Developing games as a qualitative method for researching menstrual hygiene management in rural Bolivia
Murat Sahin | Jeanne Long | Bethany Caruso | Matthew Freeman | Maribel Mamani | Gladys Camacho | Koenraad Vancraeynest
The onset of menstruation has proven challenging for girls in school, with absenteeism, missed class time, reduced participation, teasing, fear, shame, and risky adaptive behaviours among the most commonly noted impacts in many settings. In 2012, Emory University and UNICEF conducted a multi-country formative study to gain a global perspective of girls' experiences. A compendium of tools was created to ensure investigation of common themes across all settings. This paper describes the process of adapting the focus group discussion (FGD) tool for Bolivia into a board game as a method to ease girls' discomfort discussing menstruation and elicit richer data. We describe the development of the menstrual hygiene management game, including structure and strategies for adapting FGD questions that increased interaction, stimulated detailed responses, and diversified participatory activities. A discussion of lessons learned will highlight elements of success and areas for improvement in future game adaptations. The paper discusses games as a research method for other topics and their applications for programme design, monitoring, and skills-based learning.Alexander, K.T., Oduor, C., Nyothache, E., Laserson, K. F., Amek, N., Eleveld, A., Mason, L., Rheingans, R., Beynon, C. and Mohammed, A. (2014) ‘Water, sanitation and hygiene conditions in Kenyan rural schools: are schools meeting the needs of menstruating girls?’ Water 6: 1453-66 <http://dx.doi.org/10.3390/w6051453≯.
Ali, T.S. and Rizvi, S.N. (2009) ‘Menstrual knowledge and practices of female adolescents in urban Karachi, Pakistan’, Journal of Adolescence 33: 531-41 <http://dx.doi.org/10.1016/j.adolescence.2009.05.013≯.
Caruso, B.A. (2014) WASH in Schools Empowers Girls’ Education: Tools for Assessing Menstrual Hygiene Management in Schools, New York: United Nations Children's Fund.
Caruso, B.A., Fehr, A., Inden, K., Sahin, M., Ellis, A., Andes, K.L. and Freeman, M.C. (2013) WASH in Schools Empowers Girls’ Education in Freetown, Sierra Leone: An Assessment of Menstrual Hygiene Management in Schools, New York: United Nations Children's Fund.
Cooper, M.A. (2002) ‘Classroom choices for enabling peer learning’, Theory into Practice 41(1): 53-7.
Dolan, C.S., Ryus, C.R., Dopson, S., Montgomery, P. and Scott, L. (2013) ‘A blind spot in girls’ education: menarche and its webs of exclusion in Ghana’, Journal of International Development 26(5): 643-57 <http://dx.doi.org/10.1002/jid.2917≯.
Haver, J., Caruso, B.A., Ellis, A., Sahin, M., Villasenor, J.M., Andes, K.L. and Freeman, M.C. (2013) WASH in Schools Empowers Girls’ Education in Masbate Province and Metro Manila, Philippines: An Assessment of Menstrual Hygiene Management in Schools, New York: United Nations Children's Fund.
Hennink, M.M., Hutter, I. and Bailey, A. (2011) Qualitative Research Methods, Thousand Oaks, CA: SAGE Publications.
IHAA (2006) TOOLS TOGETHER NOW! 100 Participatory Tools to Mobilise Communities for HIV/AIDS, Brighton, UK: International HIV/AIDS Alliance.
Long, J., Caruso, B.A., Lopez, D., Vancraeynes, K., Sahin, M., Andes, K.L. and Freeman, M.C. (2013) WASH in Schools Empowers Girls’ Education in Rural Cochabamba, Bolivia: An Assessment of Menstrual Hygiene Management in Schools, New York: United Nations Children's Fund.
McMahon, S.A., Winch, P.J., Caruso, B.A., Obure, A.F., Ogutu, E.A., Ochari, I.A. and Rheingans, R.D. (2011) ‘“The girl with her period is the one to hang her head” reflections on menstrual management among schoolgirls in rural Kenya’, BMC International Health and Human Rights 11: 7 <http://dx.doi.org/10.1186/1472-698X-11-7≯.
Mason, L., Nyothache, E., Alexander, K., Odhiambo, F.O., Eleveld, A., Vulule, J., Rheingans, R., Laserson, K.F., Mohammed, A. and Phillips-Howard, P.A. (2013) ‘“We keep it secret so no one should know”: a qualitative study to explore young schoolgirls attitudes and experiences with menstruation in rural western Kenya’, PloS One 8: e79132 <http://dx.doi.org/10.1371/journal.pone.0079132≯.
Sommer, M. (2010a) ‘Putting menstrual hygiene management on to the school water and sanitation agenda’, Waterlines 29: 268-77 <http://dx.doi.org/10.3362/1756-3488.2010.030≯.
