Development and validation of the menstrual health and hygiene (MHH) scale for adolescent girls and teachers: associating MHH needs, practices, beliefs and experiences of adolescent girls and teachers with student engagement

Abstract

"There is limited literature exploring the breadth of menstrual practices and how it affects student engagement levels in school among adolescent girls in India. This research tries to address this gap by (a) developing a new scale to understand menstrual health and hygiene (MHH) practices among students and teachers, and, (b) examining how MHH beliefs among students and teachers are linked to student engagement. Student and teacher versions of the MHH scale consisting of 80 and 60 items, respectively, were constructed using a literature review of quantitative and qualitative studies conducted in India and other lower- and middle-income countries. A cross-sectional survey was conducted online with 703 adolescent girls across classes VII to X and 318 teachers across eight schools in Delhi and Ahmedabad. Firstly, we conducted a series of factor analyses to examine the validity of MHH scale measures for both student and teacher versions. Next, multilevel modelling was employed to check how the student and teacher perceptions of MHH influenced the engagement level of adolescent girls in school. The final MHH-student and teacher version scale comprised of 58 and 39 items, respectively, capturing the gamut of menstrual practices across personal, interpersonal, and environmental factors. A ten-factor solution was the best fit for the MHH-student version data (root mean square error of approximation [RMSEA]=0.04; comparative fit index [CFI]=0.92; Goodness of fit-index [GFI]=0.91; standardised root means square residual [SRMR] = 0.06). The reliability for the sub-scales lies in the range of 0.67-0.86. For MHH- Teacher Version scale, a six-factor solution was the best fit for the data (RMSEA=0.03; CFI=0.95; GFI=0.95; SRMR = 0.05). The reliability of the sub-scales lies in the range of 0.68-0.81. Concurrent validity for both the scales was supported by using the hypothesized relationship between the sub-scale scores and confidence to manage the menstrual period. Results from multilevel modelling showed that teachers’ MHH beliefs (β=0.14, p<0.01) was a significant predictor of student engagement. In contrast, students’ MHH beliefs (β=0.02, p>0.10) was not a significant predictor of student engagement. MHH Student and Teacher Scale are the first measure to capture the breadth of menstrual practices, guided by the relevant literature and framework. It will help various non-governmental organizations, policymakers and researchers understand the ground reality of menstrual health in a particular context and contribute towards developing the literature further in this regard. Future studies should explore and validate these scales in a different context."