Title: Spanish menstrual literacy and experiences of menstruation
Version: 2 Date: 04 Jan 2023
Reviewer's report:
Thank you for the opportunity to review this manuscript. The topic of the paper, menstrual
health and education, is incredibly important and would be of interest to the readers of this
journal. The paper has potential, however I have concerns particularly around the presentation
and explanation of the materials and results sections and would like to see the author(s) revise
their manuscript. I structure my comments by paper section below and hope that they are helpful.
Introduction.
Overall the introduction could use more depth and better organization. Since the title of the
paper (and arguably the results) are about menstrual literacy, this should be foreground rather
than defining and describing menstrual health. I would recommend that the authors describe
menstrual literacy, describe why it might be lacking, and then describe the outcomes (i.e. stigma,
a decrease in menstrual health) that occur due to inadequate menstrual literacy. I would also
recommend that the authors cite studies in Spain or contextualize the results from other countries
such as the UK so that they can be understood as a result of sociocultural norms regarding
menstrual education, literacy, and health that vary by region.
I would also recommend a clarification of the purpose of the study (or perhaps a reworking of
the title if the study’s purpose really is it investigate how folks learn about menstruation). Again,
the goals of the study should match the literature discussed in addition to being reflected in the
title and results.
Method.
When describing the questionnaire, much more information is needed. It’s important to describe
the types of information gathered, the scales used, and the response options for participants.
Providing examples of some items would also be helpful.
In the data analysis section, the author(s) mentions that “we only present analysis relevant to
menstrual literacy”. It is important at this juncture to discuss how this was determined based on
their definition of menstrual literacy.
In the final paragraph, the author(s) discusses the qualitative data and describes thematic
analysis. This needs a citation and more thorough description of how the thematic analysis was
performed. The description of the codes belongs in the results section, as these codes are the
results of the thematic analysis procedure.
Results.
Overall in the results section the authors should describe the results in words or in a table;
it is redundant to state both as is the case regarding. Additionally, there is description of
specific questions and response options that belong in the method section when describing the
questionnaire (rather than in the results section). This includes sections regarding “knowledge
about menstruation at menarche”, “feelings”,
Furthermore, I would recommend a reorganization of this section as well; it is more common
to present quantitative findings first, and then present qualitative findings. More specifically,
I would recommend presenting all demographic and descriptive findings, then results of
regression analyses, then the qualitative results. There is additionally information missing from
the reporting of the regression analyses; the entire regression equation is needed for readers to
know the number of respondents, number of variables entered into the equation, and the specific
p value (rather than just stating p < or > .05).
Discussion.
It would be helpful to begin this section with a repetition of the purpose of the study and a
summary of findings (or an answer) related to this purpose.
When discussing that there was no significant difference in information on menstrual
management or bleeding for participants between 1950 and 2010, it would be helpful to describe
some implications of this – i.e. it shows us that menstrual education and menstrual health
narrative, possibly stigma as well, have not been updated or changed in a significant amount of
time to lead to more knowledge.
When the author(s) suggests that school-based education is suggested to improve menstrual
literacy, a better, more explicit connection to the findings of this study is needed. It would also
be helpful for the authors to make some recommendations about what types of information
curriculum should include and the importance of timing in school to present this information
before menarche occurs.