic complaints" subscale, items 14-19. The items refer to the "Menstrual pain symptoms" subscale and items 20-22. The items belong to the "Coping methods" sub-dimension. Cronbach's Alpha value is 0.86. It is a five-point Likert type scale consisting of 22 items. The score obtained from the sub-dimensions is calculated by taking the total score average of the items in the sub-dimensions. An increase in the mean score for sub-dimensions indicates that the severity of menstrual symptoms related to that sub-dimension has increased. At the same time, it is planned to reduce the scale score by providing planned training.
Primary Outcome Measure 3
Time frame: during 6 week
State and Trait Anxiety Scale will be used to score the state and trait anxiety level. Each expression in the scale is "Not at all" (1), "Somewhat" (2), "A lot" (3), "Completely" (4). It indicates that 0-19 points obtained from the scale mean no anxiety, 20-39 points mean mild anxiety, 40-59 points mean moderate anxiety, and 60-79 points mean severe anxiety, and individuals with scores of 60 and above need professional help. At the same time, it is planned to reduce the scale score by providing planned training.
Results and safety
Results are not available in the source record.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 8 Jul 2024.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Evşen Nazik, PhD,RN study director
Cukurova University
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing web based education and Face to face in people with Visual Impairment and Menstrual Problem, run by Cukurova University at 1 site in Turkey (Türkiye).
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 11 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: status not confirmed, as of the sponsor's last update on 8 Jul 2024. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Turkey (Türkiye). Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
Results are not available in the source record.
How can a doctor refer a patient or contact the research team?
Contact Hatice GÜDÜL ÖZ, MSc, RN (05075104883, haticegudul@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Primary Outcome Measure 1 (time frame: during 6 week). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 8 Jul 2024.