Mixed-methods Methodology Research Articles

INTELLIGENCE GATHERING AND ITS CONTRIBUTION TO NIGERIA'S NATIONAL SECURITY: A CRITICAL ASSESSMENT

The Nigerian intelligence sector faces institutional limitations that hinder the successful implementation of intelligence collecting, which is widely acknowledged as a crucial tool in tackling these issues. This paper provides a thorough evaluation of the function of intelligence gathering within Nigeria's national security framework, analysing its effectiveness in dealing with current security challenges. This study seeks to offer a thorough examination of the intelligence cycle in the Nigerian setting, including the gathering, analysis, and use of intelligence in national security strategy. The research used a mixed-methods methodology, combining quantitative data obtained from a questionnaire with qualitative insights obtained from an empirical literature analysis. The Network Theory (TNT) functions as the conceptual framework, providing a perspective to examine the intricate connections and transmission of information within the intelligence network. Statistical analysis is conducted on the questionnaire results using descriptive and inferential methods, while the findings of the literature review are consolidated to offer context and depth. The study results highlight a significant dependence on Human Intelligence (HUMINT) and source intelligence (OSINT) in Nigeria, with a lack of implementation of Geospatial Intelligence (GEOINT) and a disregard for Measurement and Signature Intelligence (MASINT). Furthermore, the investigation exposes inadequate levels of trust and collaboration between intelligence agencies and other security organizations. The major obstacles mentioned are insufficient financial resources, insufficient training and knowledge, technical constraints, competition among different agencies, and legal and bureaucratic restrictions. The research findings indicate that although intelligence gathering is of utmost importance for Nigeria's national security, its efficacy is hindered by structural and operational obstacles. personnel growth and comprehensive strategy to improve intelligence capabilities, which involves bolstering inter- agency collaboration, allocating resources to technical progress and skilled personnel growth, and creating a strong legal and ethical structure.

Understanding the Challenges Associated with Approval of Anticancer Products to Facilitate the Regulatory Approvals: A Cross-sectional Study

Purpose: Oncological medications face a myriad of challenges, including technological, pre-clinical, clinical, and manufacturing, that lead to regulatory approval delays or failures. The present study aims to identify some challenges encountered by researchers or regulators during the development of novel cancer therapies. Methods: The present cross-sectional observational study used a mixed-method design methodology. The participants were selected via a non-random sampling method via self-selection and snowballing approach. A survey questionnaire was developed and circulated among the selected participants as a hard copy or email or a Google form. Open-ended and closed-ended questions were incorporated to identify the regulatory challenges faced during oncology drug development. The responses were collected from September 2021 to June 2022. These responses were then coded and themes were identified for the challenges. Results: A total of 87 responses were obtained for the questionnaire among the individuals contacted. Seven themes were identified from the collated responses that depicted the challenges for the regulatory approval of anticancer drug products. The majority of responders (38.2%) suggested reduced approval time whereas endpoint selection and study design were considered as a challenge by 12.0% of responders each. Furthermore, 6.0% of responders admit that timely interaction with the regulators is also a challenge that delays approval. Many challenges also exist during the product development phase; hence, 12.0% of responders reported safety issues, and 22.0% of responders reported technical issues during manufacturing as the cause of regulatory failure. Moreover, 12.0% of responders suggested the need for improvements in regulatory guidelines for oncology drug development. Conclusion: The survey indicates a lack of Indian guidelines for anticancer products, whereas limited guidance is available from other countries such as Europe or the United States. Thus, the survey points to the necessity for improvement in the regulatory guidelines and drug approval process to address the challenges unique to cancer drug development.

