Co-development and piloting of a menstrual, sexual and reproductive health intervention to improve social and psychological outcomes among secondary schoolgirls in Northern Tanzania: the PASS MHW study protocol

Abstract

IntroductionPoor menstrual health negatively impacts psychosocial and physical health, and subsequently leads to poor school outcomes, but the effort to improve adolescent girls’ menstrual health in Tanzania remains fragmented. This study aimed to develop and pilot a scalable, comprehensive menstrual, sexual and reproductive health (MSRH) intervention within Tanzanian government structures to improve MSRH practices and perceptions and the overall school climate to ensure the psychosocial well-being and optimal school participation and performance among secondary schoolgirls.Methods and analysisThis study will be conducted in three phases. Phase I will be a formative research to iteratively refine an existing puberty and menstrual health intervention, and to collaboratively design strategies to embed the intervention into government structures thereby promoting scalability. In Phase II, we will pilot and evaluate the refined intervention and implementation strategies using a mixed-methods design to assess (1) feasibility, acceptability and sustainability; and (2) effect on MSRH practices and perceptions and the overall school climate. In Phase III, we will synthesise the research findings in collaboration with the national, regional and district government and non-government stakeholders.Ethics and disseminationThis pilot study will provide evidence-based recommendations for a comprehensive, complex menstrual and puberty intervention within secondary schools in Tanzania that can be further tested for broader effectiveness across a larger population. Papers, policy briefs and both regional/international conference presentations are planned to reach academic and non-academic groups. Protocol, tools and consent have been reviewed and approved by the independent Tanzanian national ethics committee (NIMR/HQ/R.8a/Vol.IX/3647) and the LSHTM Observational/Interventions Research Ethics Committee (LSHTM Ethics Ref: 22854). The project will involve adolescents, and procedures will be followed to ensure that we obtain permission and consent of parents and guardians and assent from all adolescents below 18 years of age that will be enrolled in the study.

Unmet Menstrual Needs and Psychosocial Well-being among Schoolgirls in Northern Tanzania: Baseline Results from the PASS MHW Study

“…Further details about the tools have been published in a protocol paper. [19]. In addition, the survey questionnaire assessed girls' menstrual practices and perceptions using the menstrual practices and needs scale (MPNS)-36.…”

“…This paper seeks to extend the scope of the current limited evidence by assessing the menstrual practices and needs of girls in the school environment and examining how the school's social and physical environment impacts girls' ability to participate in school and social activities. Data come from the baseline of a school-based menstrual health project (PASS MHW) [19], before the implementation of a pilot menstrual sexual and reproductive health (MSRH) intervention. The paper uses the integrated model of menstrual experiences as a framework for analysis.…”

The Menstrual Practice Needs Scale Short Form (MPNS-SF) and Rapid (MPNS-R): Development in Khulna, Bangladesh, and validation in cross-sectional surveys from Bangladesh and Uganda

“…Trials using the MPNS measures as primary or secondary outcomes will provide insights into the sensitivity of the measure to change and use for evaluation. [8,12] Finally, future research should investigate the validity of the shorter MPNS forms in new cultural contexts, languages and age groups. As found previously, [6] the dimensionality of the MPNS-36 differs for adult women, and we would hypothesise similar differences for the short form.…”

“…[1,2] The Menstrual Practice Needs Scale (MPNS-36) [3] was published in 2020 to address this gap and has seen rapid uptake in research and practice. [4][5][6][7][8][9][10][11][12] However, this comprehensive scale is 36-items in length, presenting a barrier to implementation in short needs assessments or multicomponent surveys. Stakeholders have requested a short form to enable greater uptake.…”

“…[13] As such, it is also a measure of menstrual hygiene experience. [14] Individual scale items can be used to understand the experiences and needs of respondent population (e.g., [9]), while changes in total and sub-scale scores can be used to evaluate the effectiveness of menstrual health interventions (e.g., [8,11]). The scale can also be used in research to test associations between risk and protective exposures and menstrual experience, and to quantify relationships between unmet menstrual management needs and consequences for women's and girls' health, social and educational outcomes (e.g., [15]).…”