Developing Short and Rapid Measures of Menstrual Experience
Quantifying adolescent girls’ menstrual health needs is essential for monitoring population-level trends, evaluating the effectiveness of interventions, and understanding the relationships between menstrual experiences and broader health and well-being outcomes. The Menstrual Practice Needs Scale (MPNS-36) was developed in 2020 to address this gap, providing a comprehensive measure of girls’ experiences managing menstrual bleeding. However, the 36-item scale can present a barrier to implementation in short needs assessments or multi-component surveys.
In response to stakeholder feedback, researchers have now developed short and rapid versions of the MPNS to better meet the needs of different users. The Menstrual Practice Needs Scale short form (MPNS-SF) is an 18-item measure that retains the breadth of the original scale, while the Menstrual Practice Needs Scale rapid form (MPNS-R) condenses the assessment to just 9 core items.
Prioritizing Content Validity in Shortening the MPNS
The development of the MPNS-SF and MPNS-R was guided by several key principles:
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Maintaining Content Validity: Rather than prioritizing statistical model fit alone, the research team focused on preserving the comprehensive coverage of menstrual management experiences assessed in the original MPNS-36. This ensures the shortened versions continue to capture the full scope of needs and practices.
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Retaining Indicators for Monitoring: Several MPNS items have been included in recommended indicators for national and global monitoring of menstrual health and hygiene. The shortened versions prioritize retaining these items to enable comparability with existing datasets.
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Preserving Experiences Across Environments: The MPNS assesses menstrual experiences both at home and at school, as research has consistently highlighted differing challenges in these settings. The shortened versions maintain this distinction.
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Balancing Positive and Negative Experiences: The original MPNS intentionally included both positively and negatively framed items, as assessments have shown these capture distinct but related factors of menstrual experience. The shortened versions retain this balance.
By thoughtfully integrating stakeholder feedback, girls’ perspectives, and theoretical considerations, the research team developed shortened MPNS measures that preserve the content validity and nuance of the original scale.
Validating the MPNS-SF and MPNS-R
The development and validation of the short and rapid MPNS forms involved multiple phases and diverse data sources:
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Revalidation of the MPNS-36: The full 36-item MPNS was first revalidated in a pilot survey with 313 menstruating girls in Khulna, Bangladesh. Cognitive interviews with 20 adolescent girls in the same setting were used to refine the Bangla translation and check item comprehension.
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Short Form Development: Drawing on the cognitive interviews, item performance in past research, and stakeholder feedback, the research team developed a candidate 18-item short form (MPNS-SF) that maintained the original subscale structure.
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Short and Rapid Form Validation: The dimensionality, reliability, and validity of the MPNS-SF and 9-item rapid form (MPNS-R) were assessed in the Khulna pilot data, as well as in datasets from the original MPNS-36 development in Soroti, Uganda, and the baseline of the Adolescent Menstrual Experiences and Health Cohort (AMEHC) study in Khulna, Bangladesh.
The findings demonstrate that the MPNS-SF offers a reliable and valid measure that retains the breadth of the original scale. While the MPNS-R provides a more concise assessment, it sacrifices some structural validity. Both shortened versions exhibit hypothesized relationships with mental health, confidence managing menstruation, and school participation, though the associations are attenuated compared to the full MPNS-36.
Structural Validity of the MPNS-SF and MPNS-R
MPNS-SF: Maintaining the Original Subscale Structure
Confirmatory factor analyses across the three datasets confirmed that the MPNS-SF’s four-factor structure, reflecting the original subscales, achieved acceptable to good model fit. This included:
- Material and home environment needs
- Material reliability concerns
- Change and disposal insecurity
- Transport and school environment needs
The two subscales related to reusing menstrual materials were also replicated in the short form.
This consistency in subscale structure is important, as it allows the MPNS-SF to provide the same level of detail and nuance as the original 36-item version. Researchers and practitioners can use the subscale scores to identify specific areas of need or target their interventions.
MPNS-R: A More Simplified Structure
In contrast, the MPNS-R’s dimensionality was less stable. Exploratory and confirmatory factor analyses supported a two-factor structure as the best fit, capturing broader positive and negative experiences. However, this model did not reach thresholds of acceptable fit across all metrics.
The rapid form’s simplified structure reflects its purpose of providing a quick, high-level assessment of menstrual experiences. While it sacrifices the detailed subscale information of the MPNS-SF, the MPNS-R still offers a valid and reliable measure of the overall menstrual management experience.
Validity and Reliability of the Shortened Measures
Across the three datasets, both the MPNS-SF and MPNS-R demonstrated acceptable internal consistency reliability. The short form exhibited strong relationships with hypothesized correlates, such as mental health, confidence managing menstruation, and school participation. These associations, while attenuated, were also replicated for the rapid form.
Importantly, the MPNS-SF maintained the breadth of the original scale, ensuring it continues to capture the multidimensional nature of menstrual experiences. This is a key strength, as qualitative research has consistently highlighted the diverse challenges girls face in managing their menstrual bleeding.
The rapid MPNS-R offers a more concise assessment, making it suitable for settings where menstrual health is not the primary focus but needs to be included as part of broader water, sanitation, and hygiene or sexual and reproductive health research and programming. Its simplified structure, while reducing participant burden, means the MPNS-R may be less sensitive to detecting nuanced changes in menstrual experiences.
Implications for Research and Practice
The MPNS-SF and MPNS-R provide researchers and practitioners with flexible measurement tools to capture adolescent girls’ menstrual management experiences. The choice between the versions will depend on the specific needs and constraints of the study or program:
MPNS-SF:
– Recommended for in-depth needs assessments or evaluations of menstrual health interventions, where a comprehensive understanding of experiences is required.
– Maintains the detailed subscale structure of the original MPNS-36, enabling targeted insights and intervention planning.
– Exhibits strong relationships with hypothesized correlates, making it well-suited for research investigating the impacts of menstrual experiences.
MPNS-R:
– Suitable for rapid assessments or when menstrual health is one component of a broader study or program.
– Provides a high-level understanding of menstrual experiences while minimizing participant burden.
– May be less sensitive to detecting nuanced changes compared to the MPNS-SF, but offers a practical alternative when survey length is constrained.
Continued research using the MPNS measures, including longitudinal studies and intervention trials, will further strengthen the evidence on the relationships between menstrual experiences and broader health and well-being outcomes. As the field of menstrual health evolves, future studies should also explore the validity and reliability of the MPNS-SF and MPNS-R in new cultural contexts, languages, and age groups.
Conclusion
The development of the MPNS-SF and MPNS-R provides researchers and practitioners with flexible, validated tools to quantify adolescent girls’ menstrual management experiences. By prioritizing content validity and maintaining the breadth of the original MPNS-36, these shortened versions offer reliable and valid assessments that can support implementation, improve measurement in menstrual health research, and ultimately contribute to ensuring all girls and women can manage their menstruation with dignity and comfort.
