Interplay of Health Literacy, Dietary Behaviors, and Psychological Adjustment in Adult Females Experiencing Menstrual Irregularities
DOI:
https://doi.org/10.55737/trt/WR25.142Keywords:
Health Literacy, Eating Problems, Psychological Adjustment, Menstrual Irregularities, Structural Equation ModelingAbstract
The objective of the current study was to investigate the structural relationship among health literacy, eating, and adjustment problems in female adults with irregular menstruation. The cross-sectional research design was used. The 200 sample of female adults aged 19 or above was recruited from different cities using the snowball sampling technique. The data was collected using three scales, i.e., the health literacy scale, the eating disorder examination questionnaire, and the scale of adjustment problem for adults. The data analysis was done using descriptive statistics and structural equation modeling. The result indicated the significant structural relationship among variables. The values of GFI, AGFI, and CFI are .977, .913, and .942, respectively. The model is said to be best fitted and indicates a significant relationship. The health literacy and eating problems have a significant negative relationship, whereas health literacy has shown a non-significant relationship with adjustment problems. The eating problem and adjustment problem have a significant positive relationship.
References
Akter, M., Sujan, M. S. H., Uddin, M. R., & Kundu, L. R. (2024). Menstrual irregularity and mental health problems among Bangladeshi adolescent girls: Prevalence and associated factors of mental health problems and menstrual irregularity among Bangladeshi adolescent girls. Health Prospect, 23(3), 18-25. https://nepjol.info/index.php/HPROSPECT/article/view/61168
American College of Obstetricians and Gynecologists. (2015). Menstruation in girls and adolescents: Using the menstrual cycle as a vital sign (Committee Opinion No. 651). Obstetrics & Gynecology, 126(6), e143–e146. https://doi.org/10.1097/AOG.0000000000001215
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Publishing.
Attia, G. M., Alharbi, O. A., & Aljohani, R. M. (2023). The Impact of Irregular Menstruation on Health: A Review of the Literature. Cureus, 15(11). https://doi.org/10.7759/cureus.49146
Aziz, Z., Fazal, S., & Abbasi, P. N. (2025). Demographic Differences in Mental Health Literacy, Mental Health Status, Perceived Stress, Social Support, and Psychological Well-Being Among University Students in Pakistan. Pakistan Social Sciences Review, 9(2), 249–259. https://doi.org/10.35484/pssr.2025(9-II)19
Bae, J., Park, S., & Kwon, J. (2018). Factors associated with menstrual cycle irregularity and menopause. BMC Women's Health, 18(1). https://doi.org/10.1186/s12905-018-0528-x
Bibi, B., & Maqsood,F. (2019). Urdu translation of health literacy-EU-16 scale for use in Pakistan. (SRGP Report No: 21- 2044). Higher Education Commission. Islamabad Pakistan.
Bull, J. R., Rowland, S. P., Scherwitzl, E. B., Scherwitzl, R., Danielsson, K. G., & Harper, J. (2019). Real-world menstrual cycle characteristics of more than 600,000 menstrual cycles. npj Digital Medicine, 2(1). https://doi.org/10.1038/s41746-019-0152-7
Byrne, B. M. (2006). Structural equation modeling with EQS: Basic concepts, applications, and programming (2nd ed.). Mahwah, NJ, US: Lawrence Erlbaum Associates Publishers.
