1. Introduction
Adolescence is a sensitive growth period characterized by significant changes [1]. It is the beginning of hormonal, biopsychological, and cognitive alternations that coincide [2]. The transition from childhood to adulthood coincides with biopsychosocial changes that affect adolescent performance in adulthood, leading to different needs of this age group. Adolescents’ health needs and concerns are often overlooked in the primary care system. Adolescents are the healthiest age group who rarely visit a physician [3]. Investing in girls’ health is the primary way to achieve the millennium development goals. Given the importance of the subject and the influential role of problem-solving-based group counseling, the present study aimed to investigate the effects of problem-solving-based puberty group counseling on girls’ health concerns.
2. Materials & Methods 
This was an educational trial with a pre-test-Post-test and a control group design. The research was conducted after obtaining the approval of the Ethics Committee of Arak University of Medical Sciences in 2019. We performed a two-stage cluster random sampling using the student file during telephone calls with eligible individuals and inviting them to participate in the briefing. After completing the consent forms and pre-test evaluations, we performed the random group allocation. We allocated 30 individuals to the experimental group and 30 to the control group.
Moreover, they were from all academic grades and the age range of 15-18 years. Data collection tools included a demographic information form and the Persian version of the Adolescent Health Concern Questionnaire. The questionnaire summarizes an English questionnaire prepared by Weiler and localized in Iran. We applied the content validity method to determine the validity of the questionnaire. Furthermore, we relied on the results of a study by Baheiraei et al. [7], who examined the internal consistency of 96% by the Cronbach’s alpha method, to calculate the reliability. Group intervention with discussion was conducted for the experimental group in six 60-minute sessions. Two months after the intervention, the research units re-completed the health concern questionnaire and compared it with scores before the intervention. The control group also received the educational content of the sessions in educational pamphlets. Descriptive statistics (mean, standard deviation, frequency, & percentage), Kolmogorov-Smirnov test (based on the normal distribution of data), the Independent Samples t-test, and Paired Samples t-test (to compare the two groups before and after the intervention) were implemented in SPSS to analyze the obtained data.
3. Results
The independent t-test indicated no statistically significant difference between the control and intervention groups in terms of scores of health concern domains and the total score of concern before the educational intervention (P>0.05). Table 1 presents the individuals’ intra- and inter-group relationships before and after the educational intervention.


The results also indicated a statistically significant difference between the control and intervention groups after the intervention in terms of scores of health concerns. Still, there was no statistically significant difference between the two groups regarding sexual health and communication (P>0.05).
4. Discussion & Conclusion
The present study determined the effects of problem-solving-based puberty group counseling on adolescent girls’ health concerns. The results on health concerns indicated a significant reduction in the experimental and control groups after the intervention compared to the pre-intervention.
In the personal health field, there was no significant reduction in the personal health of the experimental group after the educational intervention compared to before the intervention. It was consistent with the results of a study by Azizi [19]. However, it was inconsistent with Mohammadipour’s study [20], probably due to differences in the demographic characteristics of the participants in the study. In similar studies [7, 8], pimples were mentioned as a general concern affecting adolescent self-esteem and ultimately effective in reducing their quality of life. In the field of sexual health, there was a significant reduction in the experimental group after the intervention compared to the pre-intervention. Reproductive health was the central concern of adolescents. The present study results were consistent with a study by Moghadam Tabrizi [8]. Concerning emotional health, there was a significant decrease in the emotional health of the experimental group after the intervention compared to before the intervention, and the findings were consistent with the results of similar studies [9, 10]. They found that problem-solving training decreased anxiety and maladaptation in high school girls. Studies [11, 12] also found that problem-solving skill training could reduce emotional anxiety. Individuals with poor problem-solving skills reacted to obstacles with evoked behaviors as soon as they encountered them [13]. Waid applied the problem-solving skill training to treat adolescents’ emotional problems and found that it decreased the adolescents’ behavioral problems and effectively reduced the distress of their families [14].

Ethical Considerations
Compliance with ethical guidelines
All ethical principles are considered in this article. The participants were informed of the purpose of the research and its implementation stage. They were also assured about the confidentiality of their information and were free to leave the study whenever they wished, and if desired the research results would be available to them. A written consent has been obtained from the subjects. Principles of the Helsinki convention was also observed. The present study was approved by the Research Ethics Committee of Arak University of Medical Sciences (Code: IR.ARAKMU.REC.1397.262). 

Funding
The paper was extracted from the MSc. thesis of the first author at the Department of Midwifery, School of Medical, Arak University of Medical Sciences. Also, this research was supported by the research assistant, Funded by the University of Arak University of Medical Sciences.

Authors' contributions
The authors of the article met the standard writing criteria based on the recommendations of the International Committee of Publishers of Medical Journals and all contributed equally to the writing of the article. 

Conflicts of interest
The authors declared no conflicts of interest.

Acknowledgements
We want to thank the Director-General of Education in Tehran Province and all students who participated in the study.


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