Measuring menstrual hygiene experience: Development and validation of the Menstrual Practice Needs Scale (MPNS-36)

Abstract

Objectives. This study describes the development and validation the Menstrual Practice Needs Scale (MPNS-36) which measures the extent to which females’ menstrual practices and environments meet their needs. Methods. A 54-item pool was developed following systematic-review of qualitative and quantitative studies and expert feedback. Item reduction and scale validation were undertaken using a cross-sectional survey of 538 menstruating schoolgirls in Soroti, Uganda. Test-retest reliability was assessed in a sub-sample of 52 girls two weeks after the first administration. Construct validity was tested through relationships with hypothesised correlates: confidence to manage menses, self-reported school absenteeism, and mental health symptoms. Results. The final MPNS-36 comprises 28 items applicable to all respondents, and 8 items capturing washing and drying experiences for those reusing menstrual materials. A four-factor solution for the core 28 items was the best fit for the data (RMSEA=0.028-0.029; CFI=0.961-0.964; TFI=0.957-0.959), supplemented by two factors for reuse (RMSEA=0.021-0.030; CFI=0.987-0.994; TFI=0.981-0.991). Subscale and total scores were calculated as mean scores to support accessibility for practitioners. Subscales were ‘material and home environment needs’ (11 items, α-ordinal=0.84), ‘transport and school environment needs’ (5-items, α-ordinal=0.73), ‘material reliability concerns’ (3-items, α-ordinal=0.55), ‘change and disposal insecurity’ (9-items, α-ordinal=0.80), ‘reuse needs’ (5-items, α-ordinal=0.76), and ‘reuse insecurity’ (3-items, α-ordinal=0.56). Relationships between subscales and hypothesised correlates supported validity. Home- and school-based items were more strongly associated with confidence to manage menstruation at home and school, respectively. Higher scores predicted not missing school during the last menstrual period (total score: OR=2.62, 95%CI=1.52-4.50). Test-retest reliability was moderate (total score: ICC(2,1)=0.69).Conclusions. The MPNS-36 demonstrated acceptable reliability and validity. It is the first measure to capture women and girls perceived menstrual hygiene and may be used across a range of study designs to assess menstrual needs. Future research should explore the suitability and sensitivity of the measure across contexts.

Attitude towards menstruation by female in-school adolescents: A comparative cross-sectional study in southwest Nigeria

“…The derived menstrual symptoms variable showed that only 22.6% and 30.0% among respondents in public and private school respectively had a positive attitude while others showed a negative attitude, as in previous studies (42)(43)(44). The signs and symptoms that herald menarche, and subsequent menstruations on monthly basis vary from one adolescent to another, as also in the postmenarche female adolescents where a signi cant negative correlation between menstrual attitudes and perimenstrual symptoms in Uganda (45), a product of inadequate and skewed awareness, and preparedness to manage some menstruation and associated discomforts (19,32,42).…”

“…The ease with which adolescents communicate about menstruation, including but not limited to feelings about the purchase and handling menstruation materials, information seeking pattern, as part of openness, was largely negative, in congruence with ndings in Uganda, and other climes where a silent culture of secrecy, inadequacy, shame and insecurity pines menstruation and menstrual hygiene management (38,(45)(46)(47)(48). Also, on their acceptance of menarche, adolescents attending public and private schools had 28.2% and 35.6% positive rating scores respectively, a pointer to the inherent challenges experienced.…”

The Menstrual Practices Questionnaire (MPQ): development, elaboration, and implications for future research

“…and 83% had gone without food, water, medicine or school supplies in the past year. Participants were selected systematically from Primary Levels 5 and 6, with additional recruitment in Levels 4 and 7 to achieve the final sample size which was based on the number of items tested for inclusion in the Menstrual Practice Needs Scale [13]. MPQ questions were included alongside the piloted scale items.…”

“…Questions about sterilisation practices, including ironing fabric materials and boiling menstrual cups were added based on the audit of past measures. Finally, questions capturing use of the usual urination location during menstruation were added based on recent studies emphasising the importance of this practice and the lack of available data [13,14].…”

“…The frequency with which materials are changed outside the home is captured by the MPQ and can indicate the extent to which participants are willing to change outside the home and are impacted by the quality of school or workplace changing facilities. Identifying menstrual material change locations at school or work can be used in needs assessment in combination with information about the type of facilities available, and quantitative or qualitative data capturing participant perceptions of facilities [13,19]. These questions can also be used as part of assessing uptake and use of facilities where interventions seek to improve these services.…”