Sommer, M. (2010b) ‘Where the education system and women's bodies collide: the social and health impact of girls’ experiences of menstruation and schooling in Tanzania’, Journal of Adolescence 33: 521-9 <http://dx.doi.org/10.1016/j.adolescence.2009.03.008≯.
Sommer, M. (2011) ‘An early window of opportunity for promoting girls’ health: policy implications of the girl's puberty book project in Tanzania’, International Electronic Journal of Health Education 14: 77-92.
Sommer, M., Ackatia-Armah, N., Connolly, S. and Smiles, D. (2014) ‘A comparison of the menstruation and education experiences of girls in Tanzania, Ghana, Cambodia and Ethiopia’, Compare: A Journal of Comparative and International Education 1-21 <http://dx.doi.org/10.1080/03057925.2013.871399≯.
Alexander, K.T., Oduor, C., Nyothache, E., Laserson, K. F., Amek, N., Eleveld, A., Mason, L., Rheingans, R., Beynon, C. and Mohammed, A. (2014) ‘Water, sanitation and hygiene conditions in Kenyan rural schools: are schools meeting the needs of menstruating girls?’ Water 6: 1453-66 <http://dx.doi.org/10.3390/w6051453≯.
Ali, T.S. and Rizvi, S.N. (2009) ‘Menstrual knowledge and practices of female adolescents in urban Karachi, Pakistan’, Journal of Adolescence 33: 531-41 <http://dx.doi.org/10.1016/j.adolescence.2009.05.013≯.
Caruso, B.A. (2014) WASH in Schools Empowers Girls’ Education: Tools for Assessing Menstrual Hygiene Management in Schools, New York: United Nations Children's Fund.
Caruso, B.A., Fehr, A., Inden, K., Sahin, M., Ellis, A., Andes, K.L. and Freeman, M.C. (2013) WASH in Schools Empowers Girls’ Education in Freetown, Sierra Leone: An Assessment of Menstrual Hygiene Management in Schools, New York: United Nations Children's Fund.
Cooper, M.A. (2002) ‘Classroom choices for enabling peer learning’, Theory into Practice 41(1): 53-7.
Dolan, C.S., Ryus, C.R., Dopson, S., Montgomery, P. and Scott, L. (2013) ‘A blind spot in girls’ education: menarche and its webs of exclusion in Ghana’, Journal of International Development 26(5): 643-57 <http://dx.doi.org/10.1002/jid.2917≯.
Haver, J., Caruso, B.A., Ellis, A., Sahin, M., Villasenor, J.M., Andes, K.L. and Freeman, M.C. (2013) WASH in Schools Empowers Girls’ Education in Masbate Province and Metro Manila, Philippines: An Assessment of Menstrual Hygiene Management in Schools, New York: United Nations Children's Fund.
Hennink, M.M., Hutter, I. and Bailey, A. (2011) Qualitative Research Methods, Thousand Oaks, CA: SAGE Publications.
IHAA (2006) TOOLS TOGETHER NOW! 100 Participatory Tools to Mobilise Communities for HIV/AIDS, Brighton, UK: International HIV/AIDS Alliance.
Long, J., Caruso, B.A., Lopez, D., Vancraeynes, K., Sahin, M., Andes, K.L. and Freeman, M.C. (2013) WASH in Schools Empowers Girls’ Education in Rural Cochabamba, Bolivia: An Assessment of Menstrual Hygiene Management in Schools, New York: United Nations Children's Fund.
McMahon, S.A., Winch, P.J., Caruso, B.A., Obure, A.F., Ogutu, E.A., Ochari, I.A. and Rheingans, R.D. (2011) ‘“The girl with her period is the one to hang her head” reflections on menstrual management among schoolgirls in rural Kenya’, BMC International Health and Human Rights 11: 7 <http://dx.doi.org/10.1186/1472-698X-11-7≯.
Mason, L., Nyothache, E., Alexander, K., Odhiambo, F.O., Eleveld, A., Vulule, J., Rheingans, R., Laserson, K.F., Mohammed, A. and Phillips-Howard, P.A. (2013) ‘“We keep it secret so no one should know”: a qualitative study to explore young schoolgirls attitudes and experiences with menstruation in rural western Kenya’, PloS One 8: e79132 <http://dx.doi.org/10.1371/journal.pone.0079132≯.
Sommer, M. (2010a) ‘Putting menstrual hygiene management on to the school water and sanitation agenda’, Waterlines 29: 268-77 <http://dx.doi.org/10.3362/1756-3488.2010.030≯.
Sommer, M. (2010b) ‘Where the education system and women's bodies collide: the social and health impact of girls’ experiences of menstruation and schooling in Tanzania’, Journal of Adolescence 33: 521-9 <http://dx.doi.org/10.1016/j.adolescence.2009.03.008≯.
