International Journal of
Environmental Research
and Public Health
Article
Women’s Cognition and Attitude with Eco-Friendly Menstrual
Products by Consumer Lifestyle
Jui-Che Tu 1 , Ting-Yun Lo 1, *






Citation: Tu, J.-C.; Lo, T.-Y.; Lai, Y.-T.
Women’s Cognition and Attitude
with Eco-Friendly Menstrual
Products by Consumer Lifestyle. Int.
J. Environ. Res. Public Health 2021, 18,
5534. https://doi.org/10.3390/
ijerph18115534
Academic Editor: Paul B. Tchounwou
Received: 25 April 2021
Accepted: 20 May 2021
Published: 21 May 2021
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iations.
Copyright: © 2021 by the authors.
Licensee MDPI, Basel, Switzerland.
This article is an open access article
distributed under the terms and
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Attribution (CC BY) license (https://
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4.0/).
Int. J. Environ. Res. Public Health 2021, 18, 5534. https://doi.org/10.3390/ijerph18115534
and Yi-Ting Lai 2
1 Graduate School of Design, National Yunlin University of Science & Technology, Yunlin 640301, Taiwan;
tujc@yuntech.edu.tw
2 Department of Creative Design, National Yunlin University of Science & Technology, Yunlin 640301, Taiwan;
a0976446672@gmail.com
* Correspondence: wendy0901@yahoo.com.tw
Abstract: With rapid technology developments and the convenient and fast pace of life in recent years,
many people are using disposable products, which cause environmental and ecological damages.
A variety of eco-friendly menstrual products have been launched on the market, and “menstrual
pads” now have a large market share in Taiwan’s menstrual product industry. This study interviewed
experts and collected questionnaires for qualitative and quantitative investigation and analysis.
The results show that women have positive and open concepts regarding sustainability, as well as a
good understanding of their body and are very interested in the performance and usage efficiency of
products. The results also indicate that consumers purchase based on their lifestyles; most women
collected enough product information before purchasing while overcoming the difficulties in dealing
with the environment and learning to adapt them, and the majority of consumers attach importance
to comfort, volume, and duration of blood absorption. The results suggest that the government
and private enterprises should increase and improve sanitation education and sanitary facilities and
guide the approach and serve as an important reference index for the promotion of eco-friendly
menstrual products for environmental benefits.
Keywords: menstruation; eco-friendly menstrual products; lifestyle; cognition and attitude
1. Introduction
With the rapid development of science and technology in recent years, people are
changing their lifestyle to mass manufacturing, mass consumption, and mass waste, which
causes ecological and environmental damages. With the outbreak of COVID-19 in 2020,
the importance of environmental sustainability is being recognized. The United Nations
has proposed 17 goals for the sustainable development of a broad vision and called for
forward-looking actions.
With the growing awareness of sustainability, eco-friendly menstrual products, such
as cloth menstrual pads, menstrual cups, and menstrual underpants, have been launched
on the market. According to the statistics of the Taiwan Environmental Information Center,
a woman uses at least 10,000 menstrual pads in her lifetime, which has a negative impact
on earth’s environments [1]. Menstrual products on the market are divided into disposable
and eco-friendly products. The former includes menstrual pads and menstrual tampons,
which are mainly composed of cotton, non-woven fabrics, and polymer absorbers, are non-
recyclable and must be buried or incinerated. It takes 50 years for a pad to decompose,
and if incinerated, its chlorinated, disinfected, and bleached pulp ingredients produce
dioxins and other harmful substances that eventually enter the food cycle, which not only
pollutes the environment but also endangers natural species. The same issue exists for baby
diapers. Since 2014, more and more mothers have been making cloth diapers themselves to
save money and protect the environment, while cloth menstrual pads, which are similar to
https://www.mdpi.com/journal/ijerph
Int. J. Environ. Res. Public Health 2021, 18, 5534 2 of 20

cloth diapers, are poorly accepted among women, because they are difficult to clean and
cannot fit the busy pace of modern life [2–9].
During menstruation, women use different menstrual products to absorb menstrual
blood and prevent outflow. The use of menstrual products can be traced back to ancient
times, when women used leaves, hay, and bark, which are easy to clean, to carry men-
strual blood due to poor living conditions [10–22]. However, women in different countries
dealt with menstrual blood in different ways, including the use of wool, folded paper,
and papyrus. With the progress of social civilization, textiles have been widely used
by contemporary people since their occurrence. In China, women put water-absorbing
materials, such as grass and wood ash or silk and hemp into a small cloth bag and tied
it around their waists with thin strings at the two ends. Such bags could be cleaned and
reused, and women called them “menstrual bags”. In the 19th and early 20th centuries,
most women in western countries used self-made menstrual pads that could be washed
and reused repeatedly. Southalls’ Pads, invented by Franklin in 1888, were first used as
trauma pads due to their excellent hemostatic performance and were the first disposable
menstrual pads when they were used by nurses as disposable sanitary products; thus,
they were the origins of disposable menstrual pads [23,24].
The UN especially mentions females in its fifth goal of sustainable development, which
suggests that women are not only a subject of significance but they also play a key role in the
process of promoting sustainable development. Women are both producers and incubators,
but their productivity is hindered by social and family inequalities. In the past, women in
most developing countries did not own lands and farms, but as they spent a lot of time
maintaining lands to support their families, they learned more about soil, plants, and trees,
thus, according to the theories of eco-feminists, they had a better understanding of the
environment and could manage the environment in a more sustainable way than men [25].
The results of relevant studies have shown that countries with more women engaging in
the government or market are less likely to have corruption issues, and from the moral
point of view, women protect the environment with a sort of natural moral concept formed
in a non-corrupt manner; therefore, they also protect natural resources [26]. Other statistics
also show that 80% of household shopping is done by women; thus, purchasing related
to the environment should be in the control of women [27]. The unequal playing field
between men and women has enormous economic costs, as it impedes the increase in
productivity. The world is responsible for realizing equal actions and exchange between
men and women in the next century.
Among women’s attitudes regarding eco-friendly menstrual products, cloth men-
strual pads and menstrual cups are the main trends, followed by menstrual underpants,
while menstrual pads and tampons account for the market majority of menstrual products.
While tampons are superior to menstrual pads in all aspects, women prefer the latter, as
the former are invasive, and people are afraid of pain and have a misunderstanding of
a “damaged hymen” [28–33]. In addition, women’s refusal to use invasive products is
also the result of the irrational interpretation of female organs by society. There is also dis-
crimination against women using menstrual cups all over online media. They put forward
the strict criteria to determine “whether a woman is a virgin” and impose the pressure of
public opinions on women, which affects their purchase of menstrual products [34,35].
Modern people live a busy life and prefer fast and convenient disposable products;
thus, the invention of disposable menstrual pads met the pursuit of modern women for
convenience [36]. In recent years, manufacturers in the market have used new technologies
and materials in menstrual pads to make the products lighter and thinner, in order to
minimize the discomfort of women during menstruation and improve their willingness
to use menstrual pads [37]. With advances in technology, innovative atypical menstrual
products are developed, which make menstrual products on the market more diversified
and cause women to promote menstrual pads, menstrual cups, and menstrual underpants.
With increasing discussions of women’s autonomous right of their bodies on the Internet
and in society, new forms of menstrual products are making a comeback [38].
Int.
Int. J.
J. Environ.
Environ. Res. Public Health
Res. Public Health 2021, 18, 5534
2021, 18, 5534 33 of
of 20
20

