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Acceptance of Sustainable Menstrual Choices among Youth: An Analysis Using UTAUT Perspective

Authors:
Universal Journal of Public Health 11(5): 549-562, 2023 http://www.hrpub.org
DOI: 10.13189/ujph.2023.110503
Acceptance of Sustainable Menstrual Choices among
Youth: An Analysis Using UTAUT Perspective
Sanchita Mehrotra1,*, Areena Zainub Mirza1, Govind Ji Pandey2, Keshav Patel3
1Amity School of Communication, Amity University Uttar Pradesh, Lucknow Campus, India
2Department of Mass Communication and Journalism, Babasaheb Bhimrao Ambedkar University, Lucknow, Uttar Pradesh, India
3Jamia Millia Islamia, India
Received March 31, 2023; Revised August 10, 2023; Accepted September 8, 2023
Cite This Paper in the Following Citation Styles
(a): [1] Sanchita Mehrotra, Areena Zainub Mirza, Govind Ji Pandey, Keshav Patel , "Acceptance of Sustainable
Menstrual Choices among Youth: An Analysis Using UTAUT Perspective," Universal Journal of Public Health, Vol. 11,
No. 5, pp. 549 - 562, 2023. DOI: 10.13189/ujph.2023.110503.
(b): Sanchita Mehrotra, Areena Zainub Mirza, Govind Ji Pandey, Keshav Patel (2023). Acceptance of Sustainable
Menstrual Choices among Youth: An Analysis Using UTAUT Perspective. Universal Journal of Public Health, 11(5), 539
- 562. DOI: 10.13189/ujph.2023.110503.
Copyright©2023 by authors, all rights reserved. Authors agree that this article remains permanently open access under
the terms of the Creative Commons Attribution License 4.0 International License
Abstract Social media applications like Instagram
have the potential to promote menstrual products and
provide sustainable choices. The objective of the study was
to determine the influence of Instagram on sustainable
menstrual choice use intention. The research heavily relies
on the self-efficacy of the consumers managing
menstruation by using the Unified Theory of Acceptance
and Use of Technology Model (UTAUT 3). A purposive
sampling technique was used to select respondents from
menstruating females willing to fill out the questionnaires.
The questionnaire was divided into three sections and each
item was scored on a 5-point Likert scale, (1) strongly
disagreed and (5) strongly agreed. A statistical analysis
method based on Structural Equation Modelling (SEM)
Partial Least Squares (PLS) was used for data analysis. The
respondents were 310 female college students from
government and private universities of Lucknow City,
Uttar Pradesh and Noida City, National Capital Region of
India. The conclusion drawn from the study suggests that
performance expectancy, effort expectancy, social
influence, facilitating conditions, habit, and personal
innovativeness play a crucial role in the user's Behavioral
Intention (BI) and Use Behavior (UB). The study
recommends that the information related to sustainable
menstrual choices on social media applications like
Instagram can help achieve menstrual equity by
empowering women to make choices regarding their
menstrual health and well-being.
Keywords Social Media Application, Youth,
Sustainable Menstrual Choices, UTAUT 3, Behavior
Intention
1. Introduction
Menstruation signifies the beginning of a girl's
reproductive life [13]. It is denoted as a significant
milestone event [4]. The Joint Monitoring Programme
framed Menstrual Hygiene Management (MHM) [5] to
promote menstrual hygiene for maintaining personal
hygiene during the menstrual cycle, including proper
disposal of sanitary materials. WHO/UNICEF Joint
Monitoring Programme 2012, Menstrual Hygiene
Management (MHM) is an all-inclusive strategy for
managing menstrual health that provides knowledge,
access to menstrual products, and facilities for changing,
cleaning, and discarding menstrual products. Menstrual
health and hygiene (MHH) is essential for the holistic
development of the female. It leads to healthy lives
receiving an equitable education and achieving gender
equality [6]. Maintaining good menstrual hygiene practices
can give rise to mobility and lessen the risk of urinary tract
infections, genital tract infections, and unpleasant odor
among young girls [4].
550 Acceptance of Sustainable Menstrual Choices among Youth: An Analysis Using UTAUT Perspective
Earlier literature on menstrual hygiene and health
emphasizes the significance of developing methods [7] that
effectively combine information and education with
suitable infrastructure and menstrual supplies in a
supportive policy framework [8, 9]. Various menstrual
absorbent choices are now available; however, choosing
sanitary products is determined by various factors, such as
accessibility, cultural acceptability, and financial
affordability [6, 1012]. According to National Family
Health Survey (NFHS-4), conducted in 2015-2016 by the
International Institute for Population Sciences [IIPS],
commercial disposable sanitary pads are widely used by
young women between the ages of 15 to 24 in Indian urban
areas [13]. Using disposable sanitary pads for absorbing
menstrual blood is accepted as the most appropriate option
for maintaining menstrual hygiene in India [10, 14, 15]. As
per the empirical and anecdotal evidence, using cloth pads
harms women's reproductive health and increases the risk
of infection [16]. The Lancet research highlights the
significance of menstrual hygiene education, initiatives to
generate positive norms surrounding women's biological
processes, and the possibility of alternative or reusable
products to promote menstrual hygiene [17].