Sommer, M. (2011) ‘An early window of opportunity for promoting girls’ health: policy implications of the girl's puberty book project in Tanzania’, International Electronic Journal of Health Education 14: 77-92.
Sommer, M., Ackatia-Armah, N., Connolly, S. and Smiles, D. (2014) ‘A comparison of the menstruation and education experiences of girls in Tanzania, Ghana, Cambodia and Ethiopia’, Compare: A Journal of Comparative and International Education 1-21 <http://dx.doi.org/10.1080/03057925.2013.871399≯.
Alexander, K.T., Oduor, C., Nyothache, E., Laserson, K. F., Amek, N., Eleveld, A., Mason, L., Rheingans, R., Beynon, C. and Mohammed, A. (2014) ‘Water, sanitation and hygiene conditions in Kenyan rural schools: are schools meeting the needs of menstruating girls?’ Water 6: 1453-66 <http://dx.doi.org/10.3390/w6051453≯.
Ali, T.S. and Rizvi, S.N. (2009) ‘Menstrual knowledge and practices of female adolescents in urban Karachi, Pakistan’, Journal of Adolescence 33: 531-41 <http://dx.doi.org/10.1016/j.adolescence.2009.05.013≯.
Caruso, B.A. (2014) WASH in Schools Empowers Girls’ Education: Tools for Assessing Menstrual Hygiene Management in Schools, New York: United Nations Children's Fund.
Caruso, B.A., Fehr, A., Inden, K., Sahin, M., Ellis, A., Andes, K.L. and Freeman, M.C. (2013) WASH in Schools Empowers Girls’ Education in Freetown, Sierra Leone: An Assessment of Menstrual Hygiene Management in Schools, New York: United Nations Children's Fund.
Cooper, M.A. (2002) ‘Classroom choices for enabling peer learning’, Theory into Practice 41(1): 53-7.
Dolan, C.S., Ryus, C.R., Dopson, S., Montgomery, P. and Scott, L. (2013) ‘A blind spot in girls’ education: menarche and its webs of exclusion in Ghana’, Journal of International Development 26(5): 643-57 <http://dx.doi.org/10.1002/jid.2917≯.
Haver, J., Caruso, B.A., Ellis, A., Sahin, M., Villasenor, J.M., Andes, K.L. and Freeman, M.C. (2013) WASH in Schools Empowers Girls’ Education in Masbate Province and Metro Manila, Philippines: An Assessment of Menstrual Hygiene Management in Schools, New York: United Nations Children's Fund.
Hennink, M.M., Hutter, I. and Bailey, A. (2011) Qualitative Research Methods, Thousand Oaks, CA: SAGE Publications.
IHAA (2006) TOOLS TOGETHER NOW! 100 Participatory Tools to Mobilise Communities for HIV/AIDS, Brighton, UK: International HIV/AIDS Alliance.
Long, J., Caruso, B.A., Lopez, D., Vancraeynes, K., Sahin, M., Andes, K.L. and Freeman, M.C. (2013) WASH in Schools Empowers Girls’ Education in Rural Cochabamba, Bolivia: An Assessment of Menstrual Hygiene Management in Schools, New York: United Nations Children's Fund.
McMahon, S.A., Winch, P.J., Caruso, B.A., Obure, A.F., Ogutu, E.A., Ochari, I.A. and Rheingans, R.D. (2011) ‘“The girl with her period is the one to hang her head” reflections on menstrual management among schoolgirls in rural Kenya’, BMC International Health and Human Rights 11: 7 <http://dx.doi.org/10.1186/1472-698X-11-7≯.
Mason, L., Nyothache, E., Alexander, K., Odhiambo, F.O., Eleveld, A., Vulule, J., Rheingans, R., Laserson, K.F., Mohammed, A. and Phillips-Howard, P.A. (2013) ‘“We keep it secret so no one should know”: a qualitative study to explore young schoolgirls attitudes and experiences with menstruation in rural western Kenya’, PloS One 8: e79132 <http://dx.doi.org/10.1371/journal.pone.0079132≯.
Sommer, M. (2010a) ‘Putting menstrual hygiene management on to the school water and sanitation agenda’, Waterlines 29: 268-77 <http://dx.doi.org/10.3362/1756-3488.2010.030≯.
Sommer, M. (2010b) ‘Where the education system and women's bodies collide: the social and health impact of girls’ experiences of menstruation and schooling in Tanzania’, Journal of Adolescence 33: 521-9 <http://dx.doi.org/10.1016/j.adolescence.2009.03.008≯.
Sommer, M. (2011) ‘An early window of opportunity for promoting girls’ health: policy implications of the girl's puberty book project in Tanzania’, International Electronic Journal of Health Education 14: 77-92.
