Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego (UCSD), San Diego, California, United States of America.
School of Public Health, San Diego State University (SDSU), San Diego, California, United States of America.
PLoS One. 2024 May 10;19(5):e0303378. doi: 10.1371/journal.pone.0303378. eCollection 2024.
Domains of adequate menstrual health (MH) include access to water, sanitation, and hygiene (WASH). People who menstruate with social disadvantages-such as homelessness or drug injection practices-often face barriers to WASH access. However, validated instruments to measure MH are limited among marginalized populations, and available instruments involve lengthy surveys. We developed and evaluated psychometric properties of a novel 'MH WASH Domain Scale-12' among people who menstruate and who inject drugs in the Tijuana-San Diego region and identified correlates of MH access using this scale.
We constructed a MH-scale based on access to twelve WASH-related items: (1) menstrual products, (2) body hygiene (bathing per week), (3) water sources for bathing, (4) improved, (5) non-shared, (6) available, (7) private, (8) nearby, (9) and safe sanitation facilities, (10) availability of soap, (11) water source for handwashing, and (12) handwashing facilities with soap/water. Variables were dichotomized and summed, with scores ranging from 0-12 points and higher scores indicating better MH access. We assessed the scale's reliability and construct and content validity using data from a binational cross-sectional study. The sample included people who inject drugs (PWID) who had ever menstruated in their lifetime and were 18+ during 2020-2021. MH-WASH items were described, and the scale was further used as an outcome variable to identify correlates.
Among 125 (124 cis-female and 1 trans-male) PWID that reported menstruating, our 'MH WASH Domain Scale-12' was reliable (Cronbach's alpha = 0.81, McDonald's Omega total = 0.83) and valid. We identified two sub-domains: Factor-1 included items describing 'WASH availability' and Factor-2 contained items related to 'WASH security'-encompassing physical and biological safety. Scale scores were significantly lower among participants experiencing unsheltered homelessness compared to participants experiencing sheltered homelessness or living in permanent housing.
We constructed and validated a novel and reliable scale to measure MH-related WASH access that can be used to assess MH among marginalized populations in English- and Spanish-speaking contexts. Using this scale we identified disparities in MH-WASH access among PWID and who menstruate in the US-Mexico border region.
充分的月经健康（MH）领域包括获得水、卫生和个人卫生（WASH）。那些在社会上处于不利地位的人，例如无家可归或注射毒品的人，往往难以获得 WASH。然而，在边缘化人群中，验证有效的 MH 测量工具是有限的，而且现有的工具涉及冗长的调查。我们在提华纳-圣地亚哥地区的经期和注射毒品者中开发和评估了一种新的“MH WASH 领域量表-12”的心理测量特性，并使用该量表确定了与 MH 获得相关的因素。
我们根据十二项与 WASH 相关的项目构建了一个 MH 量表：（1）经期用品，（2）身体卫生（每周洗澡次数），（3）洗澡用水源，（4）改良的，（5）非共用的，（6）可用的，（7）私人的，（8）附近的，（9）安全的卫生设施，（10）肥皂的可用性，（11）洗手的水源，以及（12）带有肥皂/水的洗手设施。变量被二值化并求和，得分范围为 0-12 分，得分越高表示 MH 获得情况越好。我们使用 2020-2021 年期间参加过一项跨国横断面研究的、曾经有过经期的、18 岁以上的、注射毒品者（PWID）的数据，评估了该量表的可靠性和结构及内容效度。MH-WASH 项目进行了描述，并且该量表进一步被用作识别相关因素的结果变量。
在 125 名（124 名 cis-女性和 1 名跨性别男性）报告有经期的 PWID 中，我们的“MH WASH 领域量表-12”具有可靠性（克朗巴赫 α = 0.81，麦克唐纳 Omega 总 = 0.83）和有效性。我们确定了两个子领域：因子-1 包括描述“WASH 可用性”的项目，因子-2 包含与“WASH 安全性”相关的项目，包括物理和生物安全。与有庇护所无家可归的参与者相比，没有庇护所无家可归的参与者的量表得分明显较低，而有庇护所无家可归的参与者和居住在永久性住房中的参与者的量表得分较高。
我们构建并验证了一种新的、可靠的测量工具，用于测量与月经健康相关的 WASH 获得情况，可用于评估英语和西班牙语环境下的边缘化人群的月经健康状况。使用该量表，我们发现美国-墨西哥边境地区的 PWID 和经期女性在 WASH 获得方面存在差异。