In India, more than 121 million young women and
adolescent girls use at least eight sanitary pads for every
cycle, equating to 1 million non-biodegradable pads
created each month and 12 billion pads produced and
disposed of yearly [18]. Menstruation products, apart from
commercial sanitary pads, are menstrual cups, menstrual
sponges, menstrual panties, reusable pads, and
biodegradable disposable pads, along with others [19].
Accessibility to menstruation products and guidance on
safe and proper use is essential for improving MHM, where
innovations in menstrual health have redesigned hygiene
products to meet the difficulties girls and women have in
getting menstruation products and related information [6].
Sustainable menstruation products are introduced in
India and have reimagined hygiene products [20], produced
from materials like bamboo fiber, banana fiber, or cotton,
which are biodegradable, compostable, and reusable [21].
These products are significantly more comfortable and
hygienic than sanitary pads made of plastic since they are
devoid of chemicals and plastic [22]. The myths and taboos
around menstruation make the use of sustainable menstrual
products less desirable [23].
Social media acts as a powerful tool for young people to
accept new suggestions and ideas about their bodies and
health [24]. Youths are identified to be the early adopters
and most frequent users of social media [25, 26].
The use of social media for ascertaining information
regarding menstrual hygiene management and sustainable
menstrual product needs may significantly impact the
youth population of India, with a particular focus on young
women [27, 28]. From the literature review, very little
evidence on sustainable menstrual choices focusing on
young females' use intentions in an Indian context has been
discussed. This study aimed to examine the relationships
between technology (Instagram) and female youth
acceptance of sustainable menstrual choices. Also, the
study determines the influence of Instagram on sustainable
menstrual choice use intention through the self-efficacy of
the youth using the UTAUT perspective. Different
constructs of technology, the Unified Theory of
Acceptance and Use of Technology Model (UTAUT-3)
given by Farooq et al. [29] was used to validate the
proposed conceptual framework. In addition, the self-
efficacy component was added to measure the confidence
and comfort of female youths in addressing their menstrual
needs.
2. Literature Review
2.1. The Unified Theory of Acceptance and Use of
Technology Model-3
Significant components of theories that have been
around for a while, such as TAM, TRA, TPB, IDT, and
others, are synthesized in the UTAUT model [30]. In this
model, performance expectancy (PE), effort expectancy
(EE), social influence (SI), and facilitating conditions (FC)
are established as the four main factors that influence an
individual's adoption of IS and IT. UTAUT is used to
analyze the behavior of actual technology users, with
Behavioral Intention (BI) to use in determining the users'
intentions for technology acceptance [30]. Venkatesh et al.
[31], finally expanded the UTAUT model to incorporate
the three extra constructs of hedonic motivation (HM),
price value (PV), and habit (HB) to evaluate the adoption
of technology by users. Seven significant determinants of
information technology and system adoption behavior are
included in the extended UTAUT, also known as UTAUT-
2 [31].
An addition to the UTAUT-2 model, Farooq et al. [29]
developed the UTAUT 3 framework, which included eight
factors that affect how people accept new technology:
Performance Expectancy (PE), Effort Expectancy (EE),
Social Influence (SI), Facilitating Condition (FC), Habit
(HB), Hedonic Motivation (HM), Price Value (PV), and
the eighth element, Personal Innovativeness (PI) in IT. The
UTAUT 3 model's authors assert that it has a 66%
explanatory power for forecasting technology adoption
[29]. Therefore, the UTAUT 3 model was selected.
2.2. Motley of Sustainable Menstrual Choices in
Context to Instagram
Since 2014, India has been at the forefront of acting in
menstrual hygiene initiatives across the globe. The
introduction of the Swachh Bharat Mission (SBM) in
October 2014 marked a turning point for India's sanitation
and hygiene, including Menstrual Hygiene Management
Universal Journal of Public Health 11(5): 549-562, 2023 551
[32]. The collective efforts are taken by the Department of
Drinking Water and Sanitation, Ministry of Health and
Family Welfare, as well as the private sector,
manufacturers, and entrepreneurs towards spreading
awareness regarding Menstrual Hygiene Management [33].
The state governments of India present innovative and
promising MHM models by sharing easy-to-implement
solutions which act as an essential parameter in improving
the lives of girls and women [34]. Reusable pads, menstrual
cups, and biodegradable sanitary pads are the types of
sustainable menstrual choices/products promoted on
different social media platforms in order to give options to
consumers as a basket of choices.
Social media is a web-based, interactive application used
in both internet-based and computer technologies [35]. The
advancement of information and communication
technology (ICT) has significantly shaped people's lives,
and in recent years the reach of social media has increased
[36]. Social media is an effective medium to raise
awareness about various topics, such as social and public
health issues [37]. As per the report on Statista India,
India's internet penetration rate has increased to over 48
percent and is ranked the second largest internet market
after China in 2022 worldwide [38].