Modern peoplepeopleareareaccustomed
accustomedtoto lives
lives of of convenience,
convenience, pursuing
pursuing material
material growth
growth and
and holding
holding ontoonto the idea
the idea that that science
science and and technology
technology willwill solve
solve all their
all their problems.
problems. There-
Therefore,
fore, disposable
disposable products
products have flooded
have flooded our People
our lives. lives. People aretoused
are used to disposable
disposable products,
products, includ-
including
ing disposable disposable
sanitary sanitary
napkins, napkins,
which are which are necessary
necessary menstrual menstrual
products products in a
in a woman’s
woman’s
life. Variouslife.harmful
Varioussubstances
harmful substances can be generated
can be generated when recycling
when recycling sanitarysanitary
productsprod-
and
are likely
ucts and areto eventually enter the food
likely to eventually enterchain.
the foodThis chain.
will not only
This cause
will notenvironmental pollu-
only cause environ-
tion, butpollution,
mental it also endangers
but it alsonatural species
endangers and their
natural habitats.
species and theirIn view of the
habitats. In seriousness
view of the
of the aboveofproblems,
seriousness the abovereusable
problems, environmentally friendly menstrual
reusable environmentally products are
friendly menstrual an al-
products
ternative
are to replace
an alternative towomen’s physiological
replace women’s needs and
physiological reduce
needs andthe environmental
reduce burden.
the environmental
This study
burden. This intends
study to explore
intends to consumers’ cognition
explore consumers’ and attitude
cognition toward environmentally
and attitude toward environ-
friendly menstrual products. According to the current living conditions
mentally friendly menstrual products. According to the current living conditions of female groups,
of fe-
data analysis and feedback collation were carried out, including personal
male groups, data analysis and feedback collation were carried out, including personal internal factors
and social
internal external
factors and factors, in orderfactors,
social external to promote theto
in order reduction
promoteof thedisposable
reductionproducts and
of disposable
the promotion
products and the of promotion
the use of environmentally friendly menstrual
of the use of environmentally friendly products,
menstrual as shown
products,in
Figure
as shown 1. The purpose
in Figure of this
1. The studyof
purpose is this
as follows:
study is as follows:
1.
1. This paper
This paper analyzes
analyzes the
the development
development of of menstrual
menstrual products
products by
by literature
literature and
and com-
com-
pares disposable and reusable variations, so as to understand the representative
pares disposable and reusable variations, so as to understand the representative sig-
significance
nificance of different
of different menstrual
menstrual productsatatthe
products thedemand
demandlevel
level and
and environmental
environmental
protection level.
protection level.
2.
2. Through expert
Through expert interviews,
interviews, this
this paper
paper aims
aims to
to understand
understand the
the development
development status
status
and future trends of the menstrual products market and analyze consumers’
and future trends of the menstrual products market and analyze consumers’ needs at
needs
different
at levels
different from
levels froma marketing
a marketing perspective.
perspective.
3.
3. Through questionnaire surveys, this
Through questionnaire surveys, this paper paper analyzes
analyzes consumers’
consumers’ cognitive
cognitive concepts
concepts
on menstruation and sustainability issues and compares their motives and doubts
on menstruation and sustainability issues and compares their motives and doubts
about the use of environmentally friendly menstrual products.
about the use of environmentally friendly menstrual products.
4. To explore the factors that consumers consider when purchasing environmentally
4. To explore the factors that consumers consider when purchasing environmentally
friendly menstrual products and understand the consumption identity and resistance
friendly menstrual products and understand the consumption identity and re-
of menstrual products.
sistance of menstrual products.
5. To summarize menstrual products for simulation analysis, extract ethnic lifestyle
5. To summarize menstrual products for simulation analysis, extract ethnic lifestyle
patterns and influencing aspects of using products, and provide a reference basis
patterns and influencing aspects of using products, and provide a reference basis and
and indicators for future sustainable issues in environmentally friendly menstrual
indicators for future sustainable issues in environmentally friendly menstrual prod-
products planning.
ucts planning.

Graph.
Figure 1. Research Correlation Graph.

2.
2. Materials
Materials and
and Methods
Methods
2.1. Research Process
This study
study was
was first
firstcarried
carriedout
outqualitatively
qualitativelyand
andthen
thenquantitatively.
quantitatively. In In
phase 1, a1,lit-
phase a
erature review was conducted to collect the information of menstrual products,
literature review was conducted to collect the information of menstrual products, sustain- sustainable
development,
able development,andand
lifestyle, andand
lifestyle, thethe
outlines and
outlines andkey
keypoints
pointswerewere summarized [39,40].
summarized [39,40].
In phase
phase 2,
2, the
theinterview
interviewoutline
outlinewaswasdetermined
determinedaccording
according to to
thethe
literature review,
literature andand
review, ex-
Int. J. Environ. Res. Public Health 2021, 18, 5534 4 of 20
Int. J. Environ. Res. Public Health 2021, 18, 5534 4 of 20

perts in different fields were interviewed in a semi-structured manner. The feasibility of the
experts in different fields were interviewed in a semi-structured manner. The feasibility
questionnaire survey was also studied in this phase. In phase 3, provisional questionnaires
of the questionnaire survey was also studied in this phase. In phase 3, provisional ques-
were designed. Questionnaires in this study were used to learn about the cognition and
tionnaires were designed. Questionnaires in this study were used to learn about the cog-
attitude of eco-friendly menstrual products by the women of the different groups. Finally,
nition and attitude of eco-friendly menstrual products by the women of the different
IBM SPSS 22 software (International Business Machines Corporation, New York Armonk,
groups. Finally, IBM SPSS 22 software (International Business Machines Corporation, New
USA) was used to analyze the questionnaire results, as shown in Figure 2.
York Armonk, USA) was used to analyze the questionnaire results, as shown in Figure 2.

Figure2.2.Research
Figure Researcharchitecture
architecturediagram.
diagram.

2.2. Research Targets

Different types of menstrual products available on the market were analyzed for
strengths and weaknesses, as shown in Table 1, in order to learn the main functions of the
products [1]. Different consumer groups have different demands in use, and most of them
 Int. J. Environ. Res. Public Health 2021, 18, 5534 5 of 20

2.2. Research Targets

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convenience
be groups.
being
convenience
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infection,
menstruation inbut and
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observe
reused,
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andwereThe
sanitary
likely
study
the
cause
factors subjects
issues
than
included
to
menstrual
sanitary no tam-
learn
issues
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related of
as
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to
to this
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theybe
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cause
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to
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menstrual in cognition
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groups,pendent
years habit
containing
pects the
of
old
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and
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issues 440
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capability,
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statistics,
changed
interviews age and
ranges
factors,
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and average
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questionnaire age
and
ofproducts ofthetheir menolipsis
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ofold.
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be
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feeling
to
then
reused,
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IBMby to of questions
supplementary
and The
clean,when
blood
cause
age
between
cleaned
when
clean,
the
SPSS women
of
summarized
which
adjusted no
of
which
22
eco-friendly
worn,according
subjects
sanitary
to
women’s
different
worn com-
causes
harminto
because
causes
of
software the
in
of
in-
the
the order
this
groups,
in- first
different
was
menstrual
to to
study
USD identify
experts’
convenience
formal
infection,
the
convenience
used USD were products.
advice.
20/piece
and
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menstruation less
subjects
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groups.
to analyze
the
women
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questionnaires likely
is
were
sanitary
The the
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12 total
issues
than tam-
grouped
issues
subjects
questionnaire
448
of
relationships
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into
this three
study
questionnaires
results age
were
fromrangescon-
women
the to
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included
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identify
 when
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the
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be being
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study
reused,of study
conducted
factors
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cleaned
feeling underpants
when
cause to
related
noworn,
harmlearn
[45]to
com-
to about
expert
the 
between
women’scompared the
changed
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 interviews
products
fortable
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of
48 blood
to
recognition
inand
learned
convenience
environment observethe
andand
52
and if and
not
years
summarized
event
the adapted
sanitary aattitude
timely
amenstrual
ofquestionnaire
of old,
greater
to blood
issues inoforder
female
eco-friendly  eco-friendly
investigation.
consumers
menstrual
ponsto time
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Takes tomenstrual
identify aged Provi-
products.
clean,the
supplementary from 18 toin-
influencing
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causes 50 relationships
yearsUSD old 20/piece
dealing
and with
con-
 Int. J. Environ. Res. Public Health 2021, 18, 5534 6 of 20

to 52 years old, female consumers aged from 18 to 50 years old dealing with menstruation
were included as subjects. In order to analyze the differences in cognition and attitude
between different groups, the subjects were grouped into three age ranges to identify
the factors related to women’s recognition of eco-friendly menstrual products. Finally,
IBM SPSS 22 software was used to analyze the questionnaire results from the aspects of
reliability and narrative statistics, factors, and clusters, and the differences were compared
and summarized in order to identify the influencing relationships and constructs between
the different lifestyles of the different subjects.

