Menstrual Attitudes Research Articles

Development and validation of a questionnaire to evaluate attitude about menstruation among adolescent girls

Abstract: CONTEXT: Cultural influences promote secrecy, making it difficult for girls to openly discuss menstruation. This further impacts their attitude and emotional well-being. Showing adolescent girls the reality of menstruation would give them a clear understanding of menstruation. AIMS: The aim of this study was to develop and validate a questionnaire to evaluate attitude about menstruation among Adolescent girls. SETTINGS: Adolescent girls in Belagavi city. DESIGN: Exploratory study. SUBJECTS AND METHODS: The Adolescent Menstrual Attitude Inventory Questionnaire (AMAI-Q) was developed using a multistep method divided into two phases. Phase I: Concept elicitation, which includes identification of domains and item generation; and expert input, which includes content validation. Phase II: Pilot testing of 11 adolescent girls and reliability calculation using Cronbach’s alpha. STATISTICAL ANALYSIS USED: The content validity index of the questionnaire was calculated, and the reliability of the questionnaire was assessed using Cronbach’s alpha. RESULTS: The content validity of the questionnaire was tested using the content validity index, which was found to be 0.911. Reliability was assessed using Cronbach’s alpha and was found to be 0.818, indicating good reliability. CONCLUSIONS: The proposed questionnaire, AMAI-Q is well-validated, easy to administer, and has good reliability. AMAI-Q will be a suitable scale to evaluate attitude about menstruation among adolescent girls.

Effectiveness of 8-Week Exercise Programs in Improving Menstrual Characteristics in Female Adolescents in Saudi Arabia.

Background: This study aimed to evaluate the effectiveness of 8-week exercise programs (aerobic, stretching, and aerobic plus stretching) in improving menstrual characteristics in female adolescents in Saudi Arabia. Methods: In this quasi-experimental study, seventy-eight healthy female adolescents aged 12-18 from secondary and high schools in Riyadh participated. Participants were divided into three groups and subjected to different types of exercises (aerobic, stretching, and aerobic plus stretching) for 20-30 min, three times a week. Menstrual pain, stress, and attitudes were assessed using the Numerical Rating Scale, Adolescent Stress Questionnaire Short Version, and Adolescent Menstrual Attitude Questionnaire, respectively. Assessments were conducted before the intervention and after the third menstrual period post-intervention. Results: The aerobic exercise group experienced a significant reduction in the mean length of the menstrual cycle (p = 0.025). The aerobic plus stretching group had the most significant reduction in mean menstrual pain scores (p < 0.0001). Stress scores were significantly reduced in the stretching group (p < 0.0001). Conclusion: We conclude that combining aerobic and stretching exercises significantly reduces menstrual pain, while aerobic exercise decreases menstrual cycle length and pain.

INVESTIGATION OF THE EFFECT OF AN ONLINE YOGA-BASED EXERCISE PROGRAM ON WOMEN WITH PRIMARY DYSMENORRHEA: A RANDOMIZED CONTROLLED TRIAL

Purpose: It was aimed to investigate the effects of telerehabilitation method and online yoga-based exercise program on pain, menstrual attitude, body awareness and quality of life in women with primary dysmenorrhea (PD). Methods: This study is an experimental randomized controlled single-blind study. Fifty women (25 in the intervention group, and 25 in the control group) between the ages of 18-35 were included in the study. At the beginning of the study, both groups were given informational training on PD and treatment methods. In addition to informational training, an online yoga-based exercise program was applied individually to the intervention group, twice a week for 8 weeks, for a total of 16 sessions. Visual analog scale (VAS), menstrual attitude scale (MAS), body awareness questionnaire (BAQ), short form-36 (SF-36), and satisfaction questionnaire were used for data collection. Results: The VAS score of the intervention group decreased from 6.76 to 3.76 points. VAS (p

A pilot survey of students' menstrual attitudes, experiences, and needs on an urban university campus.