With the advancements in communication technologies
and growth in the internet market of India, social media can
be used as an effective medium to promote menstrual
health and hygiene initiatives [28]. Due to its extensive
reach and capacity to target particular consumers,
Instagram is a potent tool for promoting feminine hygiene
products [39]. Such marketing campaigns help raise
consumer knowledge about menstruation care and give
details on products and services that may help manage
periods safely and hygienically [40]. Instagram is a
platform that brands utilize to provide visually appealing
content for their target audience on a variety of menstrual-
related themes. Through Instagram, marketers disseminate
educational content on issues linked to menstruation
hygiene, including common myths and appropriate
practices. Brands can easily determine what their
consumers want and need through user-generated content,
which informs product development and marketing
initiatives [41]. Ridgeway C.L. [42] considers the growth
in technological advancements combined with men's and
women's persistent desire to improve their lifestyles. Such
advancements produce continuing pressure that affects the
underlying structure of social institutions, as defined in her
book "How Gender Inequality Persists in the Modern
World." Positions of power and domination are engrained
in the culture of India's social institution expectations;
Instagram helps reduce menstruation stigma and enhance
self-efficacy [42]. Instagram is a low-cost medium and
accessible with a variety of issues, explored and addressed
in line with the Technological Theory of Mutual
Acceptance between lead marketing and target audience
[43]. As a result, this fosters a mutually beneficial
interaction between society and technology, further
changing and impacting the consumers' perspective.
2.2.1. Campaigns Spreading Awareness on Sustainable
Menstrual Choices via Instagram Social Media
Platform
As per the insights from Feminine Hygiene Products
Market (2022) report, the period care industry highlights
the growth in demand for innovative sanitary products
globally [44]. The rise of activist-led, "period positive"
movements against menstruation stigma and international-
level initiatives to address period poverty has given rise to
this innovation [45]. Social enterprises and private label
brands like PeeSafe, Eco femme, Sanfe, Carmesi, Sirona,
SafeCup, Everteen, Heyday, Anandi, Saathi, and Nua,
along with others, are highly active in promoting
sustainable menstrual choices on Instagram regularly, as
stated in Exchange4media and Brand equity marketing
campaigns' web portal. These brands have created
impactful campaigns to raise awareness about sustainable
menstrual care options in India. The #RedIsTheNewGreen
Campaign by Saathi, # MyPeriodMyChoice Campaign by
Team Sakhi, #MenstrualHealthMatters Campaign by
Menstrupedia, #IChooseReusable Campaign by SheCup,
#PeriodRevolution Campaign by Nua, #PassTheCup By
Pee Safe, 'The Period Girl' campaign by Carmesi are few
of the most popular campaigns promoted on Instagram in
the country. These brands used hashtags to spread
messages on different themes about the benefits of reusable
menstrual products, healthy menstrual practices, the
importance of menstrual health education, and encouraging
women to make informed decisions about their menstrual
care. Instagram campaigns on sustainable menstrual
choices influence users to participate in sharing their stories
about their menstrual journey, including links to websites
that provide information about sustainable menstrual
products.
In order to engage with customers and raise personal
hygiene awareness, manufacturers of feminine hygiene
products also work with renowned worldwide development
organizations and social media influencers, emphasizing
providing comfort and support throughout regular
menstruation days [44].
3. Conceptual Model and Hypothesis
Development
According to the context of this study, the researcher
chose the following constructs based on the UTAUT 3
model: Performance Expectancy (PE), Effort Expectancy
(EE), Social Influence (SI), Facilitating Conditions (FC),
Habit (HB), Personal Innovativeness (PI). The conceptual
framework that has been proposed was modified from the
UTAUT 3 model [29]. The level of acceptance of
sustainable menstrual choices through Instagram as the
social media platform defines youth use intentions and
behaviors. The moderating variable considered in the
552 Acceptance of Sustainable Menstrual Choices among Youth: An Analysis Using UTAUT Perspective
context of this study and mentioned in the proposed
conceptual model was the Self-Efficacy component, and
the mediating factor was Social Media (Instagram) use.
There are 15 path lines in the proposed conceptual
framework, including Self-efficacy (SE) and Social Media
(Instagram) use, denoted as IAU. The hypothesis is
formulated under each construct considered in this study.
Figure 1 shows the proposed conceptual framework for
this study.
2.1. Performance Expectancy
Performance Expectancy (PE) relates to how effectively
prospective prospects for sustainable menstrual choices
believe that technology like Instagram will help them gain
knowledge about different menstrual products and can
achieve their goals and improve their menstruation
management. Therefore, we hypothesize that:
H1: Performance Expectancy (PE) significantly
influences female consumers' Behavioral Intentions to
adopt/accept sustainable menstrual choices through
Instagram.
2.2. Effort Expectancy
Effort Expectancy (EE) can be explained as the users'
conviction to use Instagram as a technological
advancement for retrieving information related to
menstruation and sustainable menstrual choices. EE will
help consumers evaluate their menstrual choices based on
ease of use with the help of Instagram. It is interpreted that
female youth believe that Instagram is easy to use for
gaining information regarding sustainable menstrual
choices. Therefore, we hypothesized that:
H2: Effort Expectancy (EE) significantly influences
female consumers' Behavioral Intention to use sustainable
menstrual choices through Instagram.
2.3. Social Influence
Social Influence (SI) refers to how other people
influence a user's decision to accept a product [31]. Female
consumers will assess their sustainable menstrual choices
according to their peers' perceptions of the menstrual
choices promoted on Instagram. Thus, it is hypothesized
that:
H3: Social Influence (SI) has a positive significant
influence on female consumers' Behavioral Intention to use
sustainable menstrual choices through Instagram.
Figure 1. The Proposed Conceptual Model (Source: Author)
Universal Journal of Public Health 11(5): 549-562, 2023 553
2.4. Facilitating Conditions
Facilitating Conditions (FC) are the means to make
product usage effortless. Female consumers will assess
their choices for sustainable menstruation based on their
product's accessibility, price, and assistance through social
media (Instagram campaigns, posts, and reels) to use the
product effectively. FC affects both intention and actual
user behavior. Therefore, we hypothesize that:
H4a: Facilitating Conditions (FC) significantly
influence female consumers' Behavioral Intention to use
Instagram for sustainable menstrual choices.