2.3. Research Subjects

This study was carried out in two phases. In phase 1, experts, including one represen-
tative academic researcher on gender issues in Taiwan and two practitioners of eco-friendly
menstrual products, were interviewed in a semi-structured manner, and their information
is shown in Table 2. The interviews were intended to learn about the opinions of consumers
on sustainable environmental protection, as well as consumers’ feedback on different
. Environ. Res. Public Health 2021, 18, 5534 5 of 20
menstrual products on the market, in order to understand the market operation of existing
eco-friendly menstrual products and the key factors for products to focus on the revolution
. Environ. Res. Public Health 2021, 18, 5534 of menstruation [28,46,47]. The interviews were recorded, and key points 5 of 20 identified,
were
. Environ. Res. Public Health 2021,mainly
18, 5534 require the prevention
analyzed, of outflow,
and organized, comfort,
in order and
to fully affordablethe
understand sales price. Such
interview differ-
information
5 of 20 to provide
ent demandsa of consumer groups lead to
reference for future studies. diversified functions of menstrual products on
the market
. Environ. Res. Public Health 2021,mainly [2–4,7].
18, 5534 require the prevention of outflow, comfort, and affordable sales price. Such differ-
5 of 20
Table 2. Information of interviews.
ent demands of consumer groups lead to diversified functions of menstrual products
mainly require the prevention of outflow, comfort, and affordable sales price. Such differ- on
Table
the 1.market
Strengths and weaknesses of menstrual products on the market.
[2–4,7].
. Environ. Res. Public Health 2021,ent
Interviewee demands of consumer groups lead to diversified functions of menstrual
18, 5534 Organization products
Years of 5 ofon20
Date/Place of
Number Title Relevant Experience/Research Field
Service Interview
Type
. Environ. Res. Public Health 2021, the
mainly 18, market
5534 [2–4,7].
requireStrengths
the prevention of outflow, comfort, Weaknesses and affordable sales price. MarketSuch
price differ-
5 of 20
Table 1. Strengths and weaknesses of menstrual  lead products
Research
Thick, field: on the
Culture market.
and social
ent demands of consumer groups touncomfortable
diversified
geography, ghost
to wear
functions
geography,
of menstrual products on
Taiwan
. Environ. Res. Public Health 2021,
National
Table 18,1.5534
Dong
StrengthsHwa and weaknesses of  Outflow
menstrual of blood
products if not
on the timely
market. 5 of 20
Type the
mainly
University
market
Department
[2–4,7].
requireStrengths
the
of prevention
Associate of outflow,
regional Weaknesses
comfort,
culture, and
urban affordable
geography MarketSuch
sales price. price differ-
20 March 2020
A changed 10 year
Public Health 2021,ent demands of consumerProfessorgroups  leadPromoter
Thick, of cloth menstrual
touncomfortable
diversified to wear padsof menstrual
functions Video interview
. Environ. Res.
Type 18, 5534
Taiwan and Strengths  Causes
in too
Taiwan Weaknesses
much waste and odors, Marketproducts
price 5 ofon20
mainly
Regional
Table  1. require
Discarded
Studies
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and prevention
used, clean
weaknesses ofof outflow,
Outflow
menstrual comfort,
of blood
products ifand
on not
the affordable
timely
market. sales price. Such differ-
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Thick, the
uncomfortable
attracts issue
mosquitoes toof cloth
wear menstrual USD 0.2/piece
ent  Easydemands
to use and oftheconsumer
change groups lead
changed
padsto indiversified functions of sales
menstrual products on
. Environ. Res.
TypePublic Health 2021,mainly 18, 5534 require Strengths
prevention of outflow,
Outflow
Single use,ofthe
comfort,second-hand
blood
composed ifand
notoftimelycloth course
affordable
materials price. Such differ-
Market price 5 of 20
the market [2–4,7].  Causes tooWeaknesses
much waste and odors,
ent
Table  1. demands
Discarded
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afterand consumer
used, clean groups lead
changed
that touncomfortable
do diversified
not easily functions
decompose, not of menstrual products on
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require
to use[2–4,7].
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and change
preventionofof menstrual
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andFounder
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products
of
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mosquitoes
too much waste
eco-friendly
the
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and to market.
wearMood”,
affordable
and odors,
sales price. Such differ-
USD 0.2/piece
the
ent market
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organization
use,of blood
composed iffor menstrual
notoftimely
materials
. Environ. Res.
Type
Menstrual Public Health
pads [41] Table 1.demands
2021, 18, 5534
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and consumer
Strengths weaknesses groups  lead
of menstrual
and toproducts
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in Taiwan
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USD products
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 Easy to use and change changed
that doof not easily decompose, not
. Environ. Res. Public Health 2021, the
mainly 18,1.market
5534 [2–4,7].
require the prevention of outflow, One the
Thick, forgotten
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comfort,
uncomfortable
use, composedwhen and to
of of the
wear
materials
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affordable
because sales price. Such differ- 5 of 20
Type Table Strengths and weaknesses of menstrual
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eco-friendly
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odors,
in Taiwan Market price
ent
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demands
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of used, clean groups
consumer  lead
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cause of no
not blood
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diversified if notresulting
feeling, timely
decompose,
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in of menstrual products on9 April 2020
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 Thick, attracts
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Type Table Easy
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used,
change
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clean
weaknesses of changed
menstrual
uncomfortable
eco-friendly
infection products
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to wear
the market. Market price Cafe
the
mainly market
 Causerequire [2–4,7].
no feeling the prevention
when 
worn, com-of outflow, cups”
Single
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in
use, Taiwan
comfort,
composed
forgotten
bloodwhen
of much ifand of
notwornaffordable
timely because sales price. Such differ-
materials
Tampons [42]  Single
Causes
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use,
of composed
the waste
developers
uncomfortable of and odors,
materials
of menstrual
to wear not USD 0.4/piece
ent  fortable
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demands after used,
ofthe clean
consumer that do not easily decompose,
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menstrual products on
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the1.
 Discarded
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require
to useafter
and
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used,
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of outflow,
andunderpants
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that do
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price.
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waste
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uncomfortable
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to
of market.
and
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wear odors,
on
materials Taiwan’s
ent  Cause demands of used,
consumer
clean groups lead touse,
diversified functions
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after whenclean
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Tampons [42][41]  Discarded after Costly
 Single composed
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 fortable
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and change
andonline
that
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infection
tampon
attracts
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 Costly of
not easily
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blood decompose,
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materials
and not
odors,
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no feeling
after worn, com-  that
whenclean
used,  Easily
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use,
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forgotten
easily
composedwhen worn
decompose,
of because
not
materials
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pads Table  1. No
CanStrengths
outflow
be reused,ofand
bloodweaknesses
cause no harm toof changed
 Single
eco-friendly
themenstrual
and products
use,
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attracts composed on the
of “Good
mosquitoes market.
of Moon
materialsMood”, USD 0.4/piece
0.2/piece
fortable Thick,
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cause
not no feeling, to wear
resulting in in-
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and used,
change eco-friendly
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that do
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too to
muchclean,
easily wastewhich
decompose,and causes
not
odors,
environment clean  Costly
an
that
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do not
use, easily
composed for menstrual
decompose,
of not
materials
Type [41][43] Table  1. Discarded
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blood
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clean
weaknesses Outflow
 Costly
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products
convenience
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if not
on the
sanitary timely
market.
issues Market price
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pads Artemis Cause no feeling
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attracts
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that inwhen
not composed
easily Taiwan
mosquitoes worn because
decompose, not USD
USD 0.2/piece
10/piece 9 April 2020
Tampons [42]
C EasyMedical
Device
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be use and change
cause Designer
no harm to the changed
 Single
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Product of blood
designer if not
of of materials
timely
“menstrual cups” USD 50.4/piece
year
 fortable
Easy Limited
to observe the menstrual blood  Thick,
Single
they
Costly
Takes uncomfortable
use,
cause
time composed
no
to feeling,
clean, to
of wear
materials
resulting
which causes in in- Cafe
Type  Discarded Strengths
after used, clean  eco-friendly
Causes
in
that too
Taiwan
do not Weaknesses
much
easily waste
decompose,and odors,
not Market price
 No environment
Discarded
outflow after
of used, no
blood clean  Easily
changed
that doforgotten
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not blood
easily when
if notworn
timely
decompose, because
not
Menstrual pads [41] Can
when bebeing
reused, cause
cleaned harm to the  infection
convenience
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and of the and
uncomfortable
attracts sanitary
developers
mosquitoes to ofissues
wearmenstrual USD 0.2/piece
Cloth menstrual pads [43]  Cause tono
Comfortable,feeling when worn, com-  they
breathable eco-friendly
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cause to clean,
feeling, which causes
resulting in in- USD 0.4/piece
10/piece
Tampons [42]  Can Easybe use
environment
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and
reused, change
aftercause
used, no harm to the  Takes
clean changed
eco-friendly
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underpants
timeof composed
of inwhen
blood
to Taiwan
clean,if
if not of materials
timely
which causes in- USD
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use, blood
composed not worn
oftimely because
materials
 fortable convenience
infection
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Costly
that too and
much sanitary
waste andissues
odors,
Cloth menstrual pads [43]  environment
Comfortable,
Cause
Discardedno afterbreathable
feeling when
used, worn,
harmcom-
clean that do
changed
to the  convenience
they
changed not
cause
do easily
of no
not and decompose,
sanitary
feeling,
easily issues
resulting
decompose, not
in
not USD 10/piece
Tampons
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pads  No Can
whenoutflow
bebeing
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reused,
after blood
cause
cleaned
used, no
clean Outflow
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 Easily use,
and attracts
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composed
forgotten
eco-friendly
Takes time to
if notof
mosquitoes
when
clean,
timely
materials
worn
which because
causes in- USD
USD 0.4/piece
0.2/piece
 Cause Easy to
fortable
Easybe observe
no feeling
to reused, the
use andcause
environment
menstrual
when
change worn, blood
com-  infection
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too much waste and odors,
eco-friendly because
 Can Cause
Discardedno feeling
after when
used,
In no harm2,
worn,
clean
phase com- the  Takes
changed
toquestionnaires
that
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they
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use,
cause
convenience to
notwere clean,
easily
composed
no sent
feeling,
and which
decompose,
sanitaryof to causes
and not
materials
resulting
issues in in-
collected from female consumers with
Tampons
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Cloth menstrualcups
[42]
pads [44]
[41][43]
pads  fortable
when
No beingafter
outflow
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cleaned
of blood
used,
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and
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use, no
attracts feeling, of
composed
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materials in USD
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0.2/piece
10/piece
 environment
fortable
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be use and
reused, change
independent
cause no harmeconomic
to the  convenience
eco-friendly
that do
infection
capability
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easily
who
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to clean,decompose,
if could
not issues
buy
timely
which not
causes their
not in- menstrual products at will to learn
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tono of blood
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of blood blood  infection,
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notbut
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easily
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forgotten clean,
likely
decompose,
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when
of
which
than
worn
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materials
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causes
becausein-
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changed
women use, composed of materials USD 0.4/piece
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fortable
when
observe the menstrual blood convenience
pons notof
eco-friendly
that do
cause different
and
easily
no sanitary
decompose,
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issues
resulting groups. AsUSD
in summarized and analyzed,
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fortable cleaned
reused, cause no harm to the  they convenience
cause
not no
and sanitary
feeling, issues
resulting in USD 20/piece
Cloth menstrual pads  Cause Discarded
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when
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outflow
after used,
cleaned
the
of whenclean
breathable
no feeling factors
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affecting
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that
 Easily
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eco-friendly
infection
easily
forgotten
to
purchase and
clean,decompose,
when worn
adapted
ofwhich not
tobecause
causes
eco-friendly in- menstrual 10/piece
products were identified,
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blood no harm to the  Outflow
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infection,
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but clean,
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which
likely thancauses
tam- in-
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Tampons cups
[42][44]  fortable
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Can tono feeling
observe
reused, when
the
cause noworn,
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harm com-
blood
to the 
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eco-friendly
cause
convenience
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composed
when
feeling,
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resulting
of
because
issues
materials in USD 0.4/piece
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Cloth menstrual pads [43]  environment Easy
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fortable and
to observe their
the
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causes
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because
 Cause Discarded
when
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outflow feeling
being used,
cleaned
observe
of when
the
blood
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menstrual blood  Easily
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convenience
infection
not easily
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and
decompose,
when worn
adapted
sanitary tobecause
issues
Cloth menstrual pads [43]  Can Easy
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tonoreused,
observe
no
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when
breathablenoworn,
harmcom-
menstrual
worn, to
com- the  Takes
blood pons time no
convenience
changed
they cause
eco-friendly toand
clean, which
sanitary
feeling, causes
issues
resulting in in- USD 20/piece
10/piece
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Tampons cups
[42][44][45]
Cause
 fortable
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whenbebeing
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feeling
reused,
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when
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Results
cause
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clean
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time
cause
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of no clean,
feeling,
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to the  Interviews
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forgotten lesswhen
and
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than tam-
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fortable rized
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breathable
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10/piece
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fortable feeling
observe
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blood  pons Requires
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in-
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but blood
likely than tam-
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of
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toexpert convenience
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products
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inno and
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Cloth menstrual pads [43]  Easy Cause
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cleaned
study
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observe
reused,
conducted
when
the menstrual
breathable
feeling when
cause noworn,
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to the
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convenience
 pons
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sanitary
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 Requires
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infection,
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not than
timely
which tam- in-
causes
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fortable
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observe the were
menstrual blood 
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and adjusted
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habit
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outflow of the menstrual blood  convenience
breathable
blood
they
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pons
changed
cause
products in
no
time toand
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conducted
blood
when according
harm
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interviews
infection,
convenience ofbut advice.
blood
and
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a worn
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sanitary total
timely
questionnaire
than of 448 online
tam-
issues questionnaires
investigation. Provi-
 Cause when
Easy to
Requiresbeing
no
environment
cleaned
observe
feeling the menstrual
when
no change ofno worn,
the blood
com-
usage  To be
Easily
amount learned
forgotten and
of menstrualwhenadapted tobecause
bloodcauses in-
Menstrual underpants [45] were  Can Easy be
to reused,
fortable observecause
collected, and harm
8 invalid
the menstrual to the  Takes
changed
questionnaires
blood pons
Requires time to clean,
were which
excluded;
supplementary sanitarythus, 440 questionnaires
USD 20/piece were
Int. J. Environ. Res. Public Health 2021, 18, 5534 7 of 20

