Re-validation and adaptation of the Menstrual Practice Needs Scale to measure the menstrual experiences of adult women working in Mukono District, Uganda

Objectives. The Menstrual Practice Needs Scale (MPNS) is a comprehensive measure of menstrual self-care experience including access to sufficient, comfortable absorbents, supportive spaces for managing menstruation and for disposal and laundering of used materials. It addresses a critical measurement gap to improve quantitative menstrual health research. The scale was validated in a population of adolescent schoolgirls. This study appraises its performance among adult women.Methods. Seven cognitive interviews provided insights into the interpretability and acceptability of scale items. A cross sectional survey of 525 working women who had menstruated in the past six months (including 435 working in markets, 45 in schools and 45 working in health care facilities) in Mukono District, Uganda was used to test the dimensionality, reliability, and validity of the measure. Results. The 36 scale items were well understood by the study population. Dimensionality was tested for the 28 items relevant to women disposing of menstrual materials and 32 items relevant to those washing and reusing materials. The original subscale structure fit with the data, however fell short of recommended thresholds for those disposing of materials (RMSEA=0.069; CFI=0.840; TLI=0.824). An alternative sub-scale structure was an acceptable fit for those disposing (RMSEA = 0.051; CFI=0.911; TLI=0.897) and reusing materials (RMSEA=0.053; CFI=0.915; TLI=0.904). MPNS total and sub-scale scores demonstrated acceptable internal consistency. Higher scores reflected more positive menstrual experiences and were associated with greater wellbeing (total score r=0.24, p<0.001), not missing work due to the last menstrual period (total score OR=2.47 95%CI 1.42-4.30), and confidence to manage menstruation at home and work. Conclusions. The MPNS offers a valid and reliable way to assess menstrual health needs. The revised factor structure can be used for adult samples who work. Findings also highlight challenges in assessing the variety of experiences relevant to managing menstrual bleeding.