H4b: Facilitating Conditions (FC) significantly
influence female consumers' usage of sustainable
menstrual choices through Instagram.
2.5. Habit
Habit (HB) measures the amount that a person behaves
in an instance because of prior knowledge [31]. HB creates
a cognitive commitment to specific behavior and
frequently inhibits any modifications in actual behavior
[46]. The utilization of technology and user intention are
both significantly impacted by HB. When female
consumers use Instagram frequently, habits are being
developed for using the product more efficiently. This can
be done by purchasing through online sources. By
developing these habits, female consumers can be more
consistent in using sustainable menstrual products and
adopt them in their daily lives. Therefore, it is hypothesized
that:
H5a: Habit (HB) significantly influences female
consumers' Behavioral Intention to use Instagram.
H5b: Habit (HB) significantly influences female
consumers' Use Behavior to use Instagram.
H5c: Habit (HB) significantly influences female
consumers' use of sustainable menstrual choices through
Instagram.
2.6. Personal Innovativeness in Sustainable Menstrual
Choices
Song [47], recognized it as a personality attribute that
motivates users to use Instagram. PI influences both user
intention and technology Use Behavior. It will thus be
hypothesized that:
H6a: Personal Innovativeness (PI) in sustainable
menstrual choices significantly influences female
consumers' Behavioral Intention to use Instagram.
H6b: Personal Innovativeness (PI) in sustainable
menstrual choices significantly influences female
consumers' Use Behavior to use Instagram.
H6c: Personal Innovativeness (PI) to use sustainable
menstrual choices through Instagram influences female
consumers significantly.
2.7. Behavioral Intention to Adopt Social Media
Applications for Sustainable Menstrual Choices
The behavioral preparedness to accept, utilize, or
embrace a specific technology is known as Behavioral
Intention (BI) [48]. Behavioral Intention refers to a youth's
individualistic or subjective likelihood of performing a
specific behavior [49, 50]. Following behavioral Intention
to utilize Instagram for self-efficacy, female consumers
will believe that they can retrieve knowledge about
sustainable menstrual choices using social media
(Instagram campaigns, posts, and reels) by different brands.
Therefore, the hypothesis can be formulated as:
H7a: Behavioral Intention (BI) has a positive significant
influence on female consumers' intent towards using
Instagram for accessing sustainable menstrual hygiene
choices information.
H7b: Behavioral Intention (BI) has a significant positive
effect on Use Behavior (UB).
2.8. Self-Efficacy in Managing Menstrual Hygiene
Needs
Self-Efficacy is an added construct in this study to define
menstrual hygiene needs through self-efficacy and is
measured through the Menstrual Hygiene Needs Self-
Efficacy (MHNSE) scale.
According to Bandura's self-efficacy theory (1986) [51],
self-efficacy is defined as the confidence and the belief that
an individual can control their behavior under the
circumstances that impact their lives. The development of
a person's self-efficacy beliefs is influenced by information
from past personal experience, subjective experiences from
family and peers, social reinforcement (such as motivation),
and their own physiological condition, which among
females, can be satisfied through social media sites.
Therefore, Instagram can help promote better menstrual
hygiene practices, reduce misinformation, and improve
access to resources through effective social media
campaigns. Additionally, Instagram can be used to break
down taboos and create a more inclusive environment.
Therefore, the hypothesis can be formulated as
H8a: Self-efficacy (SE) in managing menstrual hygiene
needs has a positive relationship between Instagram use
and other components such as performance expectancy,
facilitating conditions, effort expectancy, habit, social
influence, and personal innovativeness.
H8b: Self-efficacy (SE) in managing menstrual hygiene
needs has a significant positive effect on female behavior
and intention to use Instagram's other components such as
performance expectancy, facilitating conditions, effort
expectancy, habit, social influence, and personal
innovativeness.
554 Acceptance of Sustainable Menstrual Choices among Youth: An Analysis Using UTAUT Perspective
The gap identified from the literature is that social media
and self-efficacy have yet to be used to analyze
performance using IT-enabled technologies [52, 53]. Based
on Instagram and self-efficacy, consumers' UGC (User
Generated Content) adoption brings confidence to
successfully generate information relating to sustainable
menstrual choices through the campaigns done by different
sanitary brands.
Through campaigns focusing on education, awareness,
and empowerment, Instagram can help promote better
menstrual hygiene practices, reduce misinformation, and
improve access to resources. Additionally, social media
can be used to engage in meaningful conversations, break
down taboos, and create a more inclusive environment.
Self-efficacy is critical in determining whether females will
use Instagram to access menstrual hygiene-related content
and search their Instagram pages.
4. Research Methodology
4.1. Research Design and Data Collection
A cross-sectional research design using quantitative
techniques was applied to assess female consumers'
intentions to accept sustainable menstrual choices through
Instagram. The population selected was young females
studying in private and government universities in two
major cities of Uttar Pradesh state: Lucknow City (capital
of Uttar Pradesh) and Noida City (National Capital Region
of India). The data was gathered during the academic year
2021-2022. A purposive sampling technique was used to
generate a sample from menstruating females. The sample
of young females was taken between 18-26 years of age.