to acquire in-depth feedback from experts, the interviews were guided by questions about
different constructs and were not limited to the preset questions [39,40].
Three experts provided advice in different fields in this study. Associate Professor Lin
talked about consumers’ current use of cloth menstrual pads, who such consumers are,
and the price of environmentally friendly menstrual products, and how academic promo-
tion reflects the difference in the cognition of menstruation among the young generation.
Manager Shi, a former project manager of the “menstrual cup” and current developer of
menstrual underpants, talked about the marketing of atypical menstrual products and
offered information regarding the current development trends of menstrual cups and men-
strual underpants, how consumers’ lifestyles affect the usage habits of menstrual products,
and the conditions for the promotion of relevant products. Designer Chen, a designer
of menstrual cups and menstrual underpants, talked about the appearance, functions,
and structural differences of different types of menstrual cups, as well as users’ usage
habits and concerns about comfort during the development of the products [1,28,29].
The interviews mainly covered three aspects, namely (1) the impact of sustainability
and consumers’ lifestyles, (2) the current development of eco-friendly menstrual products,
and (3) the characteristics and elements of eco-friendly menstrual products, and the three
main categories of this study were determined according to the results. Then, several sub-
categories and open decoding were converged in order, and the key elements of context
decoding were extracted, summarized, and integrated according to six constructs, as shown
in Table 3.

