How do women and girls experience menstrual health interventions in low- and middle-income countries? Insights from a systematic review and qualitative metasynthesis

Shannon, Alexandra K.; Melendez‐Torres, G. J.; Hennegan, Julie

doi:10.1080/13691058.2020.1718758

Cited by 35 publications

(33 citation statements)

References 24 publications

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“…It is plausible that experiences and learnt expectations from home environments influence perceptions of school environments. Changes to individuals’ expectations for their menstrual experience in response to interventions were an overarching theme of a recent meta-synthesis of qualitative studies of menstrual health interventions and would fit with this interpretation of our findings 41. Alternatively, a joint predictor, such as internalised stigma, may contribute to both appraisals.…”

Section: Discussionsupporting

confidence: 67%

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

Hennegan

Nansubuga²,

Smith³

et al. 2020

BMJ Open

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Strengths and limitations of this study► This study reports the development and validation of the Menstrual Practice Needs Scale (MPNS-36) and the conceptual justification for the measure. ► Measure development drew on systematic reviews and findings from studies of measurement challenges in menstrual health research across a range of contexts. ► The MPNS-36 sought to measure the degree to which the practices and environments used in managing menstrual bleeding meet respondents' needs. ► There were no existing validated measures of menstrual experience against which to demonstrate the convergent and divergent validity of the scale. ► The scale was tested among schoolgirls in Uganda, a single population and language, and requires further research on cross-cultural validity and use in other populations. AbStrACtObjective 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, 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-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 reliabili...

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Section: Discussionsupporting

confidence: 67%

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

Hennegan

Nansubuga²,

Smith³

et al. 2020

BMJ Open

Self Cite

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“…Changes to individuals' expectations for their menstrual experience in response to interventions was an overarching theme of a recent meta-synthesis of qualitative studies of menstrual health interventions and would fit with this interpretation of our findings. [36] Alternatively, a joint predictor, such as internalised stigma, may contribute to both appraisals. This should be explored in future research and may indicate the need to assess both location responses even if interventions only focus on school infrastructure.…”

Section: Discussionmentioning

confidence: 99%

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

Hennegan¹,

Nansubuga²,

Smith³

et al. 2019

Preprint

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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.

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“…Progress has been made against the research needs that were identified. Overall, support from global funding bodies and research councils has increased, facilitating research beyond qualitative and descriptive studies [20] to include cross-sectional studies in Bangladesh [21], pilot intervention trials in Kenya, Uganda and the Gambia including varying combinations of WASH, sexual and reproductive health (SRH) and education [23], intervention studies in Bangladesh and Uganda [24,25]; full intervention trials in Kenya, and systematic reviews with meta-analyzes analyzing MHM-related evidence and measures and outcomes being utilized [1,9,10,[26][27][28][29]. In Kenya and the Philippines (see Boxes 2 and 3), evidence has fed directly into national policy and monitoring efforts influencing both countries' education systems.…”

Section: Update Of Progess Since 2014mentioning

confidence: 99%

Menstrual hygiene management in schools: midway progress update on the “MHM in Ten” 2014–2024 global agenda

Sommer

Caruso

Torondel

et al. 2021

Health Res Policy Sys

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Progress has been made in recent years to bring attention to the challenges faced by school-aged girls around managing menstruation in educational settings that lack adequate physical environments and social support in low- and middle-income countries. To enable more synergistic and sustained progress on addressing menstruation-related needs while in school, an effort was undertaken in 2014 to map out a vision, priorities, and a ten-year agenda for transforming girls’ experiences, referred to as Menstrual Hygiene Management in Ten (MHM in Ten). The overarching vision is that girls have the information, support, and enabling school environment for managing menstruation with dignity, safety and comfort by 2024. This requires improved research evidence and translation for impactful national level policies. As 2019 marked the midway point, we assessed progress made on the five key priorities, and remaining work to be done, through global outreach to the growing network of academics, non-governmental organizations, advocates, social entrepreneurs, United Nations agencies, donors, and national governments. This paper delineates the key insights to inform and support the growing MHM commitment globally to maximize progress to reach our vision by 2024. Corresponding to the five priorities, we found that (priority 1) the evidence base for MHM in schools has strengthened considerably, (priority 2) global guidelines for MHM in schools have yet to be created, and (priority 3) numerous evidence-based advocacy platforms have emerged to support MHM efforts. We also identified (priority 4) a growing engagement, responsibility, and ownership of MHM in schools among governments globally, and that although MHM is beginning to be integrated into country-level education systems (priority 5), resources are lacking. Overall, progress is being made against identified priorities. We provide recommendations for advancing the MHM in Ten agenda. This includes continued building of the evidence, and expanding the number of countries with national level policies and the requisite funding and capacity to truly transform schools for all students and teachers who menstruate.

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How do women and girls experience menstrual health interventions in low- and middle-income countries? Insights from a systematic review and qualitative metasynthesis

Cited by 35 publications

References 24 publications

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

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

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

Menstrual hygiene management in schools: midway progress update on the “MHM in Ten” 2014–2024 global agenda

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