        TY  - JOUR
T1  - Turkish Validity and Reliability Study of the Negative Menstrual Attitudes Assessment Scale: A methodological study
AU  - Güven Santur, Sinem
AU  - Özşahin, Zeliha
AU  - Aksoy Derya, Yeşim
PY  - 2025
DA  - September
Y2  - 2025
DO  - 10.33808/clinexphealthsci.1649275
JF  - Clinical and Experimental Health Sciences
PB  - Marmara University
WT  - DergiPark
SN  - 2459-1459
SP  - 636
EP  - 646
VL  - 15
IS  - 3
LA  - en
AB  - Objective: The objective of this study is to determine the validity and reliability of the Negative Menstrual Attitudes Assessment Scale (NMAS) in Türkiye. The NMAS is a scale that evaluates women’s negative attitudes towards menstruation..Methods: This study employed a methodological approach and concentrated on female students registered in the Faculty of Health Sciences at a public institution from June to August 2023. The scale underwent a three-phase Turkish adaption procedure, comprising linguistic validity, content validity, and a pilot implementation. The pilot research had a cohort of 30 individuals. Following this, construct validity was assessed using Kaiser-Meyer-Olkin, Exploratory Factor Analysis (EFA), and Confirmatory Factor Analysis (CFA). Furthermore, assessments were performed to evaluate reliability, encompassing Cronbach’s α internal consistency coefficient, item-total correlation, test-retest analysis, and ROC analysis for determining cut-off scores.Results: According to the EFA analysis, which confirmed the validity of the 15-item scale, it was determined that no items had factor loadings below 0.30. The subsequent CFA analysis validated the three-factor structure of the NMAS, exhibiting good fit indices. The resultant 15-item scale consists of three sub-dimensions: Debilitating Event, Bothersome Event, and Natural Event. The internal consistency coefficient of NMAS, as determined by Cronbach’s alpha, was 0.861, 0.855, 0.784, and 0.772 for the overall measure and its sub-dimensions, respectively. Moreover, the item-total correlation and test-retest analysis of the scale demonstrate a robust association.Conclusion: A rigorous and accurate instrument has been created to evaluate unfavorable menstruation attitudes among women in Turkish culture. The scale demonstrated robust psychometric properties, confirming its validity and reliability for assessing negative menstrual attitudes in Turkish culture.
KW  - Negative menstrual attitudes
KW  - NMAS
KW  - Menstrual attitude
KW  - Reproductive age
KW  - scale
CR  - Varışoğlu Y, Irmak Vural P. Genç kadınların menstrual deneyimleri ile depresyon, anksiyete ve stres düzeylerinin
karşılaştırılması. Balıkesır Health Sciences Journal. 2022; 12(3):620-627. https://doi.org/10.53424/Balıkesırsbd.1166739 (Turkish)
CR  - World Health Organisation. A cross-cultural study of menstruation: ımplications for contraceptive development
and use. Studies in Family Planning, 1981, 12(1), 3–16. https://doi.org/10.2307/1965859 Accessed 17th November 2023.
CR  - Kawata R, Endo M, Rai SK, Ohashi K. Development of a scale to evaluate negative menstrual attitudes among Nepalese women. Reproductive Health. 2022;19(1):1-11. https://doi.org/10.1186/S12978.022.01426-6
CR  - Borjigen A, Huang C, Liu M, Lu J, Peng H, Sapkota C, Sheng J. Status and factors of menstrual knowledge, attitudes, behaviors and their correlation with psychological stress in adolescent girls. Journal of Pediatric and Adolescent Gynecology. 2019, 1;32(6):584-589. https://doi.org/10.1016/j.jpag.2019.08.007
CR  - Aker MN, Ozdemir F, Ozturk FO. The effects of ambivalent sexism on nursing students’ menstrual attitudes. Journal
of Psychiatric Nursing. 2021;12(1):29-34. https://doi.org/10.14744/phd.2021.20981
CR  - Demirel S, Terzioğlu F. Gaziantep ili Şahinbey ilçesi ilköğretim okullarında öğrenim gören 5. ve 6. sınıf kız öğrencilerin menstruasyon fizyolojisine ilişkin bilgilerinin belirlenmesi. Hemşirelikte Araştırma Geliştirme Dergisi. 2003;5(2):47-60, https://doi.org/10.69487/hemarge.694660 (Turkish)
CR  - Özdemir F, Tezel A, Nazik E. The determination of menstrual attitude with health self-efficacy perception in adolescents. Kocaeli Tıp Dergisi. 2013;2(3):18-23.
