The development of a questionnaire for the assessment of menstrual health literacy amongst active females : a thesis present in partial fulfilment of the requirements for the degree of Master of Science in Nutrition and Dietetics, Massey University, Auckland, New Zealand
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Date
2023
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Massey University
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Abstract
Background: Poor menstrual health literacy (MHL) is a factor that contributes to females not seeking medical help for abnormal menstrual symptoms that may impact their mental, social, and physical health (Garside et al., 2008). Few studies have focused on testing baseline functional knowledge of the menstrual cycle (MC) outside the context of pregnancy and menopause. The primary objective of this study was to investigate MHL levels of physically active females residing in New Zealand using a developed validated questionnaire. A secondary objective was to understand where females get their MC information from, what sources they consider to be trustworthy and what MC information they would like to know more about. Methods: A MC knowledge questionnaire was developed by the research team (n=3), and reviewed by academics (n=4), medical experts (n=4), sporting organisation staff (n=5), and target population (n=10) to ensure content validity. Active females (n=203) between the ages of 16-40 years completed an online questionnaire. The questionnaire included a total of 25 knowledge questions and was split into four categories: menstrual cycle (Q=9), menstruation (Q=6), symptoms (Q=4), and health outcomes (Q=6). All correct options were coded as ‘1’ and incorrect options were coded as ‘0’. A total score of 44 was possible. Responses (single and multiple answer multi-choice questions) were analysed using descriptive statistics which were presented as mean, SD and frequency (%). Results: The overall knowledge score was 51.8% (22.8± 3.4). The highest knowledge scores were noted for symptoms (80.5%), followed by menstruation (79.8%), and the menstrual cycle (64.2%). Females scored poorly when asked about health outcomes related to the MC (20.4%). The majority of the participants (n=123, 61.5%) identified the internet as their main source of MC information. Friends (n=82, 41%), school sex education (n=73, 36.5%) and social media (n=73, 36.5%) were the next most common sources of MC information. Participants considered the most trustworthy sources of information to be doctors/general practitioners (n= 96, 48%) and healthcare professionals (n=70, 35%). The most common topics that females wanted to know more about were diet and the MC (n=115, 57.5%), training and the MC (n=115, 57.5%), MC tracking (n=78, 39%), MC and mood (n=75, 37.5%) and Relative Energy Deficiency in sport/Low Energy Availability/Female Athlete Triad (n=71, 35.5%). Conclusion: Overall functional knowledge levels of the MC and associated health outcomes is low in active females in New Zealand. Healthcare professionals and doctors are considered the most trustworthy sources of information; however, they are not the most common sources of information that females will engage with. Developing online educational resources on the MC, associated health outcomes and lifestyle factors (diet, physical activity) with medical and healthcare professionals may be considered in future female health education.