A multi-case study exploring the effect of interventions on food safety culture maturity

In each food business, a food safety culture (FSC) with a certain maturity level prevails. Previous research has demonstrated that the maturity level of the prevailing FSC can be assessed, but empirical proof of FSC maturity improvement remains limited especially in food processing companies. This study aimed to zoom in on the food safety culture improvement trajectory of four food processing case studies, focusing on human-organizational dimensions of food safety culture. First, a pre-assessment of the maturity of the prevailing food safety culture was executed in each case company (assessment time 1) by application of a validated mixed-methods methodology which includes three different tools (the food safety climate questionnaire, management interview, and on-site evidence collection visits). Based on this pre-assessment, underdeveloped dimensions or gaps in the prevailing food safety culture were identified to find improvement needs. In each of the 4 included distinct case companies, an intervention was implemented. In the first case company, case 1, a food safety key performance indicator (KPI) system was implemented as the intervention, with shared monitoring and shared responsibilities for KPI improvement. Coincidentally, case company 2 and case company 4 selected the same intervention. Case 2, as well as case 4, decided to implement structured group discussions with operators to collect input for collaborative action point selection, aiming for their active involvement in food safety. In case 3, a food safety culture check system was implemented for systematic reward and recognition. After intervention implementation, the post-assessment was conducted (assessment time 2), applying the exact same methodology as the pre-assessment. To investigate the extent of improvement, comparison of the pre- and post-assessment in each of the four cases was first done descriptively by comparing the means. Next, data collected via the food safety climate questionnaire was compared statistically via Mann-Whitney U tests. Analyses showed a substantial objective and subjective (employees’ perceptions) improvement of the targeted food safety culture gaps in companies 1 and 2, demonstrating that food safety culture improvement was achievable through a science-based and cocreated intervention process and implementation plan compliance. In cases 3 and 4, marginal improvements and unchanged scores were revealed. Comparison of cases’ trajectory characteristics and resulting success rates demonstrated that senior management involvement was essential for interventional success, as well as implementing culture interventions on an organizational or group level, instead of only including selected employees.

Breaking barriers: The impact of girls’ education on poverty eradication in northern Nigeria – A Focus on Sokoto State

This research explores the critical role of girls' education in alleviating poverty in Sokoto State, Nigeria. It highlights the significant gender disparities in educational access, driven by cultural norms that prioritize boys' education, which impede both individual potential and broader economic growth. The research underscores that educated women contribute to workforce participation and family income, thereby fostering community development and reducing poverty. Despite some progress, challenges such as socio-cultural attitudes, inadequate infrastructure, and economic constraints persist, necessitating a multi-faceted approach involving policy reforms and community engagement. The study employs a mixed-methods methodology, revealing that while enrolment rates have improved, gender inequities remain pronounced. It advocates for targeted interventions and community involvement to shift perceptions and enhance girls' educational opportunities, ultimately aiming for sustainable development goals in Northern Nigeria.

Culinary medicine in type 2 diabetes management: co-designing the Cook2DIAbeat training program

Abstract Background Type 2 diabetes (hereinafter diabetes) stands among the top ten drivers of disease burden. Globally, more than 59 million adults are living with diabetes with a projection of 15% increase by 2045. The Cook2DIAbeat project aims to develop a tailor-made nutrition training program based on culinary medicine, for patients with diabetes to achieve lifelong dietary changes. The aim of the present work was to reveal potential drivers and barriers related to lifelong dietary modifications. Methods The study was implemented in February-July 2023 in Spain, Belgium, Greece, and Cyprus. A mixed-method co-design methodology was conducted: co-creation sessions with individuals with diabetes, family members, and healthcare professionals, and an online survey with patients with diabetes. Results In total, 23 health professionals and 25 patients and family members participated in the co-creation sessions, and 212 patients in the online survey. Patients and health professionals recognized the added value of the culinary approach for diabetes management. The main perceived barriers for changing dietary habits included difficulties accessing reliable and non-conflicting information, lack of time, emotional and psychological issues, and limited social support. Individuals at an advanced age and of low socioeconomic status seem to demand specific educational approaches addressing the actual challenges of their daily life. Conclusions The study indicated that training should provide reliable information and address psychosocial aspects. The translation of the dietary guidelines through the culinary medicine approach seems to be well-received by the target group. Last, the content needs to be tailored to suit the specific age group and socioeconomic background of the patients. Key messages • Reliability, practicability are three key characteristics of a nutrition training program in diabetes management. • Cultural and socioeconomic barriers needs to be taken into consideration.

