Table 3.

Parents perspective of factors that influenced their daughter’s experience of menarche and learning to manage menstruation using a socio-ecological theoretical framework

Level	Parent’s Perspective of Relevant Factors
Intrapersonal (personal knowledge, self-concept)	• Education/knowledge about periods prior to menarche • Cognitive ability to understand periods • Emotional response to periods • Age at menarche • Sense of burden by current health management routines (e.g., bladder and bowel routines) • Desire for privacy • Desire for care from only females • Relevant health history (e.g., epilepsy)
Interpersonal (individual relationships)	• Parent’s ability to educate daughter about what a period • Parent’s knowledge about best menstrual products • Parent guilt to ask school caregivers for assistance • Parent preference not allow school caregivers to help with menstrual management • Parent sense of burden by current health management routines (e.g., bladder and bowel routines) • Knowledge of daughter’s health care provider • Support of daughter’s health care provider
Institutional (systems and community) and Policy (polities and laws)	• Lack of health care provider knowledge • School support • Availability of female caregivers at school • Lack of private bathrooms at school
Societal (cultural norms)	• Lack of accessible products • Lack of disability-specific sexual health education • Societal avoidance of being discrete/not talking about periods (postulated by authors)