Capturing Comprehensive Experiences of Menstrual Management
As a seasoned expert in water and sanitation services, community engagement, and advocacy, I am thrilled to share insights on the Menstrual Practice Needs Scale (MPNS) and its shorter adaptations – the MPNS Short Form (MPNS-SF) and the MPNS Rapid (MPNS-R). These tools provide a comprehensive and participant-centered approach to understanding the multifaceted experiences of menstrual management, which is essential for improving menstrual health outcomes worldwide.
Importance of Measuring Menstrual Experiences
Quantifying adolescent girls’ menstrual health needs has long been a challenge, hindering our ability to monitor population-level progress and evaluate the effectiveness of interventions. The MPNS-36, published in 2020, addressed this critical gap by providing a validated measure of individuals’ experiences during their last menstrual period. By assessing the extent to which needs for menstrual materials, disposal, spaces for changing and laundering reusable materials were met, the MPNS-36 offered a holistic perspective on the menstrual hygiene experience.
However, the comprehensive nature of the MPNS-36, with its 36 items, presented a barrier to rapid implementation in short needs assessments or multi-component surveys. Stakeholders requested the development of shorter versions to enable greater uptake and applicability across diverse research and programmatic contexts.
Introducing the MPNS Short Form and Rapid Versions
In response to stakeholder feedback, our team set out to develop the MPNS Short Form (MPNS-SF) and the MPNS Rapid (MPNS-R) versions. The guiding principles for item reduction were to:
- Prioritize Content Validity: Maintain the breadth of menstrual management experiences captured in the original MPNS-36, even if this meant sacrificing some structural validity.
- Retain Key Indicators: Ensure the inclusion of items that have been recommended as national and global indicators for monitoring menstrual health and hygiene.
- Preserve Home and School Experiences: Continue to differentiate between experiences in the home and school environments, as research has consistently shown these differ for adolescents.
- Balance Positive and Negative Appraisals: Include both positively and negatively framed items to offer a more nuanced assessment of the menstrual experience.
The MPNS-SF emerged as an 18-item measure, with 14 core items applicable to all respondents and 4 additional items for those who reported washing and reusing menstrual materials. This short form maintains the original six subscales, with the four core subscales demonstrating good structural validity across multiple populations.
In contrast, the MPNS-R is a more streamlined 9-item rapid assessment tool. While this version sacrifices some structural validity, it captures the diverse range of menstrual management needs in a concise format. A two-factor structure was found to be the most appropriate, though it fell short of adequate fit in our tests.
Validation Across Diverse Populations
To ensure the robustness of the shorter MPNS versions, we conducted rigorous validation across multiple datasets. This included:
- Khulna Pilot, Bangladesh: We revalidated the original MPNS-36 and then developed and tested the MPNS-SF and MPNS-R in this sample of 313 menstruating girls.
- Khulna Cohort Baseline, Bangladesh: The MPNS-SF was further validated in this baseline survey of 891 menstruating girls.
- Soroti, Uganda: The MPNS-SF and MPNS-R were tested in the dataset from the original MPNS-36 development, which included 538 menstruating girls.
Across these diverse contexts, the MPNS-SF demonstrated strong structural validity, internal consistency, and associations with hypothesized correlates, such as mental health, school participation, and confidence managing menstruation. The MPNS-R, while exhibiting poorer structural validity, maintained acceptable internal consistency and replicated key associations, albeit with some attenuation.
Tailoring the MPNS to User Needs
The MPNS-SF and MPNS-R offer researchers, practitioners, and policymakers flexible options to capture the multifaceted experiences of menstrual management. The MPNS-SF provides a reliable and valid 18-item measure, well-suited for research and evaluation where a more comprehensive assessment is required. Conversely, the MPNS-R’s brevity makes it appropriate for inclusion in broader surveys or rapid needs assessments where menstrual health is not the primary focus.
Importantly, both shorter versions preserve the essential breadth of experiences measured in the original MPNS-36. This ensures that evaluations of menstrual health interventions can still capture the holistic impact on individuals’ blood management practices and perceptions of the environments used for menstrual care.
Implications for Research and Practice
The availability of the MPNS-SF and MPNS-R expands the toolbox for menstrual health research and programming. Researchers can now choose the version that best suits their study objectives, whether it be a comprehensive assessment of menstrual experiences or a rapid snapshot within a broader investigation.
For program implementers and policymakers, these shorter forms enable more efficient needs assessments and monitoring of menstrual health indicators. The MPNS-SF, in particular, offers a participant-centered measure that can inform the design and evaluation of menstrual health interventions, ensuring a focus on the diverse needs of the target population.
Furthermore, the consistent performance of the MPNS-SF across contexts strengthens the comparability of data collected using this measure. This harmonization of menstrual health measurement is crucial for building the evidence base, tracking progress toward global goals, and advocating for improved menstrual health policies and services.