Development of an Integrated Physiotherapy Treatment Protocol for Desk Job Personals: A Pilot Research

Objectives: To develop an Integrated validated Physiotherapy Treatment Protocol for Desk Job personnel along with an assessment of its effectiveness. Methods: The research was conducted utilizing a mixed-method methodology. Interviews with thirty computer professionals (having more than five years of experience) and a thorough in-depth literature research were conducted to identify various symptoms which are commonly seen among computer professionals. Search engines such as Ovid MEDLINE, Cochrane Library, Pubmed, and EBSCO CINAHL were used with terms such as Neck Problems in Computer Professionals(cs), Treatment Techniques used in Cervical Spondylitis, and Motor or Sensory issues in Computer Professionals. The treatment protocol was created with the help of identified symptoms and validated using the Delphi technique. After the protocol was developed, a randomized control trial was conducted with thirty samples in each group. A developed and validated regimen was provided to the participants. Findings: Item level CVI ranges from 0.79 to 1. The Kappa results demonstrated the protocol's strong content validity, which ranged from 0.79 to 1. In comparison to day 1, there was a decline in both groups' scores of NDI and NPRS on day 30, and there was an even more noticeable decrease on day 60. The experimental group showed a much greater reduction in neck pain and disability when compared to the control group. Novelty: The study has focussed on a new category of occupational health issues, namely computer-related health issues, for which there is no established set of Physiotherapy Protocol that can either prevent or treat the issues. Keywords: Numeric Pain Rating Scale (NPRS), Neck Disability Index (NDI), Content Validity Ratio (CVR) and Content Validity Index (CVI), Integrated Physiotherapy Treatment Protocol (IPTP)

Learning and Development Program’s Admission Requirements and Student Engagement as Success Determinants in Accountancy

This study focuses on the admission criteria of a bachelor of accountancy (BAcc) degree program as one of many factors influencing students’ success in graduating in the regulated time frames. The present study used constructivist learning and student engagement theories as connected lenses to explore the effect of admission criteria on first-year-level students’ academic performance. The research findings emanate from a mixed methods methodology using logistic regression, one of the choice models in the International Business Machines (IBM) Statistical Package for Social Scientists (SPSS), and semi-structured interviews. A sample of 43 was randomly selected from the list of 91 students with NSC-level accounting to match the number of 43 students who did not do NSC-level accounting offered in South African high schools. This gave the researchers a study sample 86, which reduced 81 following incomplete data submission by five students. The study’s findings suggest a sensitive understanding of students’ engagement with program materials and admission criteria. The admission criteria embraces prior high school knowledge reflected in the NSC-level admission points score (APS) and NSC-level mathematics. In addition, student dedication is a dimension of student engagement that we explored. The value of the study is a contribution to the reconsideration of student engagement alongside program admission requirements, leading to the integration of constructivist learning and student engagement theories. Prior studies have not integrated constructivist learning and student engagement theories into their research design. We recommend the continued use of the NSC-level APS score and mathematics in the admission requirements of the BAcc learning and development programs. We also recommend using teaching and learning activities that bring out student dedication. More research should be done on all aspects of student engagement premised on graduating students.