CR  - Altıntaş RY, Bakır S, Gül İ, Süer N, Kavlak O. Hemşirelik öğrencilerinde menstruasyon tutumunun genital hijyen
davranışlarına etkisi. Turkish Journal of Family Medicine and Primary Care. 2021;15(3):568-75, https://doi.org/10.21763/tjfmpc.931262 (Turkish)
CR  - Åkerman E, Wängborg A, Persson M, Sörensdotter R, Klingberg-Allvin M. Navigating menstrual stigma and norms:
a qualitative study on young people’s menstrual experiences and strategies for improving menstrual health. BMC Public Health. 2024;17;24(1):3401. https://doi.org/10.1186/s12889.024.20936-5
CR  - Hennegan J, Shannon AK, Rubli J, Schwab KJ, Melendez-Torres GJ. Women’s and girls’ experiences of menstruation in low-and middle-income countries: A systematic review and qualitative metasynthesis. PLoS Medicine. 2019 16;16(5):e1002803. https://doi.org/10.1371/JOURNAL.PMED.1002803
CR  - Betsu BD, Medhanyie AA, Gebrehiwet TG, Wall LL. Menstrual hygiene management interventions and their effects on schoolgirls’ menstrual hygiene experiences in low and middle countries: A systematic review. Plos One. 2024;
22;19(8):e0302523. https://doi.org/10.1371/journal.pone.0302523
CR  - Lawal AM, Idemudia ES, Balogun SK. Menstrual attitude dimensions, anxiety and body esteem in adolescent girls.
Psychology, Health &amp; Medicine. 2020; 25(4):418-425. https://doi.org/10.1080/13548.506.2019.1640885
CR  - Ramamoorthy S, Vijayalakshmi TN, Manickavasagan Y, Palaniswamy S. Assessment of relationship between
premenstrual syndrome symptoms with sleep quality and menstrual attitudes in medical students: A cross-sectional study. National Journal of Physiology, Pharmacy and Pharmacology. 2024;14(4):760-768 https://doi.org/10.5455/njppp.2023.13.084.042.02318092023
CR  - Brooks-Gunn J, Ruble DN. The menstrual attitude questionnaire. Psychosomatic Medicine. 1980 1;42(5):503-
512.
CR  - Firat MZ, Kulakaç Ö, Öncel S, Akcan A. Menstrual attitude questionnaire: confirmatory and exploratory factor analysis with Turkish samples. Journal of Advanced Nursing. 2009;65(3):652-662. https://doi.org/10.1111/j.1365-
2648.2008.04919.x
CR  - Johnston-Robledo I, Chrisler JC. The menstrual mark: Menstruation as social stigma. The Palgrave handbook ofcritical menstruation studies. 2020;25:181-199. https://doi.org/10.1007/S11199.011.0052-Z
CR  - Sommer M, Hirsch JS, Nathanson C, Parker RG. Comfortably, safely, and without shame: defining menstrual hygiene management as a public health issue. American Journal of Public Health. 2015;105(7):1302-1311. https://doi.org/10.2105/AJPH.2014.302525
CR  - Kubovskı, Anna; Cohen Shabot, Sara. Experience of menstruation with the use of reusable menstrual products:
a qualitative study among menstruators in Israel. Culture, Health &amp; Sexuality. 2024, 26.7: 904-919. https://doi.org/10.1080/13691.058.2023.2260465
CR  - Karakoç AG, Dönmez L. Ölçek geliştirme çalışmalarında temel ilkeler. Tıp Eğitimi Dünyası. 2014;13(40):39-49. https://doi.org/10.25282/TED.228738 (Turkish)
CR  - Bowling A, Ebrahim S. Handbook of health research methods: investigation, measurement and analysis. McGraw-Hill Education (UK); 2005; 16.