The survey was done by getting a questionnaire with the
needed consent from the respondents. The questionnaire
was circulated among 325 female students, and 15
respondents were identified as duplicates. The participant
selection was made through rigorous criteria to avoid
confounding interests. The study included all the
menstruating females pursuing different courses from the
universities. Primary data sources, such as questionnaires,
and secondary data sources, such as books, scientific
publications, and previous research articles, were used in
this study. The Partial Least Square Structural Equation
Model (PLS-SEM) method was employed to analyze the
data.
Therefore, the total sample size for this study is n=310
respondents; 144 (46.45%) of those who responded were
between the ages of 18 and 20, 123 (39.68%) were between
the ages of 21 and 23, and 43 (13.87%) were between the
ages of 24 and 26. Refer to Table 1.
Data analysis used the Partial Least Square Structural
Equation Model (PLS-SEM) method. The validity of the
data was examined using a convergent and discriminant
validity test. Convergent validity was assessed using the
AVE, whose significance level should be 0.5. Cross-
loading criteria and HTMT were used to calculate
discriminant validity for the reliability test, and both values
should be less than 0.7. Path co-efficient T value and P
value were used to calculate the significance of the
relationship to evaluate the model's validity.
Table 1. Demographic characteristics
Items
Description
N
%
Gender
Female
310
Age
1820
144
46.45
2123
123
39.68
2426
43
13.87
Specialization
Social science
58
18.71
Engineering
98
31.61
Science & technology
80
25.81
Management
60
19.35
Others
14
4.52
Use
Instagram
App
Less than 1 hour
64
20.65
1-2 hours a day
90
29.03
3-4 hours a day
126
40.65
More than 4 hours in a day
30
9.67
4.2. Questionnaire Development
The questionnaire was divided into three sections. The
first section consisted of the demographic profile of
respondents who use Instagram. The self-efficacy of
females in managing their periods was measured in the
second section (Annexure A) using 'The Menstrual Practice
Needs Scale (MPNS-36)' and 'Self Efficacy in Addressing
Menstrual Needs Scale (SAMNS-26)' [54, 55]. Part A
consisted of a total of twelve items, and Part B consisted of
a total of five items. The third section of the questionnaire
consisted of six constructs on UTAUT-3 as per the
proposed conceptual model: performance expectancy (PE,
three items), effort expectancy (EE, three items), social
influence (SI, three items), facilitating conditions (FC, two
items), habit (HB, two items), personal innovativeness (PI,
three items) and Behavior Intention (BI, three items). Each
item was scored on a 5-point Likert scale, (1) strongly
disagreed and (5) strongly agreed. There were 36
measurement items, including second-order Self-Efficacy
constructs and UTAUT 3 constructs (Annexure B).
The content of Instagram posts from sustainable
menstrual choices brands was gathered and then
categorized into major themes and subthemes (Annexure
C). The content was analyzed according to different
components of UTAUT-3 to prepare the final questionnaire.
The table formulated in Annexure C represents the themes
and sub-themes extracted from the brands of sustainable
menstrual choices through their Instagram posts, comments,
likes, and views from the post.
Universal Journal of Public Health 11(5): 549-562, 2023 555
5. Result Analysis
In the study, the responses from the questionnaire were
analyzed according to the constructs of UTAUT 3, as
mentioned in the proposed conceptual framework (Figure
1). The result analysis consists of the measurement model
results, the self-efficacy results, and the analysis of data
gathered from Instagram posts on sustainable menstrual
choices by different brands.
5.1. Measurement Model
5.1.1. Reflective Indicator Loadings
In the PLS-SEM, the reflective indicator loading should
be >0.7. After the measurement through the computation,
the loadings were found to be greater than 0.7. The highest
loading was considered as PI was PI2 (0.932), while the
lowest loading was measured as SI was SI3 (0.758). The
data analysis of the 36 indicators was done in (Table 2).
5.1.2. Internal Consistency Reliability
To measure the consistency of the result across the
loading indicators is known as Internal Consistency
Reliability (ICR).
CA and CR were examined in the current result
measurement. The loading should have an ICR value that
ranges from 0 to 1. CA and CR should be significant to >0.7.
Table 2 represents the analyses of CA and CR. Composite
reliability and CA values of the given constructions are
higher than recommended. The composite reliability and
the CA values for all the given constructs are considered,
exceeding the referred numbers. PE has a CA of 0.918 and
CR of 0.955; EE has a CA of 0.911 and CR of 0.922; SI
has a CA of 0.889 and CR of 0.937; FC has a CA of 0.926
and CR of 0.933; HB has CA of 0.855 and CR of 0.892,
and PI has CA of 0.877 and CR of 0.929.