Evaluating both usability and accessibility: the case of access@tour by action – a digital solution for accessible tourism

Aim: Information systems can help improve accessible tourism conditions. During the development of accessible technology, a crucial phase is testing. Notwithstanding, usability testing methodologies often dismiss accessibility. To overcome this gap, this work contributes with an innovative mixed-method testing methodology that integrates accessibility and usability components in technology evaluation. The capabilities of this methodological process are demonstrated through testing the prototype of a mobile solution for accessible tourism – access@tour by action. Methods: Nine experts evaluated the platform and helped correct accessibility failures. Afterward, 78 end-users tested the prototype. The procedure includes a set of tasks to be performed in the prototype and a final questionnaire. This questionnaire was specifically created for accessibility markets and is itself a significant contribution. Results: Testing with experts helped improve the prototype’s accessibility before it reached end-users. The results with end-users are provided in two distinct ways. First, the task performance measures are presented, which showed overall good completion rates. Second, the results obtained from the questionnaires are disclosed. Overall, the platform was considered relevant, accessible, and easy to use. Still, some minor flaws were identified regarding interface connectivity, symbology, and reading sequence. Thus, improvements are suggested based on obtained feedback. Conclusion: The testing procedure was essential to gather input from a user point of view, ensuring the final version of the access@tour by action is accessible and, therefore, “usable”. This allowed for validating the methodological method, significantly contributing to future research on evaluating technology accessibility.

Exploring Teachers' Perspectives on Utilizing Local Resources to Address Substance Abuse within Schools

The purpose of this study was to identify the conceptual foundations that underlie school teachers' preferences for the utilization of personal resources to address the problem of substance abuse at the school level. Also, it was examined whether there is a relationship between the school teachers’ perceived approaches with their gender, school type, and socioeconomic status. The participants in the study consisted of school teachers working in secondary schools located in four densely populated districts of Karachi, Pakistan. The research was conducted using a mixed-method methodology. Data were collected by using semi-structured interviews through personal visits. A qualitative analysis method was used to find out the perceptions of school teachers regarding their preferred approach to deal the issue of drug abuse. In addition, a quantitative analysis was performed to ascertain the relationship, if any, between participants' demographics and their preferred approach. The results show that the school teachers selected effective strategies to address this issue at the school level within their means, including emotional competence, psychological competence, religion, and monitoring.

Translanguaging pedagogy on the digital stage: exploring Chinese undergraduates’ English grammar learning through DingTalk platform

The internet sphere has become a disruptive platform for education, leading to a reworking of the language instruction scene. This research investigates the intersection of Translanguaging Pedagogy with the dynamic digital platform DingTalk, with the objective of enhancing the English grammar learning experience for Chinese undergraduate students. The goal of this study, which is multilingual context-based, is to investigate the as-yet-unexplored field of using students’ linguistic repertoires in virtual environments. Utilising a mixed-methods methodology, this work incorporates a quasi-experimental design and qualitative investigation to elucidate the complex interaction between Translanguaging Pedagogy and the immersive potential of DingTalk. The study involved a population of 58 Chinese undergraduate students, with qualitative insights further enriched through interviews with 4 participants. The results reveal notable enhancements in English grammatical skills among individuals who participated in the Translanguaging method using DingTalk. These findings underscore the effectiveness of incorporating Mandarin as a cognitive bridge. Qualitative observations shed light on the cognitive and emotional aspects of this new method, unveiling its profound influence on the acquisition of language. The present study aims to alter educational paradigms by illustrating the mutually beneficial connection between pedagogy and technology in the context of improving language acquisition. In light of the global shift towards remote education, this research presents a groundbreaking approach that paves the way for a future characterised by comprehensive and skill-oriented language instruction, fostering inclusivity.

Trust building across and within cultures: A study of Guinea, West Africa, and China

Adopting a cross-cultural perspective, this study provides insights into how Chinese multinational corporations (MNCs) with a focus on Confucian values, builds trust and contributes to the globalization process in African settings, specifically Guinea. Using a mixed-methods methodology, we explore the dynamics of trust relationships within and across cultures. In Study 1, semi-structured interviews were conducted with 19 Chinese supervisors, 20 Guinean supervisors and 19 Guinean workers. We found Chinese expatriates to emphasize ability and integrity in trust building while Guinean workers care more about benevolence. Drawing on the insights of study 1, we proposed a model of interpersonal trust within and across cultures. In this Study 2, data was collected from 182 Guinean workers and their direct Chinese/Guinean supervisors. We found Guinean subordinates’ trust in the organization to mediate between their trust in Guinean supervisors and their performance. In addition, Guinean supervisor’s trust in Chinese supervisor positively affects Guinean subordinate’s trust in organization and also moderates the positive relationship between Guinean subordinates’ trust in the organization and their performance. We draw implications for management relationships between two cultures that are seemingly different from both studies.