CR  - Alpar, R. Spor, sağlık ve eğitim bilimlerinden örneklerle uygulamalı istatistik ve geçerlik güvenirlik. Detay Yayıncılık,
2010. Accessed 18th January 2025. (Turkish)
CR  - Tekin H. Eğitimde ölçme ve değerlendirme (20. Baskı). Ankara: Yargı Yayınevi. 2010. Accessed 18th January 2025. (Turkish)
CR  - Büyüköztürk Ş. Faktör analizi: Temel kavramlar ve ölçek geliştirmede kullanımı. Kuram ve Uygulamada Eğitim Yönetimi. 2002;32(32):470-483. (Turkish)
CR  - Gürbüz S. AMOS ile yapısal eşitlik modellemesi. Ankara: Seçkin Yayıncılık. 2019;2. Accessed 18th Janurary 2025. (Turkish)
CR  - Urbina S. Essentials of psychological testing. John Wiley &amp;Sons; 2014. Accessed 17th December 2024.
CR  - Raines-Eudy R. Using structural equation modeling to test for differential reliability and validity: An empirical demonstration. Structural Equation Modeling: A Multidisciplinary Journal. 2000;1;7(1):124-141. https://doi.org/10.1207/S15328007SEM0701_07
CR  - Briggs SR, Cheek JM. The role of factor analysis in the development and evaluation of personality scales.
Journal of Personality. 1986;54(1): 106–148. https://doi.org/10.1111/J.1467-6494.1986.TB00391.X
CR  - Gözüm S, Aksayan S. Kültürlerarası ölçek uyarlaması için rehber II: Psikometrik özellikler ve kültürlerarası karşılaştırma. Hemşirelikte Araştırma Geliştirme Dergisi. 2003;5(1):3-14. (Turkish)
CR  - Arbuckle JL. IBM SPSS Amos 20 user’s guide. Amos development corporation, SPSS Inc. 2011:226-9.
CR  - Çokluk Ö, Şekercioğlu G, Büyüköztürk Ş. Sosyal bilimler için çok değişkenli istatistik: SPSS ve LISREL uygulamaları. Ankara: Pegem akademi; 2012. (Turkish)
CR  - Mardia KV. Applications of some measures of multivariate skewness and kurtosis in testing normality and robustness studies. Sankhyā: The Indian Journal of Statistics, Series B. 1974 1:115-28. https://www.jstor.org / stable/ 25051892
CR  - Bollen KA, Long JS. Tests for structural equation models: introduction. Sociological Methods &amp; Research. 1992;21(2):123-131. https://doi.org/10.1177/004.912.4192021002
CR  - Maruyama G. Basics of structural equation modeling. Sage; 1997;22.
CR  - Meydan CH, Şeşen H. Yapısal eşitlik modellemesi AMOS uygulamaları. Detay Yayıncılık; 2011. (Turkish)
CR  - Kline RB. Principles and practice of structural equation modeling. Guilford Publications; 2023 24.
CR  - Civelek ME. Normal olmayan dağılım ve küçük örneklem büyüklüğü kıstları altında kovaryans tabanlı ve kısmi en
küçük kareler yapısal eşitlik modellemesi yöntemlerinin karşılaştırılması. Eurasian Econometrics Statistics &amp; Emprical Economics Journal. 2018 15:39-50.
CR  - Özdamar K. Eğitim, sağlık ve davranış bilimlerinde ölçek ve test geliştirme yapısal eşitlik modellemesi. Eskişehir: Nisan Kitabevi Yayınları. 2016. (Turkish)
CR  - Cole DA. Utility of confirmatory factor analysis in test validation research. Journal of Consulting and Clinical
Psychology. 1987;55(4):584-590. https://psycnet.apa.org/ record/1988-00102-001
CR  - Jöreskog KG, Sörbom D. LISREL 8: Structural equation modeling with the SIMPLIS command language. Scientific Software International; 1993.
CR  - Kvalem IL, Dahr Nygaard IM, Træen B, Ivanova A, Dahlgren CL. Menstrual attitudes in adult women: a cross-sectional study on the association with menstruation factors, contraceptive use, genital self-image, and sexual openness. Women’s Health. 2024;20: 174.550.57241249553. https://doi.org/10.1177/174.550.57241249553
CR  - Larki M, Salavati A, Azmoude E. The relationship between menstrual patterns and menstrual attitude dimensions among women of reproductive age: cross-sectional survey. Sultan Qaboos University Medical Journal. 2022,26;22(2):241-249.https://doi.org/10.18295/squmj.7.2021.079
UR  - https://doi.org/10.33808/clinexphealthsci.1649275
L1  - https://dergipark.org.tr/en/download/article-file/4651652
ER  -