In the United States, many menstruators face barriers to period management, such as period poverty, or the lack of access to relevant knowledge and affordable menstrual products. Our current understanding of the social, emotional, and physical impacts of period poverty on students in post-secondary institutions is largely limited. The purpose of this pilot study is to assess period poverty, period-related class disruption, and avoidance of menstrual hygiene management on campus among students and to identify recommendations for action at the University of Illinois Chicago and other urban universities. An online cross-sectional study from February to May 2023. Enrolled students who were at least 18 years old completed an anonymous, self-administered online survey. Through descriptive statistics and chi-square tests in SAS version 9.4, we analyzed the sociodemographic, academic, and menstrual characteristics of those who had a period in the past 12 months. We also performed a thematic analysis of students' open-ended responses regarding their menstrual experiences on campus. Of our sample (N = 106), 17.1% of students have faced period poverty, 55.8% experienced period-related class disruption, and 47.5% avoided changing their menstrual products on campus. The relationships between the three menstrual experiences were statistically significant. In the open responses, students reported that their personal experiences with menstruation were largely painful and disruptive. We identified the following themes: (1) inadequate water, sanitation, and hygiene facilities; (2) understocked, empty, or non-existent menstrual product dispensers; (3) a desire for additional resources for menstruation; and (4) the unpredictability of menstruation. Our findings indicate that students continue to face obstacles to menstruation management due to inadequate support related to menstrual infrastructure, products, and pain. We outline several recommendations for university/college institutions to prioritize a more inclusive and supportive educational environment for all students.

Menstrual attitudes in adult women: A cross-sectional study on the association with menstruation factors, contraceptive use, genital self-image, and sexual openness.

Menstruation is a central part of the everyday life of most women, and menstrual attitudes may impact health and well-being. This article aimed to map menstrual attitudes among adult women and examine factors associated with these attitudes, such as aspects of menarche and current menstruation, and rarely studied factors, such as genital self-image and sexual openness. A cross-sectional online survey. A sample of 1470 women, aged 18-50 years, were recruited through social media sites. The Menstrual Self-Evaluation Scale was used to measure three different attitudes: menstruation as natural, shameful, and bothersome. Multiple linear regression analysis was used to investigate the relationship between each attitude and factors related to menarche and current menstruation, contraceptive use, genital self-image (assessed by Female Genital Self-Image Scale), and sexual openness (Personal Comfort with Sexuality Scale). Sociodemographic variables were included into the models as covariates. Agreeing with the attitude of menstruation as something natural was predicted primarily by positive emotions at menarche, experiencing less menstrual pain, using no or nonhormonal contraception, and having a positive genital self-image. Perceiving menstruation as bothersome was predicted by a lower educational level, experiencing stronger menstrual pain, having more perimenstrual psychological symptoms, and using hormonal contraceptives. Menstruation as something shameful was chiefly predicted by lower sexual openness and a negative genital self-image. Many women held attitudes about menstruation as both something natural and bothersome. Menarche and current menstruation experiences, and contraceptive method, played central roles in shaping attitudes toward menstruation as natural and bothersome. Viewing menstruation as shameful stood out from other attitudes by indicating a triad of self-objectified shame that includes menstruation, sexuality, and genital self-image. Further research into the relationships between menstruation, contraceptive use, sexuality, and body image is needed to enhance our understanding of women's menstrual health.

Attitudes Towards Menstrual Health by Female In-School Adolescents: A Comparative Cross-Sectional Study in Southwest Nigeria

Poor awareness and stigmatising experiences influence menstrual attitudes. The study compared menstruators’ cognitive attitudes towards menstrual health (MH) in public and private schools. A three-stage sampling identified respondents and outcomes reported by descriptive and inferential statistics (p < 0.05). Negative feelings (20.3% vs. 12.2%), Openness (7.3% vs. 17.2%) and living with menstruation (38.% vs. 63.9%) were significantly different, while positive feelings (36.2% vs 30.6%), menstrual symptoms (22.6% vs. 30.0%) and menarche acceptance (28.% vs. 35.6%) were similar. Negative attitude predominates (87.4%) and is negatively predicted by Yoruba ethnicity (77.9%). Overall, menstruators exhibited negative menstrual attitudes. Puberty education through ethnic constructs is recommended to improve attitudes.