Table 3. Analysis and summary of interviews information.

Construct of Analysis Description

Change of lifestyle in the context of universal
sustainability
Factors promoting green consumption
Correlation between development of eco-friendly
menstrual products and lifestyle
Differences in the use of eco-friendly menstrual
products between different groups
Current development of the menstrual product
market in Taiwan
Conditions for promotion of eco-friendly
menstrual products
Policies in Taiwan that promote use habits
Life-affecting technologies
Consciousness and behavior affected by people in society
Influential social conducts
Sense of crisis and reflection that promote eco-friendly awareness
Influential social trends (external environment, online communities)
Personal traits
Better quality of life
Society calls for eco-friendliness in addition to convenience and cleanliness
Society calls for the autonomous selection of products in addition to the
autonomous right of the body
The understanding of menstruation turns from negative to positive
Diversified products meet the needs of people of different lifestyles
Differences in education and stratum
Difference in demand between different occupations
Difference in focus between different age groups
Different willingness to use between people with different personal traits
Positively correlated with the focus on environmental protection
Nature of eco-friendly menstrual products
Disposable menstrual pads account for the majority
There are diversified products
Eco-friendly menstrual products are attracting more attention
Attractive product design
Good sanitary education
More diversified products in the market
Better environment and facilities for using the products
Lower cost of menstrual cups

As shown above, the differences in the lifestyles between individuals had special
importance in the analysis of the user groups. Both the development of eco-friendly
menstrual products affected by lifestyle and the difference between individuals in the use
of eco-friendly menstrual products were related to social conduct, age, stratum, occupation,
Int. J. Environ. Res. Public Health 2021, 18, 5534 8 of 20

and personal traits. According to the focus of the above-mentioned expert interviews,
a follow-up questionnaire survey on consumers was drawn up with a 5-point Likert scale,
as shown in Table 4. By analyzing the lifestyle and purchasing considerations of different
consumer groups, this paper explores the cognition and attitude of consumer groups and
the acceptance factors of other non-environmental menstrual products users [1,46].

Table 4. Questionnaire Survey.

I. Consumer Lifestyle
[Part I] Please describe your views on the issue of sustainability and your usual actions
1. I attach importance to environmental protection and worry
about the destruction of nature.
2. When buying goods, I will give priority to
environmental protection.
3. I will bring my own environmentally friendly bags,
chopsticks and cups, and try not to use disposable goods.
4. I am willing to buy green goods, even if the price is more
expensive.
5. I will reduce the production of garbage and implement
garbage classification and recycling.
6. I don’t think the sanitary napkins used by women during
menstruation are environmentally friendly.
[Part II] Please describe your views on menstrual issues and your usual actions
1. I’m afraid the hymen will rupture.
2. I think invasive menstrual products will hurt the hymen.
3. I think the deep meaning of menstrual blood is dirty
and filthy.
4. I think menstruation is an inconvenience to life.
5. When menstruating, you should not enter the temple
to worship.
6. I don’t think it’s convenient to exercise when I
have menstruation.
7. When I have my period, I feel ashamed and find it hard to
talk about.
8. I think it is shameful for others to see menstrual products,
and I will especially put these products in small bags.
[Part III] Understand your life style through descriptions of other daily life, personal characteristics, interests and opinions
1. I like novel and fashionable things.
2. I love some dangerous and exciting activities.
3. I do things very subjectively and don’t care what others think.
4. I prefer to do it myself rather than rely on others.
5. I pay attention to the practicality of products.
6. I will collect product-related comments and feedback through
associated networks.
7. Vibrant, healthy and natural products can attract me more.
8. When shopping, I will accept or listen to the opinions of my
family and friends.
9. I’m always learning about new knowledge and technology.
10. I have a high acceptance of new things.
11. Before shopping, I will do research on the Internet to check
the evaluation and price of netizens.
12. When shopping, price is my first consideration.
7. When shopping, I will pay special attention to products with
environmental certification.
8. I will learn the information of environmentally friendly
products through the Internet.
9. I attach importance to ecological conservation and care for
the survival rights of other species.
10. I think environmental protection is more important
than convenience.
11. I support products that are more sustainable and
environmentally friendly.
12. I usually pay attention to issues related to environmental
protection and sustainability.
9. I usually use pronouns to refer to menstruation.
10. I think menstruation is only a normal physiological
phenomenon for women.
11. I support gender equality and disagree with the traditional
idea that men and women are different.
12. I think menstruation is an important cycle for reproduction
of life and should be paid attention to.
13. Women have the right to take physiological leave at school
or in the workplace.
14. In menstrual processing and self-care, I tend to hide and
be silent.
15. 1I’m afraid of touching private parts directly.
13. When shopping, I will focus on calculating the total cost
instead of just looking at the price of goods.
14. I think as long as the nature of the goods meets the demand,
it doesn’t matter if the price is higher.
15. I think the goods used can represent a person’s concern for
the things around them.
16. Users’ feedback will affect my purchase intention.
17. Innovative and unique goods are of great appeal to me.
18. I like a job that is challenging and changeable.
19. I pursue a high-quality lifestyle.
20. I usually live a fast-paced and busy life.
21. In the group, I am an easygoing person with less opinions.
22. The norms of policies affect my consumption habits.
23. I usually pay attention to the changes of social trends.
Int. J. Environ. Res. Public Health 2021, 18, 5534 9 of 20

Table 4. Cont.

II. Consumer Purchase Considerations

[Part I] The following are various factors that will affect your purchase of environmentally friendly menstrual products. Please fill
in and answer according to your emphasis on them
1. Convenience of product purchase. 6. Visual packaging of products.
2. Evaluation on the Internet or between relatives and friends. 7. Appearance modeling and color matching of products.
8. Parts of the product (Storage cloth bags, disinfection storage
3. Feedback after personal experience of product users.
boxes, etc.).
4. Amount of information available for reference. 9. The government’s public power promotes waste reduction.
5. Brand’s main image and concept. 10. Influenced by social atmosphere.
[Part II] The following are the different characteristics of each environmentally friendly menstrual product. Please fill in the answer
according to your emphasis on it
1. Environmental protection characteristics of the product itself. 11. It is convenient to exercise and go into the water.
2. Feel more comfortable physically. 12. Enabling a wider selection of products on the market.
3. There is no excess garbage. 13. Reduce menstrual blood leakage.
4. The overall use cost is cheaper. 14. Worry about cleaning or disinfection trouble.
15. Need to clean by hand, afraid of hands touching
5. It can be used with other menstrual products.
menstrual blood.
6. When cleaning, you can conveniently observe whether the 16. Require cleaning and afraid of not being able to wash
menstrual blood is healthy or not. it clean.
17. The process of learning and getting started is more
7. It can be replaced for a long time.
troublesome.
8. The product is unique. 18. Fear of pain from invasive products.
9. The project is innovative. 19. Fear of invasive products damaging the hymen.
20. Bacterial infection caused by improper handling of
10. No need to carry extra menstrual supplies for replacement.
invasive products.

