2025-26 Project (Wilbur & Polack & Greenland)

Bridging the Menstrual Health Gap: Developing and Validating Tools to Assess Menstrual Health in Individuals with Learning Disabilities

SUPERVISORY TEAM

Supervisor

Dr Jane Wilbur at LSHTM
Email: jane.wilbur@lshtm.ac.uk

Co-Supervisor

Dr Sarah Polack at LSHTM
Email: sarah.polack@lshtm.ac.uk

Co-Supervisor

Dr Katie Greenland at LSHTM
Email: katie.greenland@lshtm.ac.uk

PROJECT SUMMARY

Project Summary

PhD Opportunity: Bridging the Menstrual Health Gap for Individuals with Learning Disabilities.   

Menstruation can be particularly challenging for individuals with learning disabilities due to unique difficulties in self-care, communication, and accessing support. Current metrics primarily focus on menstrual practices and are unsuitable for assessing this population’s experiences. This PhD project seeks to fill that gap.    

This research will develop and validate metrics for assessing menstrual health experiences in individuals with learning disabilities in the UK. It will use a participatory methodology involving individuals with learning disabilities, carers, and experts. Metrics will be developed through systematic reviews, workshops, and cognitive interviews. The metrics will be tested and validated using data collected through an online survey. This project will disseminate findings through various channels to influence stakeholders and drive real change in policy and practice.    

Apply for this PhD if you want to conduct impactful and inclusive research.

Project Key Words

Menstrual health, metrics, UK, Learning Disability

MRC LID Themes

  1. Global Health
  2. Translational and Implementation Research

Skills

MRC Core Skills

  1. Quantitative skills
  2. Interdisciplinary skills

Skills we expect a student to develop/acquire whilst pursuing this project

Systematic review:  
1. Search Strategy: Translate research questions into database searches. 
2. Criteria Definition: Set inclusion/exclusion criteria to focus the review. 
3. Critical Thinking: Evaluate sources’ validity, reliability, and relevance to synthesise findings and develop new insights. 
4. Analytical Skills: Compare, contrast, and integrate results from multiple studies. 
5. Scientific writing: write and publish a journal article.   

Participatory Workshops:  
• Facilitation Skills and active listening: Leading inclusive discussions, ensuring that all participants feel heard and valued, especially when working with diverse groups. 
• Respect diversity and communicate effectively: Gain a deep understanding of the lived experiences of people with learning disabilities, recognising and valuing their unique strengths and perspectives. Communicate respectfully and inclusively by using clear, straightforward language and avoiding jargon to ensure meaningful engagement. 
• Creativity: Designing engaging, accessible activities that encourage participation and make complex ideas easier for diverse groups to grasp. 
• Adaptability: Being able to shift methods or approaches based on the group or individual’s needs during the workshop.   

Cognitive Interviews (with people with learning disabilities, carers, and experts):
• Communication: Simplifying complex questions without losing the core of what is being asked, ensuring clarity and comprehension. 
• Respect for Participant Agency: Ensuring that people with learning disabilities can express their views and maintain an ethical approach to their involvement.   

Metric Validation: Survey with a Heterogeneous Sample of 200 People with Learning Disabilities: 
• Quantitative Data Collection: Developing and distributing surveys, ensuring they are accessible to people with learning disabilities. 
• Psychometric Analysis: Applying appropriate statistical techniques (e.g., reliability analysis, factor analysis) to assess the validity and reliability of the survey metrics. 
• Survey Design: Crafting questions that are understandable and applicable to people with varying cognitive abilities. 
• Data Interpretation & Reporting: Analysing psychometric properties like reliability and validity and interpreting how well the survey measures what it is intended to. 
• Inclusive Research Practices: Developing metrics sensitive to the menstrual health needs and cognitive capacities of people with learning disabilities. 
• Statistical Software Proficiency: Conduct psychometric testing with data analysis software (e.g., SPSS, R).

Routes

Which route/s are available with this project?

  • 1+4 = No
  • +4 = Yes

Possible Master’s programme options identified by supervisory team for 1+4 applicants:

  • Not applicable

Full-time/Part-time Study

Is this project available for full-time study? Yes
Is this project available for part-time study? Yes

Location & Travel

Students funded through MRC LID are expected to work on site at their primary institution, meeting – at the minimum – the institutional research degree regulations and expectations. Students may also be required to travel for conferences (up to 3 over the duration of the studentship), and for any required training (for research degree study). Other travel expectations and opportunities highlighted by the supervisory team are noted below.