Men on Menstruation: A Causal Comparative Analysis of College Males’ Attitudes Toward Menstruation

This research explores how sibling dynamics impact college men's views on menstruation. While existing studies have looked at various angles of attitudes toward menstruation, there's a noticeable gap concerning the role of family, specifically siblings. This study fills that gap by examining whether having a sister who menstruates influences a college man's views on the topic. Using a quantitative approach, we conducted an online survey based on a modified Menstrual Attitude Questionnaire. A total of 48 undergraduate males participated, half of whom have a sister who menstruates. Data were analyzed using t-Tests, comparing average responses between the two groups. Initial findings suggest that having a sister could play a role in shaping attitudes toward menstruation, although the average responses between the two groups were similar. This research adds a new dimension to existing literature by focusing on a specific age group and their family influences, offering a fresh perspective on attitudes toward menstruation. The study is timely and relevant, given the ongoing societal discussions about menstruation and women's health. It opens the door for further research to validate these findings and explore other family and social factors that may shape attitudes toward menstruation. Examining the perspectives of young people and their familial environment provides fresh insights into society's views on menstrual health. This research is especially timely as discussions about women's health, including menstruation, are gaining more public attention than ever before.

Edukasi Kesehatan Reproduksi Remaja Putri dan Pembentukan Kader Remaja Sehat Reproduksi

This community service aims to increase young women's knowledge and form a cadre of reproductively healthy teenagers. The method for implementing this service was counseling and FGD. The evaluation instrument used the adolescent menstrual attitude questionnaire, which was analyzed descriptively. The results of this service showed that there had been significant changes in young women's knowledge regarding reproductive health and attitudes towards maintaining reproductive health during menstruation and the environment. This result was proven by pretest-posttest data on the knowledge and attitudes of young women in maintaining personal and environmental hygiene during menstruation. Apart from that, reproductive health cadres had been formed to support school activities and personal hygiene for young women. These cadres were volunteers and provided their peers with information related to reproductive health to their peers.

Women, blood, and dangerous things: socio-cultural variation in the conceptualization of menstruation

AbstractThis study examines a collection of expressions for the taboo topic of menstruation in Dutch, German, and Mandarin Chinese. A model for the identification of conceptualization patterns in taboo verbalizations is set up, analyzing each expression according to the X-phemistic mechanisms and, if applicable, the metaphorical source domains or metonymic vehicles at its origin. The various conceptualizations of menstruation are approached from a socio-cultural perspective; variation in conceptualization is examined through a correspondence regression analysis with three speaker-related explanatory variables (L1 and associated cultural background, menstrual experience, and age group). The underlying interest is linguo-cultural as the study aims to verify whether dominant menstrual attitudes are reflected in the linguistic conceptualization of menstruation within each socio-cultural group. Such correlations are indeed found, although the youngest age-group shows some unexpected linguistic behavior.

Mapping the Expertise and Understanding of Menarche, Menstrual Hygiene, and Menstrual Health among Adolescent Ladies in Low- and Center-Profit Nations

Mapping the Expertise and Understanding of Menarche, Menstrual Hygiene, and Menstrual Health among Adolescent Ladies in Low- and Center-Profit Nations

Does Phase of the Menstrual Cycle Affect Balance and Postural Control?

. The aim of the study is to examine the effects of menstrual cycle phases (MCP) on balance and postural control. The study was carried out with 63 volunteer women. Digital ovulation kits and, a Menstrual Cycle Regularity Questionnaire (MCRQ) to detect menstrual cycle regularity and duration, Premenstrual Syndrome Questionnaire (PMSQ) to question the presence of premenstrual syndrome, Menstruation Attitude Questionnaire (MAQ) to assess menstrual attitudes, International Physical Activity Questionnaire Short Form (IPAQ-SF) to question physical activity level was used. Balance and postural oscillation were evaluated with Balance Master balance and performance test device and Tekscan MatScan™ Pressure Mat System, respectively. All evaluations were repeated twice, in the preovulatory period and the postovulatory period. When the evaluations of the preovulatory period and the postovulatory period were compared, there was %3 increase in the percent weight-bearing of the non-dominant extremity (p = 0.01) and %2.5 decrease in the percent weight-bearing of the dominant limb in the postovulatory period (p = 0.01). %8 increase in functional reach distances was detected in the postovulatory period (p < 0.01). It was determined that there was %7.4 decrease in the oscillation rate of the center of gravity in the static stance with eyes open and %9 decrease in the static stance with eyes closed in the postovulatory period (p = 0.35, p = 0.18, respectively). It has been determined that the balance and postural control of young women are negatively affected in the preovulatory period and the function improved from the preovulatory period to the postovulatory period.