Calugi, S., Ricca, V., Castellini, G., Sauro, C. L., Ruocco, A., Chignola, E., ... & Dalle Grave, R. (2015). The eating disorder examination: reliability and validity of the Italian version. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 20(4), 505-511. https://doi.org/10.1007/s40519-015-0191-2
Choe, C., & Yu, S. (2025). Longitudinal cross-lagged analysis between depressive symptoms, social withdrawal, self-esteem, and school adaptation in multicultural adolescents. Psychologica Belgica, 65(1), 1-14. https://doi.org/10.5334/pb.1310
ÇINKIL, Z., & TURAL BÜYÜK, E. (2024). The relationship between health literacy and eating attitudes of adolescents. Journal of Public Health. https://doi.org/10.1007/s10389-023-02187-7
Ciołek, A., Kostecka, M., Kostecka, J., Kawecka, P., & Popik-Samborska, M. (2023). An assessment of women’s knowledge of the menstrual cycle and the influence of diet and adherence to dietary patterns on the alleviation or exacerbation of menstrual distress. Nutrients, 16(1), 69. https://doi.org/10.3390/nu16010069
Cunningham, A. C., Prentice, C., Peven, K., Wickham, A., Bamford, R., Radovic, T., Klepchukova, A., Fomina, M., Cunningham, K., Hill, S., Hantsoo, L., Payne, J., Zhaunova, L., & Ponzo, S. (2024). Efficacy of the Flo app in improving health literacy, menstrual and general health, and well-being in women: Pilot randomized controlled trial. JMIR mHealth and uHealth, 12, e54124. https://doi.org/10.2196/54124
Dar, M., Khan, A., Shah, S. S., Aleem, A., Jaber, A. A., Hussain, M., & Khan, G. M. (2025). Evaluation of health-related quality of life of female students suffering from primary dysmenorrhea: Findings of a cross-sectional study from Pakistan. Frontiers in Public Health, 13. https://doi.org/10.3389/fpubh.2025.1467377
Emiral, G. Ö., Aygar, H., & Atalay, B. (2018). Health literacy scale-European union-Q16: a validity and reliability study in Turkey. International Research Journal of Medical Sciences, 6(1), 1–7. https://www.isca.me/MEDI_SCI/Archive/v6/i1/1.ISCA-IRJMeds-2017-016.php
Fairburn, C. G., & Beglin, S. J. (2008). Eating Disorder Examination Questionnaire. Cognitive behavior therapy and eating disorders, 309(313), 509-528. https://legeforeningen.no/contentassets/47422e2cfa934c35a37fb56b9f09ef61/ede-q_norsk.pdf
Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: A “transdiagnostic” theory and treatment. Behaviour Research and Therapy, 41(5), 509-528. https://doi.org/10.1016/s0005-7967(02)00088-8
Guo, Y., Liu, Y., Ding, R., Yan, X., Tan, H., Wang, Y., Wang, X., & Wang, L. (2023). A structural equation model linking health literacy, self-efficacy, and quality of life in patients with polycystic ovary syndrome. BMC Women's Health, 23(1). https://doi.org/10.1186/s12905-023-02223-4
Güzeldere, H. K., Efendioğlu, E. H., Mutlu, S., Esen, H. N., Karaca, G. N., & Çağırdar, B. (2024). The relationship between dietary habits and menstruation problems in women: A cross-sectional study. BMC Women's Health, 24(1). https://doi.org/10.1186/s12905-024-03235-4
Hennegan, J., Winkler, I. T., Bobel, C., Keiser, D., Hampton, J., Larsson, G., Chandra-Mouli, V., Plesons, M., & Mahon, T. (2021). Menstrual health: A definition for policy, practice, and research. Sexual and Reproductive Health Matters, 29(1), 31-38. https://doi.org/10.1080/26410397.2021.1911618
Herpertz-Dahlmann, B., & Remschmidt, H. (1993). Depression and psychosocial adjustment in adolescent anorexia nervosa. A controlled 3-year follow-up study. European Child & Adolescent Psychiatry, 2(3), 146-154. https://doi.org/10.1007/bf02125569
Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1-55. https://doi.org/10.1080/10705519909540118
Kells, M. R., Davis, H. A., Todorov, S., & Wildes, J. E. (2023). Health literacy and eating disorder pathology in women with food insecurity: A preliminary cross-sectional study. Eating Behaviors, 49, 101727. https://doi.org/10.1016/j.eatbeh.2023.101727
Kilfoyle, K. A., Vitko, M., O'Conor, R., & Bailey, S. C. (2016). Health literacy and women's reproductive health: A systematic review. Journal of Women's Health, 25(12), 1237-1255. https://doi.org/10.1089/jwh.2016.5810
Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. Springer.