Conclusion
The development of the MPNS-SF and MPNS-R represents a significant advancement in the field of menstrual health measurement. By providing shorter, validated versions of the comprehensive MPNS-36, we have expanded the reach and applicability of this important tool.
Whether researchers, practitioners, or policymakers, the MPNS-SF and MPNS-R offer a reliable and participant-centered approach to understanding the multifaceted experiences of menstrual management. By capturing the holistic nature of this critical aspect of health and wellbeing, these measures can inform more effective interventions and drive progress toward a world where all individuals can manage their menstruation with dignity and ease.
Integrating the MPNS into Research and Practice
Applying the MPNS-SF in Research
The MPNS-SF is well-suited for research studies where a comprehensive assessment of menstrual experiences is required. Its 18-item structure, with four core subscales, provides a nuanced understanding of individuals’ needs and practices related to menstrual materials, disposal, changing, and the home and school environments.
Researchers can leverage the MPNS-SF to:
- Explore Associations: Investigate the relationships between menstrual experiences and other health, social, and educational outcomes, such as mental health, school participation, and confidence managing menstruation.
- Evaluate Interventions: Assess the impact of menstrual health interventions on the holistic experience of menstrual management, ensuring that all aspects of blood management practices and perceptions of the environments used for menstrual care are captured.
- Monitor Progress: Track population-level changes in menstrual experiences over time, contributing to the evidence base and informing policy and program decisions.
By maintaining the breadth of the original MPNS-36, the MPNS-SF enables researchers to paint a comprehensive picture of menstrual experiences, while reducing participant burden and enhancing the feasibility of implementation.
Integrating the MPNS-R into Rapid Assessments
For practitioners and policymakers engaged in broader water, sanitation, and hygiene (WASH) or sexual and reproductive health initiatives, the MPNS-R offers a concise 9-item tool to rapidly assess menstrual management needs. While the MPNS-R sacrifices some structural validity compared to the MPNS-SF, it still captures the diverse range of experiences related to menstrual materials, disposal, changing, and the home and school environments.
The MPNS-R can be valuable in the following contexts:
- Multi-Component Surveys: Incorporate menstrual health measurement as part of larger surveys focused on WASH, sexual and reproductive health, or other development topics.
- Rapid Needs Assessments: Quickly gather insights on menstrual management experiences to inform the design and targeting of menstrual health interventions.
- Routine Monitoring: Track changes in menstrual health indicators as part of ongoing program monitoring and evaluation efforts.
By including the MPNS-R in a broader research or programmatic agenda, practitioners and policymakers can ensure that menstrual health is not overlooked, while minimizing the time and resources required for data collection.
Adapting the MPNS Versions to Local Contexts
While the MPNS-SF and MPNS-R have demonstrated robust performance across diverse populations in Bangladesh and Uganda, it is essential to consider local contexts and cultural norms when applying these tools.
Translation and Adaptation: Ensure that the MPNS items are appropriately translated and adapted to the local language and cultural nuances. The cognitive interviews conducted in Bangladesh during the development of these shorter forms highlighted the importance of this process, as certain words and phrases required refinement to maintain conceptual equivalence.
Eligibility and Tailoring: The MPNS items related to reusing menstrual materials or changing them at school may not be applicable to all respondents. Carefully consider the target population and adjust the administration of the MPNS-SF or MPNS-R accordingly, to ensure the most relevant data is collected.
Supplementary Measures: Depending on the research or programmatic objectives, consider integrating the MPNS-SF or MPNS-R with other validated measures of menstrual health, such as those capturing menstrual knowledge, attitudes, or access to products and services. This can provide a more comprehensive understanding of the menstrual health landscape.
By thoughtfully adapting and integrating the MPNS-SF and MPNS-R, researchers, practitioners, and policymakers can leverage these tools to generate context-specific insights and drive meaningful improvements in menstrual health globally.
Collaborating for Collective Impact
The journey of developing the MPNS-SF and MPNS-R has been a collaborative effort, drawing on the expertise and perspectives of researchers, practitioners, and community members. This inclusive approach has been essential for ensuring the relevance and applicability of these measures across diverse settings.
As we move forward, continued collaboration will be key to maximizing the impact of the MPNS tools. Joint Action for Water, with its focus on water and sanitation services, community engagement, and advocacy, is well-positioned to facilitate this collaborative spirit.
We encourage researchers, practitioners, and policymakers to connect with the Joint Action for Water community to:
- Share Experiences: Contribute insights and lessons learned from applying the MPNS-SF or MPNS-R in your own work, helping to refine and improve these tools.
- Advocate for Change: Leverage the MPNS measures to advocate for improved menstrual health policies, services, and community support, drawing on the collective voice of the Joint Action for Water network.
- Foster Cross-Pollination: Explore opportunities for interdisciplinary collaboration, combining the MPNS with other measures or approaches to gain a more holistic understanding of menstrual health and its broader impacts.
By working together, we can ensure that the MPNS-SF and MPNS-R continue to evolve and serve as powerful instruments for driving progress in menstrual health worldwide.