3.2. Analysis of Consumers’ Lifestyles

The AIO scale was used in this questionnaire investigation, and IBM SPSS 22 software
was used for quantitative analysis, in order to investigate consumers’ opinions regarding
sustainability and menstruation and examine the constructs, including daily lifestyle,
personal traits, and interest in and purchase of eco-friendly menstrual products, which was
intended to define the correlation between different groups regarding their willingness to
purchase eco-friendly menstrual products [49,50].
(1) Analysis of consumers’ use of menstrual products
In this study, eco-friendly menstrual products were divided into cloth menstrual
pads, menstrual cups, and menstrual underpants. Considering that many consumers
might be using two or more types of these menstrual products at the same time
during menstruation due to product diversity in the market [46,51], the combinations
of different types of menstrual products were set as the investigation items.
As shown in Table 5, 60.7% of the subjects used menstrual pads, which still
account for the majority in Taiwan, while fewer subjects used tampons; however,
the percentage was significantly higher than before, indicating that invasive products
were less concerned by women. Among the eco-friendly menstrual products, 48.9%
of the subjects used menstrual cups, accounting for the majority, while fewer subjects
used cloth menstrual pads, with the percentage similar to the previous percentage.
The percentage of menstrual underpants users was the lowest, at only 13%, as the
products were not popular and were emerging atypical menstrual products.
Int. J. Environ. Res. Public Health 2021, 18, 5534 10 of 20

Table 5. Analysis of consumers’ use of menstrual products.

Never Used/Not Using Used/Using

Number of subjects 173 267
Menstrual pads
Percentage 39.3% 60.7%
Number of subjects 270 170
Tampons
Percentage 61.4% 38.6%
Number of subjects 301 139
Cloth menstrual pads
Percentage 68.4% 31.6%
Number of subjects 225 215
Menstrual cups
Percentage 51.1% 48.9%

Menstrual Number of subjects 383 57

underpants Percentage 87.0% 13.0%

(2) Analysis of consumers’ attitude on menstrual products

1. Concerns about the use of menstrual pads
When using menstrual pads, 84.1% of the subjects were concerned about dis-
comfort, 80.5% were concerned about their disposal, and 65.7% were concerned
about the harm to the environment, which indicates that the public attach high
importance to sustainability. In addition, 63% of the subjects were concerned
about the outflow of blood, and 52.7% were concerned about vaginal infections,
which is due to the characteristics of the products. Some subjects were also
concerned about the cost, as they had to spend more on them due to heavy
blood flow during menstruation [26,27,52].
2. Preference for the type of eco-friendly menstrual products
In the investigation of the willingness to use eco-friendly menstrual products,
the effective percentage of the subjects who were willing to use the products
was as high as 89.5%, which suggests that the current society is interested
in pursuing sustainable ecological friendliness and requires sustainable eco-
friendly menstrual products.
By excluding those not willing to use eco-friendly menstrual products, a
total of 394 subjects were investigated to determine their preference for the type
of eco-friendly menstrual products. According to the experts interviewed in this
study, most consumers preferred menstrual cups, accounting for 61.9%, while
26.1% of them preferred cloth menstrual pads, because it was troublesome to
clean the latter and users preferred convenience and cleanliness. In addition,
only 11.9% of the subjects preferred menstrual cups, as they are new to the
market, and little is known about them.
3. Motivation for the use of eco-friendly menstrual products
Combinations of different types of eco-friendly menstrual products were
included as options in this study to learn about the main motivations among
consumers regarding the use of eco-friendly menstrual products. Most sub-
jects, accounting for 75.9%, used them to respond to the call for environmental
protection, while 67.3% used the products for higher comfort and 75.3% used
them for convenience. These results are in line with the analysis results of the
concerns about the above-mentioned use of menstrual pads, indicating that
modern women are also pursuing high quality of life. Moreover, many subjects
choose eco-friendly menstrual products due to their inherent extra strengths,
such as the convenience of menstrual cups for exercise and water sports, and the
different patterns of cloth menstrual pads. A few subjects choose these products
to save money [2,52].
4. Concerns regarding the use of eco-friendly menstrual products
Int. J. Environ. Res. Public Health 2021, 18, 5534 11 of 20

Subjects of the same group had almost the same concerns regarding the
use of eco-friendly menstrual products, which reflects their different needs in
life. Those not using eco-friendly menstrual products stated their concern about
infections and pain caused by invasive products [1,2], which indicates that the
current development of menstrual cups is still limited to a certain group of con-
sumers, while those who had a correct understanding of physiology were using
invasive products properly after learning and were not likely to have infections
resulting from inadequate disinfection [2,47]. This analysis result is in line with
the point of view of Expert C, meaning when a product is well developed and
its user group expands, some use it before having a good understanding of
sanitation, which results in improper use and infections. Some users also raised
the concern that it is inconvenient to use eco-friendly menstrual products in the
current environment, as they need to be cleaned and few facilities are available.
The government and private enterprises should make efforts to improve this
situation in the future [53].
(3) Analysis of consumers’ cognition and behavior
The 5-point Likert scale was used to measure the subjects’ cognition of sustain-
ability and menstruation. Cognitive and behavioral decisions are derived from the
theory of planned behavior, which affects the constructs, including behavioral be-
liefs, behavioral attitudes, normative beliefs, subjective beliefs, perceived behavioral
control, and behavioral intentions [54].
The analysis of consumers’ cognition of sustainability is shown in Table 6.
Although some subjects did not agree to sustainability, the subjects agreed or strongly
agreed to sustainability on the whole, indicating that the public has a high sense of
identity regarding sustainability and would act to protect the environment.

Table 6. Table of consumers’ cognition of sustainability.

Item Strongly Disagree Fair Agree Strongly

Disagree Agree
I attach importance to environmental
1 5 6 46 220 163
protection and worry about nature 1.1% 1.4% 10.5% 50.0% 37.0%
being damaged.
I give priority to environmental friendliness 2 15 123 213 87
2
when buying goods. 0.5% 3.4% 28.0% 48.4% 19.8%
I prepare my own eco-friendly bags,
3 3 16 88 207 126
chopsticks, and cups, and do not use 0.7% 3.6% 20.0% 47.0% 28.6%
disposable products, as possible.
I am willing to buy eco-friendly products 3 20 127 226 64
4 0.7% 4.5% 28.9% 51.4% 14.5%
even at a high price.
I reduce waste, and classify and 2 2 34 217 185
5 0.5% 0.5% 7.7% 49.3% 42.0%
recycle waste.
I do not think it is eco-friendly to use 8 31 79 178 144
6 1.8% 7.0% 18.0% 40.5% 32.7%
menstrual tampons.
I pay special attention to products with 6 36 187 153 58
7
eco-friendly certificates when I shop. 1.4% 8.2% 42.5% 34.8% 13.2%

8 4 9 83 218 126
I learn about eco-friendly products online. 0.9% 2.0% 18.9% 49.5% 28.6%
I value ecological conservation and care 3 4 83 207 143
9 0.7% 0.9% 18.9% 47.0% 32.5%
about the survival rights of other species.
I think environmental protection is more 3 21 118 203 95
10 0.7% 4.8% 26.8% 46.1% 21.6%
important than convenience.
I support products that are more sustainable 1 0 26 223 190
11 0.2% 0.0% 5.9% 50.7% 43.2%
and eco-friendly.
I always pay attention to issues related to 2 4 83 220 131
12 0.5% 0.9% 18.9% 50.0% 29.8%
environmental protection and sustainability.
Int. J. Environ. Res. Public Health 2021, 18, 5534 12 of 20

In the investigation of menstruation, all items, except Item 10 (I think menstruation

is a normal physiological phenomenon of women) and Item 13 (Women should have the
right to take menstrual leave from school or work), were negative statements, as shown
in Table 7. Most subjects agreed with positive statements and disagreed with negative
statements, indicating that most modern women had different cognitions and behaviors of
menstruation compared to traditional ones. It should be noted that most subjects agreed to
the negative Item 4 (I think menstruation brings inconvenience to life), as women deal with
menstruation in different ways because of their physiological structure, which is different
from men, and some women had pain during menstruation [34]. In the future, social forces
should attach importance to such issues when building women-friendly facilities [53].

Table 7. Table of consumers’ cognition of menstruation.

