About the Menstrual Practice Needs Scale (MPNS-36)

The Menstrual Practice Needs Scale (MPNS-36) is a set of 36 self-report questions that measure the extent to which respondents’ menstrual management practices and environments were perceived to meet their needs during their last period.

The measure can be self-completed as a survey, or can be administered through an interview. The MPNS-36 was developed to provide a participant-centered approach to assessing menstrual experience and menstrual needs. 

A brief summary of the development of the MPNS-36 is provided below.

For more detailed information on development, please see the full publication at: Hennegan, J., Nansubuga, A., Smith, C., Redshaw, M., Akullo, A., & Schwab, K.J. (2020). Measuring menstrual hygiene experience: Development and validation of the Menstrual Practice Needs Scale (MPNS-36) in Soroti, Uganda. BMJ Open, 10, e034461. http://dx.doi.org/10.1136/bmjopen-2019-034461

Development of the MPNS-36

Determining what to measure

The first step in developing the MPNS-36 was to define the concept for measurement.

Our team systematically reviewed past research on women’s and girls’ experiences of menstruation in low- and middle-income countries. The full report of this review is available here. We found when women and girls were interviewed about their menstrual experiences, they consistently discussed the challenges they faced in managing their menstrual discharge. For example, they discussed being dissatisfied with the materials they used to absorb menstrual blood and difficulties changing or disposing of materials in ways they felt were acceptable. They also discussed the role of the spaces (environments) that they used to undertake their menstrual practices. For example, the sanitation facilities that they used throughout the day to change their menstrual materials, or the locations they used to dry reusable menstrual materials. In interviews, women and girls described the way that these spaces supported them, or failed to support them, to care for their bodies during menstruation.

Unmet menstrual management and environment needs were important parts of individuals’ menstrual experiences. Further, unmet needs were consistently described as leading to distress, and had implications for participants health, well-being, education and social participation.

Thus, we determined that whether or not women’s and girls’ menstrual practices and environments were perceived as supportive, reliable and acceptable to them was an important part of their menstrual experience. Further, this concept was consistent with the goals of many menstrual health and hygiene interventions, which seek to improve women’s and girls’ experiences of menstruation. At the same time, we determined through a review of the measures used in the study of menstrual experience that there were no tools that existed to quantitatively measure this concept. 

 

Developing the scale

There are a wide range of practices that females undertake to manage menstrual discharge. In developing a tool that could be widely used in research and practice, we needed to balance measuring experiences across the different types of practices (for example, the menstrual material used, disposal, storing and transporting materials), and the length of the scale. Any measure that focused too heavily on only one practice would not fairly represent experiences. At the same time, we can never ask as many questions as we would like to.

We used the findings from our review of women’s and girls’ menstrual experiences to help generate a large pool of statements that captured the variety of different menstrual practice and environment needs. For example, “I had enough of my menstrual materials to change them as often as I wanted to.” We generated a total of 54 statements that reflected menstrual practice and environment needs. This created a scale much longer than would be practical to use, and allowed us to test out the different items (statements) to identify which would contribute to a useful and intuitive tool, removing items that fit poorly. 

We asked experts to rate the usefulness of the different items, and our 4-point response options (“Always”, “Often (or more than half the time)”, “Sometimes (or less than half the time)”, “Never”). 

We then tested the scale through a study of the experiences of 538 menstruating schoolgirls in Soroti, Uganda. 

 

Testing the scale

The test 54-items were administered in a sample of menstruating schoolgirls, along with questions we could use to assess the performance of our items, and questions about menstrual practices that we tested in developing the Menstrual Practices Questionnaire

In testing out the MPNS, our team found that the questions were straight forward to administer and were understood by participants. To pilot the measure, research assistants provided schoolgirls with paper copies of the questionnaire. Girls completed the survey in groups of 6, marking their own responses, with the research assistants providing verbal translation of each question and facilitating the survey. This included an activity to help participants familarise themselves with using the response options.

Using the data from all 54-items we undertook a series of analyses to understand how the different statements (items) ‘fit’ together. We wanted to determine if participants responded to all items similarly (indicating that there was just one single concept we were measuring) or if there were groupings of items that may indicate that our scale contained multiple dimensions. Through this process, we removed items that fit poorly with the scale, or items that were too similar to one another.

Through this process we identified multiple dimensions within our scale. Four were applicable to all respondents, and a further two applied to those who washed and reused menstrual materials.

Material and home environment needs: these items captured the extent to which respondents were satisfied (had their needs met) in relation to their menstrual materials and environments (spaces) they used to mange their menstruation at home.

Material reliability concerns: a group of three items ‘fit’ together to capture respondents worries about the reliability of their menstrual materials (that they would leak, that they would run out of materials, or that materials would move out of place)

Transport and school environment needs: this group of items captured the extent to which respondents needs were met in relation to carrying and changing materials at school

Change and disposal insecurity: this group of items reflected respondents worries and concerns that they would not be able to change or dispose of materials when they needed to, and their concerns about privacy and safety while managing menstruation both at home and at school. 

Reuse insecurity: these items applied to those who reused materials and captured concerns around washing and drying materials.

Reuse needs: these items applied to those who reused materials and captured the extent to which respondents were satisfied with (had their needs met) in relation to washing and drying materials.

These dimensions form the sub-scales of the MPNS-36.

 

We found that the sub-scales had acceptable internal consistency, that is, individuals responded in a similar way across items in the sub-scale. We also found that the sub-scales, total score, and other questions included in our study (self-reported school absenteeism, psychological distress, and confidence to manage menstruation at home and school) were related in ways we expected. These relationships supported our interpretation that the scale was measuring what we set out to measure. 

The MPNS-36 thus provides a way for researchers and practitioners to understand if the menstrual management and environment needs of their population are being met.