Objective This study describes the development and validation of the Menstrual Practice Needs Scale (MPNS-36), which measures the extent to which respondents’ 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 subsample of 52 girls 2 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 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 (root mean square error of approximation (RMSEA)=0.028–0.029; comparative fit index (CFI)=0.961–0.964; Tucker-Lewis index (TLI)=0.953–0.955), supplemented by two factors for reuse (RMSEA=0.021–0.030; CFI=0.987–0.994; TLI=0.981–0.991). Subscale and total scores were calculated as mean scores to support accessibility for practitioners. The subscales were ‘material and home environment needs’ (11 items, αordinal=0.84), ‘transport and school environment needs’ (5 items, αordinal=0.73), ‘material reliability concerns’ (3 items, αordinal=0.55), ‘change and disposal insecurity’ (9 items, αordinal=0.80), ‘reuse needs’ (5 items, αordinal=0.76) and ‘reuse insecurity’ (3 items, αordinal=0.56). Relationships between subscales and hypothesised correlates supported validity. Home-based and school-based items were more strongly associated with confidence to manage menstruation at home and school, respectively. Higher total scores indicated more positive experiences and were associated with greater odds of not missing school during the last menstrual period (OR=2.62, 95% CI 1.52 to 4.50). Test–retest reliability was moderate (total score: intraclass correlation coefficient, ICC(2,1)=0.69).
Conclusions The MPNS-36 demonstrated acceptable reliability and validity. It is the first measure to capture perceived menstrual hygiene and may be useful across a range of study designs. Future research should explore the validity and suitability of the measure across contexts and populations.
- menstrual hygiene
- menstrual health
- validation studies
- outcome assessment
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Contributors JH designed the study, undertook the analysis and interpretation, and wrote the first draft of the manuscript. AN, CS, MR, KJS and AA contributed to study design and interpretation, and critically reviewed the manuscript. MR critically reviewed measure materials and analytic strategy. AN coordinated the data collection and implemented the study protocols. AA facilitated the translation and back-translation of survey tools, and supported data collection and feedback on the performance of items. All authors have approved the final manuscript.
Funding This study was funded by The Case for Her and the Osprey Foundation of Maryland. Irise International receives funding from various sources to develop school-based menstrual health interventions in East Africa and from Sustain For Life to work with schools in Soroti, Uganda.
Competing interests CS works for Irise International, an organisation dedicated to creating a world where all women and girls can reach their full potential, regardless of their periods. AN and AA work for Irise Institute East Africa, a local implementing partner of Irise International.
Patient consent for publication Not required.
Ethics approval All girls provided signed assent to participate. Parents were informed about the study through parent–teacher meetings at each school, teacher contact with parents, and information sheets in English and Ateso sent home with girls prior to the study. Parents were asked to contact the school or study staff if they did not consent to their daughter’s participation, or express concerns during parent–teacher meetings. No parents expressed concerns about the study and no girls declined participation. Ethical approval was provided by Johns Hopkins School of Public Health Institutional Review Board (IRB approval no: 00009073) and the Mildmay Uganda Research Ethics Committee (MUREC) (approval ref: 0212–2018). The Uganda National Council for Science and Technology (UNCST) approved the study (ref: SS279ES). Feedback on draft measure items by experts through online survey and focus group discussions of resident enumerators in Niger were exempted from ethical review by the Johns Hopkins School of Public Health Institutional Review Board. Participants of these consultations consented to participate.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available in a public, open access repository. Deidentified data are available at https://osf.io/qshkc/. The final MPNS-36 measure and scoring information are available online at www.menstrualpracticemeasures.org.
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