Table 2. Construct, item II, CR, CA and AVE
Construct
Code
Loading
CA
AVE
Performance expectancy (PE)
PE1
0.865
0.918
0.756
PE2
0.892
PE3
0.864
Effort Expectancy (EE)
EE1
0.877
0.911
0.726
EE2
0.878
EE3
0.836
Social Influence (SI)
SI1
0.859
0.889
0.694
SI2
0.853
SI3
0.758
Facilitating Conditions (FC)
FC1
0.878
0.926
0.776
FC2
0.768
Habit (HB)
HB1
0.797
0.855
0.622
HB2
0.828
Personal Innovativeness (PI)
PI 1
0.801
0.877
0.677
PI 2
0.932
PI 3
0.797
Behavioral Intention (BI)
BI 1
0.889
0.922
0.744
BI 2
0.788
BI 3
0.835
Second order constructs
Social Media Instagram
IAU
0.945
Behavioral Intention
BI
0.899
Use Behavior
UB
0.864
Self-Efficacy
SE
0. 942
0.922
0.836
556 Acceptance of Sustainable Menstrual Choices among Youth: An Analysis Using UTAUT Perspective
Table 3. Fornell-larcker criterion
BI
EE
PE
SI
FC
HB
PI
Behavioral Intention
0.827
Effort Expectancy
0.572
0.855
Performance Expectancy
0.744
0.545
0.865
Social Influence
0.578
0.455
0.544
0.798
Facilitating Conditions
0.499
0.358
0.394
0.496
0.833
Habit
0.555
0.544
0.489
0.543
0.499
0.848
Personal Innovativeness
0.477
0.388
0.423
0.543
0.413
0.499
0.865
Table 4. Measures for cross-loading and loading
Factors
Code
BI
EE
PE
SI
FC
HB
PI
Behavioral Intention
BI_1
0.899
0.577
0.633
0.433
0.375
0.356
0.444
BI_2
0.788
0.429
0.574
0.522
0.42
0.412
0.456
BI_3
0.825
0.465
0.548
0.499
0.389
0.343
0.489
Effort Expectancy
EE_1
0.455
0.848
0.522
0.352
0.259
0.328
0.433
EE_2
0.476
0.875
0.464
0.377
0.224
0.282
0.424
EE_3
0.498
0.877
0.478
0.389
0.299
0.331
0.478
Performance Expectancy
PE_1
0.655
0.489
0.752
0.491
0.377
0.346
0.425
PE_2
0.633
0.462
0.866
0.434
0.344
0.39
0.425
PE_3
0.637
0.465
0.892
0.438
0.322
0.348
0.432
Social Influence
SI_1
0.458
0.341
0.377
0.799
0.425
0.433
0.426
SI_2
0.462
0.357
0.399
0.854
0.422
0.466
0.455
SI_3
0.398
0.322
0.366
0.787
0.399
0.399
0.425
Facilitating Conditions
FC_1
0.422
0.369
0.297
0.455
0.858
0.365
0.47
FC_2
0.392
0.276
0.327
0.399
0.853
0.344
0.411
FC_3
0.377
0.268
0.322
0.422
0.855
0.344
0.395
Habit
HB_1
0.428
0.313
0.366
0.429
0.388
0.899
0.422
HB_2
0.425
0.343
0.388
0.442
0.423
0.876
0.422
Personal Innovativeness
PI_1
0.465
0.566
0.475
0.399
0.344
0.412
0.799
PI_2
0.455
0.469
0.399
0.448
0.424
0.423
0.855
PI_3
0.434
0.384
0.379
0.393
0.358
0.378
0.796
5.2. Convergent Validity
Construct Validity is correlated with convergent validity,
and exists between the tests conducted on the same or
interrelated constructs. The AVE is calculated as
convergent validity in the study. Through the calculations,
AVE values are > 0.5 (Table 2). From the evaluation, AVE
values obtained from the constructs signify more than 0.5
of the variances. PE has an AVE of 0.756, EE has an AVE
of 0.726, SI has an AVE of 0.694, FC has 0.776, HB has an
AVE of 0.622, and PI has an AVE of 0.677.
5.3. Discriminant Validity
Discriminant validity refers to the situation when two
notions are empirically distinct. To evaluate the
discriminant validity, three different approaches, namely
cross-loading (Table 4), HTMT (Table 5), and Larcker
criterion (Table 3). As per the Larcker criterion, AVE
constructs should have a higher share variance than other
Universal Journal of Public Health 11(5): 549-562, 2023 557
constructs. According to Table 3, all construct values are
higher than their respective shared variances. The value for
PI was 0.865, which is higher than its shared variances. PE
was 0.423, EE was 0.388, SI was 0.543, FC was 0.413, and
HB was 0.499.
5.4. Structural Model
5.4.1. Collinearity
Examining the model's prediction ability is a component
of the structural model analysis. The variance inflation
factor (VIF) values should be defined before the structural
model is investigated to differentiate the collinearity value.
The predictor sets were favorable for collinearity. IAU is
the predictor of SE, UB, and BI. Behavior Intention is the
predictor of PE, EE, SI, and PI, whereas UB is the predictor
of FC, HB, and PI. The values of (VIF) should not
exceed >3. Values higher than three are often considered
multi-collinearity, as per Table 6; all VIFs are less than 3.
5.5. Analysis of the Structural Modelling
The significant factors directly impacting the study using
the path coefficients, T value, and P values were identified
for examining the structural model. Table 7 and Figure 2
display the outcomes of bootstrapping. The relationship
between PE and BI (H1) =0.499; t =9.476; p < 0.001)
and the hypothesis is accepted. The relationship between
EE and BI (H2) =0.138; t =2.359; p <0.001) and the
hypothesis is accepted. The relationship between SI and BI
(H3) (β =0.163; t =3.556; p < 0.001) and the hypothesis is
accepted. The relationship between FC and BI to use (H4a)
=0.165; t=4.136; p <0.001) and the hypothesis is
accepted. The relationship between FC and IAU (H4b)
=0.257; t=5.656; p <0.001) and the hypothesis is accepted.
