• Women's Health Research
Research Article

Applying the Integrated Model of Menstrual Experience to Validate a Framework for Healthy Menstrual Experience for Young Girls in Pakistan through Structural Equation Modelling

Women's Health Research [2021; 3(1):17-31]
Received: 30 May 2021, Accepted: 21 June 2021, Published: 25 June 2021

Research shows that young adolescent girls often do not receive the necessary information on menstruation, and the information they do receive is often late, incomplete, or inaccurate. The dearth of knowledge and prevalent misconceptions combined with the sociocultural taboo around menstruation lead to an overall negative experience for early adolescent girls at menarche and during the reproductive years to follow. This study adapted and contextualized the Integrated Model of Menstrual Experience to identify a parsimonious set of constructs that can be used to validate a framework for Healthy Menstrual Experience for young adolescent girls in Pakistan. Data were collected through a cross-sectional survey from October 2019 to December 2019 from 513 girls attending grades six to eight in secondary schools from urban locality Karachi and rural locality Khairpur, province Sindh, Pakistan. 48 items were developed on the basis of the identified constructs from the adapted model and were subjected to factor analytic techniques for reduction and validation. The validated framework was composed of 15 items and five factors, with menstrual etiquette and norm (factor 1) as the distal antecedent heavily influencing girls’ perception of safe menstrual knowledge (factor 2) and their accessibility to safe menstrual sanitation (factor 3). Knowledge and accessibility of safe menstrual sanitation are direct predictors of the core outcome, girls’ menstrual experience (factor 4), which subsequently determines their social and school attendance (factor 5). The framework was validated through Structural Equation Modelling using a Diagonally-Weighted Least Squares (DWLS) estimation fitted to polychoric correlations and asymptotic covariances to account for the ordinal nature of the data. The validated framework charts a pathway for assessing girls’ menstrual experience and its predictors, and subsequently, identifies points of intervention to ensure that young girls are able to have a healthy menstrual experience.

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