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. 2020 Feb 17;10(2):e034461.
doi: 10.1136/bmjopen-2019-034461.

Measuring menstrual hygiene experience: development and validation of the Menstrual Practice Needs Scale (MPNS-36) in Soroti, Uganda

Julie Hennegan  1 , Agnes Nansubuga  2 , Calum Smith  3 , Maggie Redshaw  4 , Agnes Akullo  2 , Kellogg J Schwab  5
Affiliations

Measuring menstrual hygiene experience: development and validation of the Menstrual Practice Needs Scale (MPNS-36) in Soroti, Uganda

Julie Hennegan et al. BMJ Open. .

Abstract

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.

Keywords: menstrual health; menstrual hygiene; outcome assessment; psychometrics; validation studies.

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Conflict of interest statement

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.

Figures

Figure 1
Figure 1
Phases of development of the Menstrual Practice Needs Scale-36.
Figure 2
Figure 2
Visual chart for the Menstrual Practice Needs Scale item response options.
See this image and copyright information in PMC

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