The relationship between HB and BI to use (H5a) (β =0.099;
t=2.467; p <0.001) and the hypothesis is accepted. The
relationship between HB and UB (H5b) (β =0.189; t=3.717;
p <0.001) and the hypothesis is accepted. The relationship
between HB and IAU (H5c) (β =0.127; t=2.557; p <0.001)
and the hypothesis is accepted. The relationship between PI
and BI (H6a) =0.285; t=5.466; p <0.001) and the
hypothesis is accepted. The relationship between PI and
UB (H6b) (β =0.432; t=8.112; p <0.001) and the hypothesis
is accepted. The relationship between PI and IAU (H6c) (β
=0.301; t=7.111; p <0.001) and the hypothesis is accepted.
The relationship between BI and IAU (H7a) =0.288;
t=8.122; p <0.001) and the hypothesis is accepted. The
relationship between BI and UB (H7b) (β =0.331; t=6.344;
p <0.001) and the hypothesis is accepted. The relationship
between SE; IAU; PE; FC; EE; HB; SI, and PI (H8a)
=0.331; t=6.344; p <0.001) and the hypothesis is accepted.
The relationship between SE; BI to use; PE; FC; EE; HB;
SI, and PI (H8b) =0.344; t=8.444; p <0.001) and the
hypothesis is accepted.
According to Table 7, all the significant values between
the correlated constructs are significantly acceptable. As
per Table 2, the second-order construct is a significant
predictor for SE. Hence, the hypothesis is significantly
accepted, and the IAU, BI, and UB hypotheses are
significantly accepted.
Table 5. Hetrotrait-monotrait (HTMT) (<0.9) ratio for discriminant validity
BI
EE
PE
SI
FC
HB
PI
Behavioral Intention
Effort Expectancy
0.659
Performance Expectancy
0.839
0.624
Social Influence
0.682
0.496
0.592
Facilitating Conditions
0.574
0.373
0.448
0.57
Habit
0.667
0.619
0.572
0.619
0.576
Personal Innovativeness
0.548
0.423
0.477
0.59
0.467
0.547
Table 6. Variance inflation factor (VIF).
BI
EE
PE
SI
FC
HB
PI
Behavioral Intention to use
1.455
Effort Expectancy
1.776
1.696
Performance Expectancy
1.886
1.688
Facilitating Conditions
1.438
1.319
Habit
1.835
1.455
Personal Innovativeness
1.451
1.369
558 Acceptance of Sustainable Menstrual Choices among Youth: An Analysis Using UTAUT Perspective
Table 7. Hypothesis testing
Path of hypotheses
Path (β)
t-value
p-values
Results
Performance expectancy -> Behavioral Intention (H1)
0.499
9.476
0.000
Accepted
Effort expectancy -> Behavioral Intention (H2)
0.138
2.359
0.000
Accepted
Social Influence -> Behavioral Intention (H3)
0.163
3.556
0.000
Accepted
Facilitating Conditions -> Behavioral Intention to use (H4a)
0.165
4.136
0.001
Accepted
Facilitating Conditions -> Social Media use (H4b)
0.257
5.656
0.000
Accepted
Habit-> Behavioral Intention to use (H5a)
0.099
2.467
0.000
Accepted
Habit -> Use Behavior (H5b)
0.189
3.717
0.001
Accepted
Habit -> Social Media use (H5c)
0.127
2.557
0.000
Accepted
Personal Innovativeness -> Behavioral Intention (H6a)
0.285
5.466
0.001
Accepted
Personal Innovativeness ->Use Behavior (H6b)
0.432
8.112
0.000
Accepted
Personal Innovativeness -> Social Media use (H6c)
0.301
7.111
0.000
Accepted
Behavioral Intention-> Social Media use (H7a)
0.288
8.122
0.000
Accepted
Behavioral Intention-> Use Behavior (H7b)
0.331
6.344
0.000
Accepted
Self-Efficacy-> Social media use and other components (H8a)
0.254
8.122
0.001
Accepted
Self-Efficacy-> Behavioral Intention and other components (H8b)
0.344
8.444
0.000
Accepted
Figure 2. Path t-value findings
Universal Journal of Public Health 11(5): 549-562, 2023 559
5.6. Self-Efficacy Result
From the hypothesis testing, it was found that there was
statistical significance between the predicted values of SE
with BI, UB, and IAU. The indicators on the general self-
efficacy scale are positive among all treatment conditions.
The findings revealed that females who use Instagram
increase their usage of sustainable menstrual choices,
which has a beneficial impact on UB and BI.
Therefore, based on the findings from the stated results,
the variable between its factors showed that female
intention towards sustainable menstrual choices increased
significantly in SE over the period of time, which can be
found from the positive relationship with the other
components such as PE, EE, SI, and PI.
5.7. Analysis of Data Gathered from Instagram Posts
on Sustainable Menstrual Choices
Data gathered from Instagram posts of different
sustainable menstrual hygiene brands are correlated with
the formulated constructs (UTAUT-3) of the study. From
the Instagram handles of the brands that are into sustainable
menstrual choices and from their posts and comments, the
themes and codes for the study observed are: Comfortable,
ecological, empowering, explore, revolution, choices, first
period, womanhood, sisterhood, period care, conversation,
unique. The comments mentioned on the Instagram posts
by consumers, such as "Information is so useful" and "Now
I know everything about periods and their choices," can be
related to the PE component of UTAUT 3. Similarly,
comments such as "Yes, I am loving environmental friendly
pads" and "Menstrual cups are great products that can
make periods less destructive in daily life" can be related to
the EE component of UTAUT 3, as discussed in the
hypothesis development section. A detailed description of
constructs, items, and observed variables is available in
Annexure B, and samples of Instagram posts are presented
in Annexure C.