Item Strongly Disagree Fair Agree Strongly

Disagree Agree

1 219 91 97 27 6
I’m afraid of having my hymen broken. 49.8% 20.7% 22.0% 6.1% 1.4%
I think invasive menstrual products will break 200 104 78 52 6
2 45.5% 23.6% 17.7% 11.8% 1.4%
the hymen.
I think the deep meaning of menstrual blood is 324 78 25 11 2
3 73.6% 17.7% 5.7% 2.5% 0.5%
dirtiness and filthiness.
I think menstruation brings inconvenience 14 22 78 217 109
4 3.2% 5.0% 17.7% 49.3% 24.8%
in life.
I do not think I should visit a temple 240 85 69 37 9
5 54.5% 19.3% 15.7% 8.4% 2.0%
during menstruation.

6 I think it is inconvenient to exercise 78 99 119 119 25

during menstruation. 17.7% 22.5% 27.0% 27.0% 5.7%

7 I feel ashamed and embarrassed about 266 118 49 6 1

having menstruation. 60.5% 26.8% 11.1% 1.4% 0.2%
I think it’s shameful for people to see menstrual 171 139 96 30 4
8 38.9% 31.6% 21.8% 6.8% 0.9%
products, so I pack them in special bags.

9 85 89 109 120 37
I usually refer to menstruation as “that thing”. 19.3% 20.2% 24.8% 27.3% 8.4%
I think menstruation is a normal physiological 0 0 7 99 334
10
phenomenon of women. 0.0% 0.0% 1.6% 22.5% 75.9%
I support gender equality and do not subscribe
11 2 2 31 117 288
to the traditional idea that men and women 0.5% 0.5% 7.0% 26.6% 65.5%
are different.
I think menstruation is an important cycle of 0 1 32 139 268
12 0.0% 0.2% 7.3% 31.6% 60.9%
life reproduction and should be valued.
Women should have the right to take menstrual 0 0 23 127 290
13 0.0% 0.0% 5.2% 28.9% 65.9%
leave from school or work.
I tend to hide and keep silent regarding 105 152 127 48 8
14 23.9% 34.5% 28.9% 10.9% 1.8%
self-care during menstruation.

15 211 116 82 26 5
I am afraid to touch my private parts directly. 48.0% 26.4% 18.6% 5.9% 1.1%

3.3. Analysis of Consumers’ Factors and Clusters

This section analyzes the differences in consumers’ lifestyles. Factor analysis was used
to simplify the items regarding consumers’ lifestyles and to extract the factors of types
of lifestyles, in order to learn the characteristics of the different lifestyles of consumers.
Exploratory factor analysis (EFA) was used, and principal component analysis and varimax
performed orthogonal rotation to extract the main factors.
Factor analysis was carried out after reliability testing. The principal component
analysis method was used to extract the main factors with eigenvalues greater than 1 as
the screening condition. A total of four common factors with eigenvalues greater than 1
Int. J. Environ. Res. Public Health 2021, 18, 5534 13 of 20

were extracted, and the accumulative explanatory variation was 49.228%, which met the
screening criteria, as shown in Table 8.

Table 8. Table of explanatory variations after rotation of the lifestyle scale.

Initial Eigenvalue
Explanatory variation Accumulative explanatory
Component Eigenvalue
(%) variation (%)
1 3.654 22.840 22.840
2 1.643 10.269 33.109
3 1.380 8.626 41.735
4 1.199 7.493 49.228

Varimax was then used to perform orthogonal rotation of the factors, and after some
items were removed according to the removal criteria, the items were simplified into four
main factors, as shown in Table 9.

Table 9. Component matrix of principal components of the lifestyle scale after analysis rotation.

Factor Component
Item
1 2 3 4
Item 3-06 0.684 0.064 0.318 0.016
Item 3-07 0.667 0.079 −0.014 0.099
Item 3-05 0.663 0.042 0.205 −0.191
Item 3-15 0.627 0.141 −0.290 0.114
Item 3-14 0.572 0.239 −0.345 0.052
Item 3-09 0.571 0.308 0.168 −0.108
Item 3-18 0.134 0.756 −0.041 −0.122
Item 3-01 0.019 0.703 0.127 −0.051
Item 3-17 0.180 0.702 0.000 0.098
Item 3-19 0.322 0.569 0.073 0.072
Item 3-20 0.041 0.509 0.147 0.142
Item 3-12 −0.057 0.072 0.771 0.182
Item 3-13 0.190 0.251 0.553 −0.035
Item 3-22 −0.064 0.097 −0.185 0.705
Item 3-21 −0.015 −0.154 0.227 0.703
The background color represents the same set of factors.

This study named four factors according to their meanings, “new information seek-
ing”, “innovation trend”, “strict budgeting”, and “easy-going and conservative”.
Cluster analysis was conducted according to the items in the AIO scale. The AIO scale
is defined as:
1. A (Activity): It is a specific action, such as media viewing, shopping, etc. Although
these actions are common, the reasons for these actions are rarely directly measured.
2. I (Interest): The degree of interest in a thing or subject, and continuous and special
attention to it.
3. O (Opinion): It is an individual’s oral or written reaction to a thing, that is, a person’s
explanation, expectation, and evaluation of the thing.
Consumers were divided into three clusters. Consumers were defined by three clusters,
and the correlation between the clusters was analyzed using the K-means cluster analysis
method. As shown in Table 10, the corresponding values show that Cluster 1 was posi-
tively correlated with Factor 1 (new information seeking) and Factor 2 (innovation trend),
and negatively correlated with Factor 3 (strict budgeting) and Factor 4 (easy-going and
conservative), which indicates that people in Cluster 1 prefer to follow trends, know how
Int. J. Environ. Res. Public Health 2021, 18, 5534 14 of 20

to get new information using Internet tools, and are willing to spend time on things that
they think are worthwhile. Cluster 2 was positively correlated with all the factors, indi-
cating that the lifestyle of the people in Cluster 2 featured all four factors, meaning they
proactively sought new information and paid attention to trends but thought carefully
before purchasing due to economic restrictions. There were many people in Cluster 2.
Cluster 3 was positively correlated with Factor 4 (easy-going and conservative), and nega-
tively correlated with other factors, which indicates that people in Cluster 3 were living a
conservative and stable lifestyle, their thoughts and actions were subject to the surrounding
environment and policies, and they usually failed to make independent judgments. People
in Cluster 3 accounted for most of the total. Based on the summary and description of all
the above characteristics, as well as the key points in expert interviews, the three clusters
were named: Cluster 1 is people seeking new information and new trends (aged from
18 to 28 years old and from 29 to 39 years old); Cluster 2 is people subject to economic
restrictions and wanting to try something new (aged from 18 to 28 years old); and Cluster
3 is people pursuing a conservative and stable life (aged from 29 to 39 years old and from
40 to 50 years old).

Table 10. Table of factor constructs and mean coefficient values of different lifestyle clusters.

Cluster 1 People Seeking Cluster 2 People Subject Cluster 3 People Pursuing

New Information and to Economic Restriction a Conservative and F-Test p-Value
New Trends and Wanting to Try Stable Life
Something New
Factor 1 0.54445 0.50325 −0.78749 152.284 0.000
new information seeking
Factor 2 0.28663 0.59175 −0.70778 115.160 0.000
innovation trend
Factor 3 −0.46268 0.70748 −0.34917 85.087 0.000
strict budgeting
Factor 4
easy-going and −0.96672 0.62362 0.03712 128.074 0.000
conservative
Number of subjects 108 157 175
Percentage (%) 24.5 35.7 39.8
People subject to economic
People seeking new People pursuing a
Name of cluster restrictions and wanting to
information and new trends conservative and stable life
try something new

3.4. Analysis of Consumers’ Considerations in Purchasing Based on Lifestyle

This section investigated the considerations of consumer clusters with different
lifestyles when purchasing eco-friendly menstrual products, including the purchase chan-
nel of products, the volume of obtained product information, users’ feedback, brand
concept, the appearance product designs, accessories, the impact of social conduct, and the
properties of the products, in order to determine whether there were significant differences
between the clusters, and the analysis results were summarized.
Factor analysis was carried out after reliability testing. The principal component
analysis method was used to extract the main factors with eigenvalues greater than 1 as
the screening condition. A total of eight common factors with eigenvalues greater than 1
were extracted, and the accumulative explanatory variation was 65.006%, which met the
screening criteria, as shown in Table 11.
Int. J. Environ. Res. Public Health 2021, 18, 5534 15 of 20

Table 11. Table of explanatory variations after rotation of the purchase consideration scale.