Sommer, M., Ackatia-Armah, N., Connolly, S. and Smiles, D. (2014) ‘A comparison of the menstruation and education experiences of girls in Tanzania, Ghana, Cambodia and Ethiopia’, Compare: A Journal of Comparative and International Education 1-21 <http://dx.doi.org/10.1080/03057925.2013.871399≯.
Alexander, K.T., Oduor, C., Nyothache, E., Laserson, K. F., Amek, N., Eleveld, A., Mason, L., Rheingans, R., Beynon, C. and Mohammed, A. (2014) ‘Water, sanitation and hygiene conditions in Kenyan rural schools: are schools meeting the needs of menstruating girls?’ Water 6: 1453-66 <http://dx.doi.org/10.3390/w6051453≯.
Ali, T.S. and Rizvi, S.N. (2009) ‘Menstrual knowledge and practices of female adolescents in urban Karachi, Pakistan’, Journal of Adolescence 33: 531-41 <http://dx.doi.org/10.1016/j.adolescence.2009.05.013≯.
Caruso, B.A. (2014) WASH in Schools Empowers Girls’ Education: Tools for Assessing Menstrual Hygiene Management in Schools, New York: United Nations Children's Fund.
Caruso, B.A., Fehr, A., Inden, K., Sahin, M., Ellis, A., Andes, K.L. and Freeman, M.C. (2013) WASH in Schools Empowers Girls’ Education in Freetown, Sierra Leone: An Assessment of Menstrual Hygiene Management in Schools, New York: United Nations Children's Fund.
Cooper, M.A. (2002) ‘Classroom choices for enabling peer learning’, Theory into Practice 41(1): 53-7.
Dolan, C.S., Ryus, C.R., Dopson, S., Montgomery, P. and Scott, L. (2013) ‘A blind spot in girls’ education: menarche and its webs of exclusion in Ghana’, Journal of International Development 26(5): 643-57 <http://dx.doi.org/10.1002/jid.2917≯.
Haver, J., Caruso, B.A., Ellis, A., Sahin, M., Villasenor, J.M., Andes, K.L. and Freeman, M.C. (2013) WASH in Schools Empowers Girls’ Education in Masbate Province and Metro Manila, Philippines: An Assessment of Menstrual Hygiene Management in Schools, New York: United Nations Children's Fund.
Hennink, M.M., Hutter, I. and Bailey, A. (2011) Qualitative Research Methods, Thousand Oaks, CA: SAGE Publications.
IHAA (2006) TOOLS TOGETHER NOW! 100 Participatory Tools to Mobilise Communities for HIV/AIDS, Brighton, UK: International HIV/AIDS Alliance.
Long, J., Caruso, B.A., Lopez, D., Vancraeynes, K., Sahin, M., Andes, K.L. and Freeman, M.C. (2013) WASH in Schools Empowers Girls’ Education in Rural Cochabamba, Bolivia: An Assessment of Menstrual Hygiene Management in Schools, New York: United Nations Children's Fund.
McMahon, S.A., Winch, P.J., Caruso, B.A., Obure, A.F., Ogutu, E.A., Ochari, I.A. and Rheingans, R.D. (2011) ‘“The girl with her period is the one to hang her head” reflections on menstrual management among schoolgirls in rural Kenya’, BMC International Health and Human Rights 11: 7 <http://dx.doi.org/10.1186/1472-698X-11-7≯.
Mason, L., Nyothache, E., Alexander, K., Odhiambo, F.O., Eleveld, A., Vulule, J., Rheingans, R., Laserson, K.F., Mohammed, A. and Phillips-Howard, P.A. (2013) ‘“We keep it secret so no one should know”: a qualitative study to explore young schoolgirls attitudes and experiences with menstruation in rural western Kenya’, PloS One 8: e79132 <http://dx.doi.org/10.1371/journal.pone.0079132≯.
Sommer, M. (2010a) ‘Putting menstrual hygiene management on to the school water and sanitation agenda’, Waterlines 29: 268-77 <http://dx.doi.org/10.3362/1756-3488.2010.030≯.
Sommer, M. (2010b) ‘Where the education system and women's bodies collide: the social and health impact of girls’ experiences of menstruation and schooling in Tanzania’, Journal of Adolescence 33: 521-9 <http://dx.doi.org/10.1016/j.adolescence.2009.03.008≯.
Sommer, M. (2011) ‘An early window of opportunity for promoting girls’ health: policy implications of the girl's puberty book project in Tanzania’, International Electronic Journal of Health Education 14: 77-92.
Sommer, M., Ackatia-Armah, N., Connolly, S. and Smiles, D. (2014) ‘A comparison of the menstruation and education experiences of girls in Tanzania, Ghana, Cambodia and Ethiopia’, Compare: A Journal of Comparative and International Education 1-21 <http://dx.doi.org/10.1080/03057925.2013.871399≯.
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