The Menstrual Practice Needs Scale Short Form (MPNS-SF) and Rapid (MPNS-R): Development in Khulna, Bangladesh, and validation in cross-sectional surveys from Bangladesh and Uganda

Objectives. Develop and validate short and rapid forms of the 36-item Menstrual Practice Needs Scale (MPNS-36). Design. Item reduction prioritised content validity and was informed by cognitive interviews with schoolgirls in Bangladesh, performance of scale items in past research, and stakeholder feedback. The original MPNS-36 was revalidated, and short and rapid forms tested in a cross-sectional survey. This was followed by further tests of dimensionality, internal consistency, and validity in multiple cross-sectional surveys. Setting and participants. Short form (MPNS-SF) and rapid form (MPNS-R) measures were developed in a survey of 313 menstruating girls (mean age=13.51) in Khulna, Bangladesh. They were further tested in the baseline survey of the Adolescent Menstrual Experiences and Health Cohort, in Khulna, Bangladesh (891 menstruating girls, mean age=12.40); and the dataset from the MPNS-36 development in Soroti, Uganda (538 menstruating girls, mean age=14.49). Results. The 18-item short form reflects the six original subscales, with the four core subscales demonstrating good fit in all three samples (Khulna pilot: RMSEA=0.064 90%CI 0.043-0.084, CFI=.94, TLI=.92. Cohort baseline: RMSEA=0.050 90%CI 0.039-0.062, CFI=.96, TLI=.95. Uganda: RMSEA=0.039 90%CI 0.028-0.050, CFI=.95, TLI=.94). The 9-item rapid form captures diverse needs. A two-factor structure was the most appropriate but fell short of adequate fit (Khulna pilot: RMSEA=0.092 90%CI 0.000-0.158, CFI=.93, TLI=.89). Hypothesised associations between the MPNS scores and other constructs were comparable between the MPNS-36 and MPNS-SF in all populations, and replicated, with attenuation, in the MPNS-R. Internal consistency remained acceptable. Conclusions. The MPNS-SF offers a reliable and valid measure of adolescent girls' menstrual hygiene experience while reducing participant burden, to support implementation and improve measurement in menstrual health research. The MPNS-R provides a brief measure with poorer structural validity, suited to including menstrual health within broader water, sanitation and hygiene or sexual and reproductive health research. ### Competing Interest Statement CS works for Irise International, an organisation dedicated to creating a world where all women and girls can reach their full potential, regardless of their periods. All other authors declare no competing interests. ### Funding Statement Development of the MPNS short form was funded by The Case for Her, the Reckitt Global Hygiene Institute (RGHI), and supported by funding from the National Health and Medical Research Council of Australia (NHMRC) (GNT2008600). The AMEHC study is funded by the National Health and Medical Research Council of Australia (NHMRC) (GNT2004222 and GNT2008600), and the Reckitt Global Hygiene Institute (RGHI). The views expressed are those of the authors and not necessarily those of RGHI. J Hennegan is supported by an RGHI Fellowship and NHMRC Investigator Grant (GNT2008600). P Azzopardi is supported by a NHMRC Investigator Grant GNT2008574. The authors gratefully acknowledge the contribution to this work of the Victorian Operational Infrastructure Support Program received by the Burnet Institute. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Khulna Pilot and Cohort, Bangladesh: The study received ethical approval from the Alfred Hospital Ethics Committee, Melbourne, Australia (369/22) and the Institutional Review Board of BRAC James P Grant School of Public Health, BRAC University (IRB-06 July 22-024), Bangladesh. National and district-level education offices provided endorsement for the study. Soroti, Uganda: Publicly available de-identified data is available at https://osf.io/qshkc/. The original study was approved by Johns Hopkins School of Public Health Institutional Review Board (IRB approval no: 00009073) and the Mildmay Uganda Research Ethics Committee (MUREC) (approval ref: 0212-2018). The Uganda National Council for Science and Technology (UNCST) approved the study (ref: SS279ES). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Khulna Pilot and Baseline. De-identified data relevant to this manuscript are available in an open access repository at https://osf.io/uh9z8/. Soroti, Uganda: Data are available in a public, open access repository. Deidentified data are available at https://osf.io/qshkc/.