The The Effect of Teacher-Student Reciprocal Relationships on Academic Performance in Bangladeshi Primary Schools

The purpose of this study was to investigate the impact of teacher-student interactions on academic success in Bangladeshi primary schools. The study employed a mixed-methods methodology and gathered data from 320 primary students and 64 instructors/teachers across sixteen elementary schools. The data collection involved the administration of survey questionnaires for both teachers and students, and focused group interviews of students and conducting semi-structured interviews with teachers. The results revealed a strong association between positive teacher-student connections and enhanced academic performance, improved student behaviour, and increased motivation. Students who reported having positive relationships with their instructors exhibited higher levels of academic success compared to those who reported negative or neutral relationships. Moreover, instructors who fostered excellent rapport with their students demonstrated higher levels of engagement and motivation, leading to improved academic achievements among their students. These findings carry significant implications for education policy and practice, emphasizing the importance of investing in teacher training and providing support to develop positive relationships with students in Bangladeshi primary schools. By prioritizing the cultivation of teacher-student bonds, educational stakeholders can potentially yield substantial improvements in student academic achievement and overall educational outcomes. Teacher’s World: Journal of Education and Res arch, 50(1): 43-60

Influence of Mentorship Programs on Students’ Academic Performance in Public Secondary Schools in Imenti North Sub- County, Meru County, Kenya

Management practices are an important ingredient in an organization. They offer a unique environment needed to attain set goals, create a good public image and build a productive relationship among the stakeholders. The main aim of this study was to determine the influence of teacher satisfaction on the academic performance of learners in public secondary schools in Imenti North sub-county, Meru County. The study was based on organizational theory, which was developed by Jaques in 1951. The study adopted a mixed methods methodology where both quantitative and qualitative methods were employed. The sampling unit consisted of public secondary schools where 6 principals were selected through purposive sampling from the top three and bottom three performing schools. Ten form three and form four students were also randomly selected from the top three and bottom three performing schools to obtain a sample size of 120 students. Data was collected using a structured questionnaire. Data collected was analyzed using descriptive and inferential statistics with the help of the statistical package for social scientists, version 26.0. A multiple Linear Regression model was used to model the relationship between the independent variable and the response variable (academic performance). The study concludes that mentorship programs have a significant positive effect on academic performance, as indicated by their p-values (P<0.05). The study recommends that schools should ensure that there are functional mentoring programs in schools, as they have been shown to positively influence academic performance. Such programs may provide guidance, support and career direction.

Environmental education within the right to education framework

The incorporation of environmental education (EE) into the framework of the right to education that has been established is being more recognized as being of utmost importance in light of the growing environmental issues. The purpose of this study is to address the important need to align environmental education (EE) with present educational demands. This will ensure that environmental awareness and sustainability are intrinsic components of educational curriculum all over the world. The purpose of this study is to investigate the manner in which EE is currently included into the framework of the right to education, with the intention of determining both the areas of strength and those that require development. The research makes use of a mixed-methods methodology, which blends qualitative insights acquired from interviews with educators and policy makers with quantitative data obtained from a survey of educational institutions located in a variety of locales. There are considerable discrepancies between urban and rural contexts in terms of resource allocation, curriculum creation, and teacher training, according to the analysis, which demonstrates that the implementation of EE takes place in a diverse terrain. A significant discovery is that even while EE is technically acknowledged in educational regulations, its actual implementation continues to be inconsistent. This is frequently reliant on the resources available in the local community as well as the dedication of the institution. Following the conclusion of the study, recommendations are provided for educational practitioners and policymakers, with an emphasis placed on the requirement for an approach to EE that is both more structured and accessible to all individuals. These findings provide a contribution to the larger conversation on sustainable education and bring to light the critical need for coordinated strategies that guarantee every kid has access to quality environmental education as part of their fundamental right to get an education.

