Development and validation of the Self-Efficacy in Addressing Menstrual Needs Scale (SAMNS-26) in Bangladeshi schools: A measure of girls’ menstrual care confidence

Abstract

Objective Qualitative studies have described girls’ varying levels of confidence in managing their menstruation, with greater confidence hypothesized to positively impact health, education, and social participation outcomes. Yet, measurement of this and other psychosocial components of adolescent girls’ menstrual experiences has been weak in global health research, in part due to a dearth of appropriate psychometric tools. We describe the development and validation of the Self-Efficacy in Addressing Menstrual Needs Scale (SAMNS-26). Methods We conducted nine focus group discussions with girls in schools in rural and urban Bangladesh to identify tasks involved in menstrual self-care. This informed our creation of an initial pool of 50 items, which were reviewed by menstrual health experts and refined through 21 cognitive interviews with schoolgirls. Using a self-administered survey, we administered 34 refined items plus additional validation measures to a random sample of 381 post-menarcheal girls (ages 9–17) and retested a subsample of 42 girls two weeks later. We examined the measure’s dimensionality using exploratory factor analysis and assessed internal consistency, temporal stability, and construct validity. Results Exploratory factor analysis suggested a 26-item scale comprising three correlated sub-scales: the 17-item Menstrual Hygiene Preparation and Maintenance (α = 0.86), the 5-item Menstrual Pain Management (α = 0.87), and the 4-item Executing Stigmatized Tasks (α = 0.77). Sub-scales exhibited good temporal stability. SAMNS-26 scores correlated negatively with measures of anxiety, and girls who preferred to stay at home during their periods had lower SAMNS-26 scores than those who did not. Conclusion The SAMNS-26 provides a reliable measure of a schoolgirl’s confidence in her capabilities to address her menstrual needs. There is initial evidence to support the measure’s construct validity in the Bangladesh context as indicated by its relationships with other factors in its theorized nomological network. The tool enables incorporation of self-efficacy into multivariate models for exploring the relationships among antecedents to menstrual experiences and hypothesized impacts on health, wellbeing, and education attainment. Further testing of the tool is recommended to strengthen evidence of its validity in additional contexts.

Protocol for the Adolescent Menstrual Experiences and Health Cohort (AMEHC) Study in Khulna, Bangladesh: A Prospective cohort to quantify the influence of menstrual health on adolescent girls’ health and education outcomes.

“…Six-day in-person training with enumerators and the repeated employment of consistent enumerators throughout the cohort will further support positive participant experiences of the study and data quality. Our hypotheses and survey measures are informed by rigorous systematic review and synthesis of past qualitative evidence,8 audits of measurement in MH research,65 66 together with qualitative interviews in the study context and primary measure development activities including cognitive interviews and pilot survey 40 47 67. Collaboration between research partners and NGO/practitioner partners supports the translation of findings with relevance for practice and stronger engagement with national, regional and local stakeholders.…”

Impact of a school-based water and hygiene intervention on child health and school attendance in Addis Ababa, Ethiopia: a cluster-randomised controlled trial

“…Secondary outcomes were pupil-reported absence (number of full days reported absent out of number of days of reporting in the past week); pupil-reported diarrhoea and pupil-reported respiratory illness in the past two days; Strengths and Difficulties Questionnaire (SDQ-25) 23 total difficulties score, a widely used measure of pupil behavioural and mental health challenges designed for use among school-aged children that has been used in a number of Sub-Saharan African countries, 24 measured among children aged 11–16 at final follow-up; Self-efficacy in Addressing Menstrual Needs Scale (SAMNS-26) 25 total score, a measure of girls’ confidence in addressing their menstrual needs; and Menstrual Practice Needs Scale (MPNS-36) 26 total score, a measure of how well current menstrual practices are perceived to meet the girls’ needs, with SAMNS-26 and MPNS-36 both measured among post-menarcheal girls aged 10–16 at final follow-up.…”

Research priorities for improving menstrual health across the life-course in low- and middle-income countries

“…22,23 The evidence on menstrual health has been consolidated in a growing body of systematic reviews, including reviews focused on specific geographies, 24–26 populations (e.g. girls with disabilities, 27 those who are displaced), 24,28 measures of exposures and outcomes, 29 23 interventions (e.g. menstrual cups, reusable menstrual pads), 30 {van Eijk, 2021 #3976} and outcomes (e.g.…”

“…[9][10][11] More recently, studies have started to describe challenges for adult women, [12][13][14][15] marginalized populations in high income countries (HICs), [16][17][18][19][20] , mental health, 21 and to develop measures for menstrual health research. 22,23 The evidence on menstrual health has been consolidated in a growing body of systematic reviews, including reviews focused on specific geographies, [24][25][26] populations (e.g. girls with disabilities, 27 those who are displaced), 24,28 measures of exposures and outcomes, 29 23 interventions (e.g.…”

“…A review of qualitative studies on menstrual health reported that 50% of the studies were published between 2015 and 2019. 4 Other priorities have also seen progress, including the need for standardized menstrual measures 34 and definitions, 23,35,36 , and the need for a research consortium, which has begun to take shape under the umbrella of the Global Menstrual Collective. Given the evolution of the field, it is therefore timely to reassess the research priorities for improving menstrual health to guide the field.…”