An Analysis of Menstrual Symptoms, Menstrual Attitudes, Physical Stress and Psychological Stress According to the Menstrual Cycle Phase.

Women undergo an array of menstrual symptoms, depending on the menstrual cycle period. This study aimed to gain a more objective understanding of the impact of menstruation by examining differences in menstrual symptoms, menstrual attitude, physical stress, and psychological stress across the menstrual cycle. This study was conducted from Apr to Jun 2021 in the Gyeonggi Province of Korea. Women aged ≥20 yr were divided into premenstrual (n=17), menstrual (n=8), and postmenstrual periods (n=23). Menstrual symptoms and menstrual attitudes were assessed using questionnaires. Quantitative electroencephalography was used to assess the physical stress indices (left and right), and the psychological stress indices (left and right), with brainwave parameters quantified by frequency series power spectrum analysis. Data were compared using the non-parametric tests. More menstrual symptoms were experienced in the menstrual period than in the premenstrual period (Z=2.16, P=.031). Menstrual attitudes did not significantly differ among menstrual periods (Z=1.20, P=.231). Physical stress indices were high (≥10 μV) throughout the menstrual cycle and there were significant differences among the three periods (left: χ2=4.00, P=.035, right: χ2=5.78, P=.046). Psychological stress indices were >1 μV during the premenstrual and menstrual periods. Women experience more severe and diverse menstrual symptoms in the menstrual period than in other periods. Objective investigations are needed to inform an effective approach for addressing negative menstruation-related experiences.

Effects of Heat Treatment On Dysmenorrhea and Its Mental Health Outcomes: A Randomized Clinical Trial

This randomized controlled prospective experimental trial was conducted with 46 students with dysmenorrhea who were randomized in a 1:1 ratio to the heat treatment group (HTG) ( n = 23) and control group (CG) ( n = 23). To HTG, dry heat was applied for 20 minutes to the lower abdominal region of the subjects when their dysmenorrhea was most severe. Visual Analogue Scale (VAS), the Short Form McGill Pain Questionnaire (SF-MPQ), the Menstrual Attitude Questionnaire (MAQ), and the Depression Anxiety and Stress Scale (DASS) were used in this study. At the first menstrual cycle, both groups received the questionnaires, and no treatment was applied. At the second, third, and fourth menstrual cycles, VAS and SF-MPQ were applied before the treatment (T1), right after the treatment (T2), and 2 hours after the treatment (T3). MAQ and DASS were applied right after the treatment. Seven subjects from HTG and four subjects from CG were excluded from the study on account of their analgesic medicine usage, inability to menstruate, or by their own requests. When HTG and CG were compared, the decrease in the dysmenorrhea pain after the heat treatment in each of the three menstrual cycles was found to be statistically significant ( P &lt; 0.05). In each of the four menstrual cycles, depression, anxiety, and stress were detected in each subject in both groups. However, the effectiveness of the treatment was not determined ( P &gt; 0.05). In HTG, awareness of the changes during menstruation was diminished with time. [ Psychiatr Ann . 2023;53(6):270–281.]

Dominant Aspects of Family Support of Menstrual Attitudes in Adolescent Girls

Adolescents are defined as individuals with an age range of 10-19 years. In Indonesia, 63.9% of girl adolescents had bad behavior in menstrual hygiene. This study will analyze the relationship between family support and menstrual hygiene attitudes of adolescent girls and the dominant aspect of family support in Jember and Bondowoso. This study uses an observational design using a cross-sectional approach and data were analyzed using multiple linear regression. The sampling technique used was proportional stratified random sampling with a total sample of 300 female adolescent respondents in rural areas of Jember and Bondowoso. Data retrieval was done by questionnaire via google form link. The results showed that there was a statistically significant relationship between family support and attitudes about menstrual hygiene (p-value = 0.012). The most dominant indicator of family support is the instrumental aspect by providing material or physical support that can support adolescent menstrual hygiene.

A Modified Menstrual Attitudes Scale: Heteronormative Attitudes, Sexism, and Attitudes Toward Menstruation in Male and Female Adults.