Pakistan’s Green Urbanization in the Perspective of Ecological Civilization

Within the context of ecological civilization, this study examines Pakistan’s path toward green urbanization. This study’s main driving force is Pakistan’s rapidly urbanizing landscape, which makes it imperative to address environmental degradation and advance sustainable development. A paradigm change towards green urbanization is required because of the multiple environmental difficulties brought about by urbanization in Pakistan, such as pollution, resource depletion, and habitat loss. This study examines the current status of green urbanization in Pakistan through a thorough analysis using a mixed-methods methodology that combines quantitative data analysis with qualitative evaluations. The findings show that, although there are regional variations in the extent of implementation, there is a growing consciousness of and desire to implement eco-friendly policies and practices within urban areas. Goals for green urbanization are seriously hampered by issues including poor infrastructure, scarce resources, and institutional capacity limitations. However, there are encouraging indications of development such as programs supporting green building techniques, sustainable transportation, and renewable energy. Beyond the confines of academia, the research has implications that teach stakeholders, legislators, and urban planners about the necessity of incorporating ecological principles into urban development initiatives. Pakistan can reduce environmental risks, increase climate change resistance, and promote inclusive, sustainable cities for future generations by adopting green urbanization.

Grief and Loss: Supporting Foster Carer Families Through Placement Terminations

ABSTRACT The importance of acknowledging the grief and loss integral to the experiences of foster carers, has long been understood. However, in a complex area of practice and an increasingly pressured out-of-home care sector, there is a need to refocus foster care program and practitioner attention on supporting carers and their families with the difficult experience of placements ending. This article reports on findings from research that aimed to understand current carer experiences of grief and loss, their coping strategies, their support needs, and the implications for a foster care agency’s duty of care towards its workforce. Through a mixed-methods exploratory methodology, data were collected through an online survey and semistructured interviews with carers affiliated with a foster carer provider operating across three Australian jurisdictions. Carers called for acknowledgement of the deep feelings they develop for the children they look after and help for the grieving process, through training, preparation, and tailored support based on authentic relationships with professionals. The need for well-trained and strongly supported agency workers was emphasised. IMPLICATIONS Providing updates to carers about foster children who have left their care can alleviate the pain of grief and loss. Training, preparation, and step-by-step support for carers can promote healthy grieving processes. Tailored support for grieving carers needs to be founded on authentic relationships with foster care professionals and open and honest communication.

Factors Influencing Online Shopping Decisions in the Fashion Industry

The purpose of this study is to pinpoint the variables that affect consumers' decisions to purchase online for fashion. This study is crucial because it can assist e-commerce businesses better understand consumer behavior and enhance their marketing tactics, which will have a substantial positive impact on the fields of management and information technology. This research employs a mixed-method methodology that combines qualitative interviews with quantitative survey data. Using an online questionnaire, 500 active Indonesian e-commerce users provided quantitative data, and 20 respondents participated in in-depth interviews that yielded qualitative data. While qualitative data were examined thematically, quantitative data were evaluated using Structural Equation Modeling (SEM) with Smart-PLS software. The key conclusions show that customer service responsiveness, product clarity, user reviews, flexible return policies, and platform trust are significant determinants of online purchasing behavior. Competitive pricing and promotional tactics also have a big impact. These results have consequences for e-commerce organizations, who should concentrate on enhancing aspects of trust, the quality of product information, and efficient promotional techniques to draw in and keep customers. The present study suggests that additional investigation is warranted to examine other variables, including the impact of social media and fashion trends on the behavior of online shoppers.