Lincoln, A., Paasche-Orlow, M. K., Cheng, D. M., Lloyd-Travaglini, C., Caruso, C., Saitz, R., & Samet, J. H. (2006). Impact of health literacy on depressive symptoms and mental health-related quality of life among adults with addiction. Journal of General Internal Medicine, 21(8), 818-822. https://doi.org/10.1111/j.1525-1497.2006.00533.x
Lohmöller, J.-B. (1989). Latent Variable Path Modeling with Partial Least Squares. Physica-Verlag HD. https://doi.org/10.1007/978-3-642-52512-4
Maat, H. P., Essink-Bot, M.-L., Leenaars, K. E., & Fransen, M. P. (2014). A short assessment of health literacy (SAHL) in the Netherlands. BMC Public Health, 14(1). https://doi.org/10.1186/1471-2458-14-990
Magallón-Botaya, R., Méndez-López, F., Oliván-Blázquez, B., Silva-Aycaguer, L. C., Lerma-Irureta, D., & Bartolomé-Moreno, C. (2023). Effectiveness of health literacy interventions on anxious and depressive symptomatology in primary health care: A systematic review and meta-analysis. Frontiers in Public Health, 11. https://doi.org/10.3389/fpubh.2023.1007238
Majeed, J., Sharma, P., Ajmera, P., & Dalal, K. (2022). Menstrual hygiene practices and associated factors among Indian adolescent girls: A meta-analysis. Reproductive Health, 19(1). https://doi.org/10.1186/s12978-022-01453-3
Malik, M., Hashmi, A., Hussain, A., Waleed Ali Khan, Jahangir, N., Malik, A., & Noreen Naz Ansari. (2023). Experiences, awareness, perceptions and attitudes of women and girls towards menstrual hygiene management and safe menstrual products in Pakistan. Frontiers in Public Health, 11. https://doi.org/10.3389/fpubh.2023.1242169
Maurya, P., Meher, T., & Muhammad, T. (2022). Relationship between depressive symptoms and self-reported menstrual irregularities during adolescence: Evidence from UDAYA, 2016. BMC Public Health, 22(1). https://doi.org/10.1186/s12889-022-13196-8
Meczekalski, B., Katulski, K., Czyzyk, A., Podfigurna-Stopa, A., & Maciejewska-Jeske, M. (2014). Functional Hypothalamic Amenorrhea and Its Influence on Women’s Health. Journal of Endocrinological Investigation, 37(11), 1049–1056. https://doi.org/10.1007/s40618-014-0169-3
Meherali, S., Matthews, B., Myhre, D., Nisa, S., Idrees, S., Faraz, A., Ullah, K., Shah, R., & Lassi, Z. (2024). Empowering mothers: Advancing maternal health literacy and numeracy through the introduction of Maternal and Child Health Calendar. Women’s Health, 20. https://doi.org/10.1177/17455057241291725
Mond, J., Hay, P., Rodgers, B., Owen, C., & Beumont, P. (2004). Validity of the eating disorder examination questionnaire (EDE-Q) in screening for eating disorders in community samples. Behaviour Research and Therapy, 42(5), 551-567. https://doi.org/10.1016/s0005-7967(03)00161-x
Mughal, F., Kumar, A., Maheshwari, J. D., Bijarani, A. N., Kazmi, T., & Nangrejo, R. (2021). Prevalence and age-related association of abnormal endocrine changes among women with menstrual disorder. Journal of Pharmaceutical Research International, 341-349. https://doi.org/10.9734/jpri/2021/v33i44b32685
Nagata, J. M., Garber, A. K., Tabler, J., Murray, S. B., Vittinghoff, E., & Bibbins‐Domingo, K. (2019). Disordered eating behaviors and cardiometabolic risk among young adults with overweight or obesity. International Journal of Eating Disorders, 51(8), 931-941. https://doi.org/10.1002/eat.22927
Napolitano, F., Bencivenga, F., Pompili, E., & Angelillo, I. F. (2019). Assessment of knowledge, attitudes, and behaviors toward eating disorders among adolescents in Italy. International Journal of Environmental Research and Public Health, 16(8), 1448. https://doi.org/10.3390/ijerph16081448
National Institute of Child Health and Human Development. (2022). Menstrual cycle: Overview. NICHD. https://www.nichd.nih.gov/health/topics/menstruation
Naz, I., Bano, Z., & Anjum, R. (2022). Construct and criterion validity of adjustment scale for adults using the correlation and Receiver-Operating Characteristics Analysis. Rawal Medical Journal, 47(1), 89-89. https://www.rmj.org.pk/fulltext/27-1582280908.pdf
Naz, I., Bano, Z., & Leghari, N. U. (2018). Construction of scales on depression, anxiety and conduct disturbance of adjustment for adults: developing a reliable measure. Isra Med J, 10(5), 310-314.
Proff, A. A., Fatima, S., & Limón, M. L. (2023). Becoming women: Period. Perceptions of barriers and facilitators to menstrual hygiene management programs for Pakistani girls. Frontiers in Public Health, 11. https://doi.org/10.3389/fpubh.2023.1083688
Rafique, N., & Al-Sheikh, M. H. (2018). Prevalence of menstrual problems and their association with psychological stress in young female students studying health sciences. Saudi Medical Journal, 39(1), 67-73. https://doi.org/10.15537/smj.2018.1.21438
Roop, J. K. (2018). Hormone imbalance—a cause for concern in women. Res J Life Sci Bioinform Pharm Chem, 4, 237-51.
Safaralinezhad, A., Lamyian, M., Ahmadi, F., & Montazeri, A. (2025). Mental health literacy of reproductive age women: A qualitative study. BMC Public Health, 25(1). https://doi.org/10.1186/s12889-025-21488-y
Sarwar, U., & Rauf, U. (2021). Social support, quality of life and mental health problems among females with and without menstruation problems: A comparative study. Khyber Medical University Journal, 14(4), 206-210. https://doi.org/10.35845/kmuj.2021.21373
Sembulingam, K., & Sembulingam, P. (2016). Essentials of medical physiology (7th ed.). Jaypee Brothers Medical Publishers.