Social shame and stigma surround menstruation, which may compromise women's health and rights in various contexts. Men's attitudes are particularly important because men often hold positions of power that influence women's experience. This study examined factors associated with menstrual attitudes, including heteronormative attitudes, sexism, and family influences. A cross-sectional Qualtrics panel survey (n = 802; aged 18-44; 50.8% female) was performed. We tested a revised menstrual attitudes scale based on items drawn from previously validated measures. Data were analyzed using a structural equation modeling framework. Factor analysis identified and confirmed a 5-factor model for menstrual attitudes. Men endorsed more negative attitudes toward menstruation than women; however, this difference was largely explained by factors other than gender in the structural equation model. After controlling for family and demographic characteristics, attitudes toward openness and secrecy surrounding menstruation were most strongly associated with gender role expectations and hostile sexism. Benevolent sexism was associated with finding menstruation debilitating, denying menstrual symptoms, and endorsing avoidance of activities during menstruation. Heteronormative and sexist attitudes were associated with more negative menstrual attitudes, while increased menstrual knowledge was associated with more positive menstrual attitudes. The difference in menstrual attitudes between males and females was explained largely by heteronormative attitudes and sexism. This suggests that attitudes toward menstruation are closely linked to social ideals about men and women.

Assessment of relationship between premenstrual syndrome symptoms with sleep quality and menstrual attitudes in medical students: A cross-sectional study

Background: Premenstrual syndrome (PMS) is defined as the recurring occurrence of some symptoms before and during the early days of menstruation and negatively impacts reproductive-age women and affects their standard of living. PMS is one of the physiological conditions that can affect women’s sleep quality, self-esteem, and impair their standard of living. Aims and Objectives: (i) To assess the correlation between the symptoms of pre-menstruation and quality of sleep; (ii) To assess the correlation between the symptoms of pre-menstruation and attitude towards menstruation; and (iii) To study the result of PMS scale (PMSS) scores by attitudes of menstruation and quality of sleep. Materials and Methods: Study participants who were medical students were instructed to complete the questionnaires regarding socio-anthropological information and questions related to their attitude towards menstruation, quality of sleep, and symptoms of PMS. Results: The study determines a high positive significant correlation between the PMSS score and the mean score of sleep quality (r = 0.894, P &lt; 0.001) and a high negative significant correlation between symptoms of the PMSS score and the total menstrual attitude mean score (r = −0.807, P &lt; 0.001). The total PMSS score was significantly affected by the total score of the Pittsburgh sleep quality index (β = 4.603; P &lt; 0.001) and the menstrual attitude questionnaire (β = −4.988; P = 0.001), as shown by multiple linear regression analysis. Conclusion: Poor quality of sleep and a negative menstrual attitude are associated with PMS symptoms. Identifying coping mechanisms for PMS and educating the girls in the reproductive age group may improve their standard of living.

Relationships between Gender Roles and Attitudes Towards Menstruation and Perception of Menstrual Pain in Iranian Women

Background: Menstruation is a prominent mark of womanhood. It is necessary to explore what factors may develop female attitudes towards this natural phenomenon in different populations. Objective: This study aimed to explore the relationships between gender roles and attitudes towards menstruation and perception of menstrual pain among Iranian women. Methods: This cross-sectional study was conducted on 164 women of reproductive age in Torbat-e Heydariyeh in the east of Iran between September and December 2019. The participants completed the Bem Sex-Role Inventory (BSRI), Menstrual Attitude Questionnaire (MAQ), and Verbal Multidimensional Scoring System (VMSS). Data analysis was then performed in SPSS 16.0. Results: According to the results, menstruation was perceived as a natural phenomenon more significantly by the androgynous group than by the undifferentiated and masculine groups (p&lt;0.05). It was also perceived as a predictable phenomenon more significantly by the feminine women than by the other gender role groups (p&lt;0.05). Furthermore, the gender role groups had no significant differences in the prevalence and severity of menstrual pain (p&gt;0.05). Conclusion: Androgynous women considered menstruation a natural phenomenon more often. Psychological interventions should focus on the correction of attitudes towards menstruation, especially in women with femininity, masculinity, and undifferentiated gender roles.