Tracking narrative change in post-intervention focus groups for teachers: an exploratory study

ABSTRACT Reliable and systematic qualitative methodologies to assess participants’ change after group interventions are scarce. This study outlines a methodolo5gical approach to use in focus groups, allowing the elicitation and coding of participants’ change talk after a group intervention. A Change Elicitation Script for Focus Groups was developed and its viability for evoking participants’ discussion around change was tested. Following a self-compassion intervention for teachers, participants’ dialogue was examined in three focus groups following a simplified version of Innovative Moments Coding System for groups. Results suggest that the Change Elicitation Script for Focus Groups effectively prompted participants’ discussion around change. The Innovative Moments Coding System for groups allowed to reliably identify, delimit, and categorize Innovative Moments throughout these dialogues. Although preliminary, this study puts forward a mixed-method methodology, applicable to the retrospective analysis of the process of change in post-intervention focus groups, from educational to clinical settings.

Higher Education in the New Reality: A Study of Students’ Preferences About Digital Learning in Mexico

ABSTRACT Due to the COVID-19 pandemic, higher education students had to switch to online classes to avoid infections, so universities had to adapt to a situation known as emergency remote education and had to provide digital content to simulate the traditional classroom experience. Now, as we transition from the pandemic, returning to in-person education has been a challenge. This period, often referred to as the “new normal,” is characterized by a mix of in-person and digital learning. Therefore, it is necessary to evaluate students’ preferences for digital education in this new educational landscape. In this exploratory empirical study, the preferences of undergraduate students at a private university in Mexico were evaluated through a survey. This survey was applied by the Directorate of Educational Innovation and Digital Learning through institutional means in September 2022. It had multiple-choice questions and an open final question. A total of 2725 responses were obtained. Student responses were analyzed using a mixed methods methodology. Responses to multiple-choice questions were analyzed quantitatively using descriptive statistics, while responses to open-ended questions were analyzed using content analysis. The results show that although students prefer academic programs with 80 to 100% in-person, they also prefer digital or remote classes. This preference is highlighted by students who work and study simultaneously. These studies show that the hybrid and flexible format (HyFlex) can take off in this new normal. However, more studies are required to demonstrate its effectiveness in learning.

Measurement of changes to the menstrual cycle: A transdisciplinary systematic review evaluating measure quality and utility for clinical trials.

Despite the importance of menstruation and the menstrual cycle to health, human rights, and sociocultural and economic wellbeing, the study of menstrual health suffers from a lack of funding, and research remains fractured across many disciplines. We sought to systematically review validated approaches to measure four aspects of changes to the menstrual cycle-bleeding, blood, pain, and perceptions-caused by any source and used within any field. We then evaluated the measure quality and utility for clinical trials of the identified instruments. We searched MEDLINE, Embase, and four instrument databases and included peer-reviewed articles published between 2006 and 2023 that reported on the development or validation of instruments assessing menstrual changes using quantitative or mixed-methods methodology. From a total of 8,490 articles, 8,316 were excluded, yielding 174 articles reporting on 94 instruments. Almost half of articles were from the United States or United Kingdom and over half of instruments were only in English, Spanish, French, or Portuguese. Most instruments measured bleeding parameters, uterine pain, or perceptions, but few assessed characteristics of blood. Nearly 60% of instruments were developed for populations with menstrual or gynecologic disorders or symptoms. Most instruments had fair or good measure quality or clinical trial utility; however, most instruments lacked evidence on responsiveness, question sensitivity and/or transferability, and only three instruments had good scores of both quality and utility. Although we took a novel, transdisciplinary approach, our systematic review found important gaps in the literature and instrument landscape, pointing towards a need to examine the menstrual cycle in a more comprehensive, inclusive, and standardized way. Our findings can inform the development of new or modified instruments, which-if used across the many fields that study menstrual health and within clinical trials-can contribute to a more systemic and holistic understanding of menstruation and the menstrual cycle.