6. Discussion
The study examined female menstrual health by
assessing self-efficacy and social media applications.
Further, the UTAUT-3 model was explored to undermine
the usage or choices of menstrual products and how social
media applications help provide MHM information. The
proposed model finds that UTAUT-3 and self-efficacy
have a more significant impact on sustainable menstrual
choices. As a result, the study outcome importantly
supports the IAU variable confirming BI, UB, and SE. To
explain it further, when social media applications influence
Behavior Intention and Use Behavior, they make it more
advantageous and acceptable and increase usability. The
outcome is anticipated that females perceive the value of
using social media applications. The results, therefore,
support the relationship between UTAUT constructs PE,
EE, FC, HB, and SI and females' perspective towards
learning about sustainable menstrual choices using IAU.
Furthermore, the study supports that the PE component
confirming H1 and H8b implies that PE considerably
influences BI and SE in making sustainable menstrual
choices. Furthermore, the result also examined the higher
influence of social media applications among females.
Likewise, the result considerably supports the IAU and the
technology used for making sustainable menstrual choices.
Confirming the hypothesis for self-efficacy (H8a and H8b)
was significant in understanding social media use and
Behavior Intention with other components of UTAUT 3.
According to the results from the conceptual model, it
shows that to stand on the scale of self-efficacy, all the
components prove to be positively significant for
sustainable menstrual choices.
Based on the UTAUT 3 perspective, all its constructs
confirm the following hypothesis formulated in this study,
in context to Instagram application use: H4b, H5c, H7a,
H8a.
When females use IAU to gain information regarding
sustainable menstrual choices, they feel confident enough
to use them. Peers and family support them to use
sustainable menstrual choices and suggest them through
IAU. The promotional campaigns of sustainable menstrual
choices on Instagram give confidence to females to interact
with other regular users and feel at ease to discuss without
hesitation. The sustainable menstrual choices available on
social media (Instagram) improve knowledge and
positively change their attitudes.
This research study has several implications based on the
conceptual model and findings. The relationship between
Social Media, Use Behavior, Behavior Intention, and Self-
Efficacy as a source for moving forward with menstrual
hygiene management among young females is the
inference that is extracted from this model. Secondly, with
the use of Instagram, the female might be capable of
learning and gaining information about MHM and adopting
sustainable menstrual choices. Instagram Application Use
should be considered an essential factor in Self-Efficacy.
7. Conclusions
To conclude, Instagram acceptability among female
users significantly affects many scales of self-efficacy for
MHM and sustainable menstrual choices. The study aimed
to propose a conceptual framework that would identify key
factors in MHM and Self-Efficacy in adopting and
accepting sustainable menstrual choices. It is also
ascertained that Behavioral Intention and Use Behavior
play a significant role in Self-Efficacy. The findings of the
present study show that menstrual hygiene needs SE is
affected by the increase in BI and UB by using IAU to
know about sustainable menstrual choices. It also affects
PE, EE, FC, SI, HB, and PI. The MHM scale of SE,
560 Acceptance of Sustainable Menstrual Choices among Youth: An Analysis Using UTAUT Perspective
including items from the two scales (MPNS-36) and
(SAMNS-26), was used in the study to assess female
Intention toward menstrual hygiene needs and their
acceptance using the Instagram application to gain
information regarding sustainable menstrual choices.
To summarize the UTAUT-3 model perspectives
utilized in this study, the PI component refers to the level
of innovativeness of female users using IAU to access
sustainable menstrual choices information. Therefore, this
finding demonstrates the willingness of females to innovate
and enhance their personalities. It can be inferred from the
study that a lack of PI may restrict the user from
experimenting with different social media applications and
gaining additional insights about sustainable menstrual
choices. The findings also revealed that females access
information on Instagram related to sustainable menstrual
choices based on their friends' shared experiences.
8. Limitations and Future Research
As per the study's limitations, the proposed conceptual
framework was initially subjected to further testing and
refinement. However, the researcher suggests further
research to strengthen these scales. Future research will be
important to validate the relationship between UTAUT-3
model components, Instagram, and self-efficacy. Applying
the research model to different age groups, demographics,
and psychographics will help the researcher test the model's
robustness across different age groups and genders.
The acceptance of sustainable menstrual choices among
youth and society can contribute to environmental
sustainability by reducing waste generated from disposable
menstrual products. The material used in sustainable
menstrual choices is hypoallergic and can help reduce the
risk of infections and allergies, which may further improve
the sexual reproductive health of women. Information
regarding sustainable menstrual choices on social media
applications like Instagram can help achieve menstrual
equity by empowering women to make choices regarding
their menstrual health and well-being.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest
concerning the research, authorship, and/or publication of
this article.
Funding
The author(s) received no financial support for the
research, authorship, and/or publication of this article.
Acknowledgments
We are very grateful to the respondents who participated
in this survey with full commitment. We acknowledge the
support of Dr. Manju Khari and Upasana Saxena for
providing their expert guidance and technical support.
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