Primary location for duration of this research degree: LSHTM, London

Travel requirements for this project: Travel on public transport to interview sites (e.g. people’s homes, daycare centres) in London and Surrey.

Eligibility/Requirements

Particular prior educational requirements for a student undertaking this project

  • Minimum LSHTM standard institutional eligibility criteria for doctoral study.
  • Masters degree in public health, epidemiology or research methods.

Other useful information

  • Potential Industrial CASE (iCASE) conversion? = No

PROJECT IN MORE DETAIL

Scientific description of this research project

RATIONALE:   
Menstruation can be particularly challenging for women and girls with learning disabilities, who face unique challenges related to self-care, communication, accessing support, and effective menstrual materials. Meaningful assessments of menstrual health and intervention effectiveness need domain-specific, holistic, and change-sensitive metrics, but quantifying experiences is challenging because existing metrics primarily focus on menstrual practices. Scales have been validated in low-income countries to measure schoolgirls’ self-perceived menstrual experiences and self-efficacy. Still, their applicability to people with learning disabilities in high-income countries remains unexplored. People with learning disabilities are often excluded from health research, and a lack of awareness and validated metrics contribute to this.    

This PhD project will develop and validate metrics for assessing the menstrual health experiences of people with learning disabilities in high-income settings. The research will inform the nature of these metrics (e.g., single questions or multi-domain scales, newly developed or adapted). This project will contribute to research and practice to improve the menstrual health experiences of people with learning disabilities. The PhD is independent and requires no additional funding.   

OBJECTIVES:  
1. Identify existing conceptual frameworks, constructs and metrics used for assessing menstrual health experiences and related well-being  
2. Explore the menstrual health experiences of women and girls with learning disabilities in the UK  
3. Develop and validate menstrual health metrics for women and girls with learning disabilities    

TECHNIQUES: 
– Metric development (constructs and questions identification, content validity): i) systematic review ii) participatory workshops and iii) cognitive interviews with people with learning disabilities, carers and relevant experts  
– Metric validation: Survey with a heterogeneous sample of 200 people with learning disabilities to assess psychometric properties, using analysis methods appropriate to the metrics developed.  
– The project will use participatory methodologies involving people with learning disabilities, carers, and representative organisations through a project advisory committee. 
– Dissemination through various channels to maximise uptake and influence stakeholders.   

CONFIRMED AVAILABILITY OF REQUIRED DATABASES: 
Students will have access to data from a current LSHTM qualitative study exploring menstrual health experiences of women and girls with Down syndrome to inform the tool development.   

POTENTIAL RISKS:  
Challenges in achieving sufficient sample size for the survey: the project will utilise and expand existing supervisor networks with relevant organisations to mitigate this. People with learning disabilities are considered a ‘vulnerable group’: the supervisory team have extensive experience in leading and conducting research with this population, including on sensitive topics, and will provide relevant training and support to the student.   

FURTHER READING: 
EARLE, S. et al. 2024. Menstruation and learning disability across the life course: Using a two-part scoping exercise to co-produce research priorities. https://doi.org/10.1111/bld.12592      
WILBUR, J., et al. 2019. Systematic review of menstrual hygiene management requirements, its barriers and strategies for disabled people. https://doi.org/10.1371/journal.pone.0210974    
HENNEGAN, J., et al. 2020. Measuring menstrual hygiene experience: development and validation of the Menstrual Practice Needs Scale (MPNS-36) in Soroti, Uganda.  10.1136/bmjopen-2019-034461   
HUNTER, EC., et al. 2022. Development and validation of the Self-Efficacy in Addressing Menstrual Needs Scale (SAMNS-26) in Bangladeshi schools: A measure of girls’ menstrual care confidence.  https://doi.org/10.1371%2Fjournal.pone.0275736

Further reading

Relevant preprints and/or open access articles:
(DOI = Digital Object Identifier.)

Additional information from the supervisory team

The supervisory team has provided a recording for prospective applicants who are interested in their project. This recording should be watched before any discussions begin with the supervisory team.

Wilbur-Polack-Greenland recording

Due to the nature of the research and participants that will be engaged, women are particularly encouraged to apply.

MRC LID LINKS

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