Shah, S. F., Punjani, N. S., Rizvi, S. N., Sheikh, S. S., & Jan, R. (2023). Knowledge, Attitudes, and Practices Regarding Menstrual Hygiene among Girls in Ghizer, Gilgit, Pakistan. International Journal of Environmental Research and Public Health, 20(14), 6424. https://doi.org/10.3390/ijerph20146424
Sharma, P., Kaur, M., Kumar, S., & Khetarpal, P. (2021). A cross-sectional study on prevalence of menstrual problems, lifestyle, mental health, and PCOS awareness among rural and urban population of Punjab, India. Journal of Psychosomatic Obstetrics & Gynecology, 43(3), 349-358. https://doi.org/10.1080/0167482x.2021.1965983
Singh, R., Sharma, R., & Rajani, H. (2015). Impact of stress on menstrual cycle: A comparison between medical and non medical students. Saudi Journal for Health Sciences, 4(2), 115. https://doi.org/10.4103/2278-0521.157886
Solmi, M., Radua, J., Stubbs, B., Ricca, V., Moretti, D., Busatta, D., ... & Castellini, G. (2021). Risk factors for eating disorders: an umbrella review of published meta-analyses. Brazilian Journal of Psychiatry, 43(3), 314-323. https://doi.org/10.1590/1516-4446-2020-1099
Sørensen, K., Van den Broucke, S., Fullam, J., Doyle, G., Pelikan, J., Slonska, Z., & Brand, H. (2012). Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health, 12(1). https://doi.org/10.1186/1471-2458-12-80
Soylu, T. (2022). Sexual quality of life and marital adjustment in women with menstrual irregularıty. International Journal of Caring Sciences, 15(1), 435-443.
Ssesanga, T., Thomas, K. A., Nelson, K. A., Oenen, E., Kansiime, C., Lagony, S., Enomut, J. R., Mayanja, Y., & Weiss, H. A. (2024). Understanding menstrual factors associated with poor mental health among female secondary school students in Uganda: A cross-sectional analysis. Child and Adolescent Psychiatry and Mental Health, 18(1). https://doi.org/10.1186/s13034-024-00829-6
Stice, E., Gau, J. M., Rohde, P., & Shaw, H. (2017). Risk factors that predict future onset of each DSM–5 eating disorder: Predictive specificity in high-risk adolescent females. Journal of Abnormal Psychology, 126(1), 38-51. https://doi.org/10.1037/abn0000219
STRIEGEL‐MOORE, R. H., SEELEY, J. R., & LEWINSOHN, P. M. (2003). Psychosocial adjustment in young adulthood of women who experienced an eating disorder during adolescence. Journal of the American Academy of Child & Adolescent Psychiatry, 42(5), 587-593. https://doi.org/10.1097/01.chi.0000046838.90931.44
Thiyagarajan, D. K., Basit, H., & Jeanmonod, R. (2024). Physiology, menstrual cycle. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK500020/
Toffol, E., Koponen, P., Luoto, R., & Partonen, T. (2014). Pubertal timing, menstrual irregularity, and mental health: Results of a population-based study. Archives of Women's Mental Health, 17(2), 127-135. https://doi.org/10.1007/s00737-013-0399-y
Tran, N. H., Dang, N. B., Nguyen, K. T., Bui, T. M., & Phan, Q. N. (2025). Gendered dimensions of menstrual health: Lifestyle, biology, and coping strategies among female medical students. Sexes, 6(3), 35. https://doi.org/10.3390/sexes6030035
Treasure, J., Stein, D., & Maguire, S. (2020). Has the time come for a new classification system for eating disorders? European Eating Disorders Review, 28(1), 1–3.
Tufail, A., Mustafa, R., Munaver, S. A., & Nawaz, B. (2022). Frequency of psychological stress among women with new onset menstrual disorders amid corona pandemic lockdown. Pakistan Journal of Medical Sciences, 38(5), 1159-1164. https://doi.org/10.12669/pjms.38.5.4606
Yu, M., Han, K., & Nam, G. E. (2017). The association between mental health problems and menstrual cycle irregularity among adolescent Korean girls. Journal of Affective Disorders, 210, 43-48. https://doi.org/10.1016/j.jad.2016.11.036
Zhong, S., Wang, S., Ding, K., Tan, W., & Zhou, L. (2024). Low mental health literacy is associated with depression and anxiety among adults: A population-based survey of 16,715 adults in China. BMC Public Health, 24(1). https://doi.org/10.1186/s12889-024-20020-y
Downloads
Published
Issue
Section
License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.