Development of a scale to evaluate negative menstrual attitudes among Nepalese women

BackgroundMenstrual attitudes include negative and positive perceptions of menstruation and are associated with reproductive health, underscoring the importance of its evaluation in women. Given that social and cultural factors affect menstrual attitudes, developing evaluation methods specific to distinct societal cultures is necessary.MethodsWe developed a scale based on the menstrual attitude questionnaire, which is the most widely used measure of menstrual attitudes, to evaluate negative menstrual attitudes among Nepalese women in consideration of Nepalese cultural backgrounds and literacy. In total, 352 Nepalese women aged 20–45 years living in urban or suburban areas in Nepal were enrolled in the study. Participants were randomly divided into two groups using the permuted block method. Using the prototype, Group 1 (n = 176) was evaluated with an exploratory factor analysis to develop a reliable scale, and Group 2 (n = 176) was evaluated with a confirmatory factor analysis to confirm the structure of negative menstrual attitudes. Further, we preliminarily examined the relationship of negative menstrual attitudes with the frequency of traditional menstrual practices and intensity of menstrual pain, which are significant reproductive health issues in Nepal, in Group 2.ResultsWe developed a 15-item, 3-factor scale to evaluate negative menstrual attitudes among Nepalese women using exploratory factor analysis. The first, second, and third factors were “Natural event” (α = 0.82), “Debilitating event” (α = 0.76), and “Bothersome event” (α = 0.69), respectively. Confirmatory factor analysis revealed that negative menstrual attitudes comprised a 3-factor structure. Participants who performed three traditional menstrual practices (“stay in their own house”, “go to public spaces”, and “contact with others generally”) demonstrated significantly higher scores for negative menstrual attitudes than did non-performers. Negative menstrual attitudes were positively correlated with the intensity of menstrual pain (r = 0.558).ConclusionsThis study is the first to evaluate menstrual attitudes and analyse its factor structure among Nepalese women. In the future, the relationship between accurately evaluated negative menstrual attitudes and reproductive health issues should be examined more comprehensively.

Menstrual Attitudes: The Gender Differences Among Nigerian University Students

Menstrual Attitudes: The Gender Differences Among Nigerian University Students

Comparison of the efficacy of pharmacological and nonpharmacological treatments in women with primary dysmenorrhea: randomized controlled parallel-group study.

To compare the effectiveness of pharmacological (PT) and nonpharmacological treatments (NPT) in women with primary dysmenorrhea (PD) and determine the most effective treatment method. We enrolled 85 PD participants with PD who were randomly classified into five groups: pharmacological groups; naproxen sodium (NS) and micronized purified flavanoid fraction (MPFF), nonpharmacological groups; motor imagery focused pelvic floor exercise (MOPEXE) and acupressure, and no treatment group; control. Initial assessment was conducted in all groups on the first day of the menstrual cycle. After the end ofthe third menstrual cycle, the specialist physiotherapist and the obstetrician conducted a final evaluation. Intensity and nature of pain were evaluated with the Short-Form McGill Pain Questionnaire (SF-MPQ), and menstrual attitudes and behaviors were evaluated using the Menstruation Attitude Questionnaire (MAQ). In the total pain dimension scores, which are the sum of the affective dimension of pain and sensory dimension scores, the pre-post treatment difference was the highest in the mean of the total pain dimension. The highest was for MOPEXE (15.12 ± 4.44), followed by MPFF (7.53 ± 6.8); acupressure (7.47 ± 5.28) and NS (4.47 ± 4.91) showed more significant change than the control group (p = 0.001). The mean difference in visual analog scale (VAS) scores was highest in MOPEXE (4.53 ± 1.5), followed by acupressure (2.35 ± 1.66); MPFF (1.88 ± 1.73) and NS (1.65 ± 1.84) scores were more significant than the control group (p = 0.001). Regarding total pain intensity, the highest was MOPEXE (2.59 ± 0.94), followed by MPFF (1.18 ± 0.88); acupressure (1.06 ± 0.83) and NS (0.82 ± 1.01) scores were more significant compared to the control group (p = 0.001). There was no significant change in the pre-post difference values in the MAQ subparameters: menstruation as deliberate event, menstruating as bothersome event, menstruation as natural event, anticipation and prediction of the onset of menstruation, and denial of any effects of menstruation; menstruation as a natural event resulted in insignificant changes in parameters (p = 0.579, p = 0.074, p = 0.892, p = 0.056, p = 0. 377). PT and NPT methods in the study were effective in coping with PD-associated pain. MPFF was more effective than the NS group in terms of relieving pain. In terms of pain, MOPEXE and acupressure groups were as effective as PT. The most effective of these treatment methods was the MOPEXE group created by the researcher.