Initial Eigenvalue
Accumulative Explanatory
Component Eigenvalue Explanatory Variation (%)
Variation (%)
1 5.431 19.395 19.395
2 4.400 15.715 35.109
3 1.911 6.825 41.934
4 1.774 6.337 48.271
5 1.439 5.139 53.410
6 1.182 4.222 57.632
7 1.064 3.798 61.430
8 1.001 3.575 65.006

Varimax was then used to perform orthogonal rotation of the factors, and after some
items were removed according to the removal criteria, the items were simplified into eight
main factors, as shown in Table 12.

Table 12. Component matrix of principal components of the purchase consideration scale after analysis rotation.

Factor Component
Item
1 2 3 4 5 6 7 8
Item 2-18 0.754 −0.255 0.035 0.126 0.050 0.082 −0.041 0.110
Item 2-16 0.738 0.043 0.104 0.020 −0.108 −0.077 0.156 −0.068
Item 2-14 0.719 0.137 0.035 0.132 −0.146 −0.152 0.085 −0.125
Item 2-20 0.717 −0.043 0.131 0.033 −0.091 0.040 0.080 0.232
Item 2-15 0.688 −0.067 −0.118 0.212 0.078 −0.066 0.004 −0.299
Item 2-17 0.646 −0.011 0.284 −0.013 0.114 −0.091 −0.050 0.000
Item 2-19 0.617 −0.274 −0.164 0.147 0.197 0.067 0.071 −0.051
Item 2-10 −0.005 0.761 0.061 −0.009 0.193 0.195 −0.017 0.128
Item 2-11 −0.082 0.743 0.098 0.041 0.205 0.091 0.042 0.061
Item 2-13 −0.028 0.722 0.049 0.136 −0.120 0.047 0.140 0.053
Item 2-07 −0.184 0.695 0.013 −0.088 0.242 0.224 −0.093 −0.021
Item 1-02 0.124 −0.068 0.788 0.061 0.179 0.104 −0.052 0.013
Item 1-03 0.051 0.033 0.782 0.006 0.080 0.137 −0.005 0.191
Item 1-04 0.072 0.209 0.652 0.088 0.014 0.051 0.194 0.190
Item 1-01 0.053 0.168 0.548 0.231 −0.111 0.228 0.163 −0.232
Item 1-06 0.217 0.008 0.049 0.861 0.094 −0.038 0.031 0.046
Item 1-07 0.149 −0.033 0.088 0.859 0.121 −0.005 0.025 0.125
Item 1-08 0.087 0.163 0.119 0.609 0.140 0.184 0.295 −0.124
Item 2-08 −0.004 0.228 0.106 0.158 0.848 0.140 0.160 0.052
Item 2-09 0.016 0.215 0.121 0.234 0.823 0.137 0.156 0.049
Item 2-04 −0.014 0.213 0.127 0.094 0.058 0.745 −0.117 0.143
Item 2-05 −0.083 0.198 0.255 −0.034 0.011 0.712 0.236 0.027
Item 2-06 −0.093 0.140 0.077 −0.001 0.297 0.642 0.218 0.150
Item 1-10 0.245 −0.011 0.075 0.175 0.124 −0.007 0.723 −0.092
Item 1-09 0.019 0.067 0.064 0.077 0.147 0.237 0.715 0.250
Item 2-02 −0.048 0.332 0.133 0.080 −0.053 0.167 −0.154 0.643
Item 2-01 −0.078 −0.033 0.084 −0.018 0.132 0.272 0.376 0.640
The background color represents the same set of factors.

Based on the results of factor analysis, the factors obtained from the questionnaire
investigation of this study were named according to the meanings of corresponding items
as “use”, “product performance”, “market information”, “product design”, “market char-
acteristics”, “benefit of use”, “market environment”, and “product value”.
Int. J. Environ. Res. Public Health 2021, 18, 5534 16 of 20

Through the analysis of the characteristics of the above factors, we can know that due
to the broad promotion of sustainability in recent years, women consumers are affected
by the cognition of environmental protection when dealing with menstruation, and some
women have begun to use eco-friendly menstrual products [37,47,55]. While the results
of this study show that disposal menstrual pads are still being used by the majority,
the number of women using atypical menstrual products, such as cloth menstrual pads,
menstrual cups, and menstrual underpants, is increasing, and consumers were willing to
try such products and experience their benefits. Atypical eco-friendly menstrual products
are the future trend for the development of the market [36,46].

4. Discussion
Regarding consumers’ cognition and willingness to use eco-friendly menstrual prod-
ucts, interviews with experts showed that people have a certain understanding of en-
vironmental protection, which is the main factor affecting social conduct, and women
hold positive and open opinions about menstruation and their body. The results of the
questionnaire analysis support experts’ conclusions regarding products available in the
market. According to the analysis tables of women’s concerns about the use of menstrual
pads and their motivations for using eco-friendly menstrual products, eco-friendliness was
the greatest concern among consumers, and according to the investigation and analysis
of consumers’ cognition of sustainability and menstruation, all the subjects had positive
cognition, and this result showed little difference between the different clusters regarding
willingness to use eco-friendly menstrual products. In conclusion, modern women have
learned about eco-friendly menstrual products from the Internet, and their opinions of
eco-friendly menstrual products were based on positive and open cognition of the body,
as well as the sense of identity to environmental protection, and they were willing to use
relevant products [1,46]. However, regarding their concerns about the use of such prod-
ucts, women decided to purchase eco-friendly menstrual products based on their needs
in life; thus, in order to meet the needs of different female groups during menstruation
and improve their willingness to purchase and use the products, the products should be
promoted according to consumers’ lifestyles [36,37,47].
Female groups with different lifestyles had different considerations in purchasing
eco-friendly menstrual products. The qualitative results of expert interviews and the
quantitative results of the questionnaire investigation focused on lifestyles and divided
female consumers into those seeking new information and trends, those subject to economic
restrictions and wanting to try something new, and those pursuing a conservative and
stable life. Those seeking new information and trends were curious about trends, paid close
attention to new information, had a basic sense of identity with eco-friendly menstrual
products, attached importance to the value attached to the products, including the eco-
friendly characteristics and concept of the products, and broke the established impression
of feeling discomfort during menstruation. As they valued the strength of eco-friendly
menstrual products to solve the inadaptability of menstrual pads, the use of the products
did not stop them from purchasing the products. Those subject to economic restriction and
wanting to try something new valued the added value of products and attached importance
to the availability of product information to avoid wasting money, meaning they would
be more willing to purchase an emerging eco-friendly menstrual product when adequate
information is available. Moreover, the inherent strengths of the products, such as money-
saving, convenience, the ability to be combined with other menstrual products, and the
ease of observing menstrual blood, were also the considerations to purchase eco-friendly
menstrual products. Those pursuing a conservative and stable life preferred to maintain
their current lifestyle and did not pursue unfamiliar popular things; thus, they had more
considerations, such as product performance and added value, when purchasing menstrual
products. Compared with other groups, while they thought comprehensively, they attached
less importance to the use of the products. The results of the expert interviews indicated
that female consumers were not overly concerned with inconvenience when dealing with
Int. J. Environ. Res. Public Health 2021, 18, 5534 17 of 20

and learning about eco-friendly menstrual products or their inadaptability to invasive

products, which is in line with the aforesaid argument that “women’s opinions on eco-
friendly menstrual products were based on positive and open cognition of the body”,
meaning there is positive feedback on the promotion of eco-friendly menstrual products.
Regarding the importance factors of eco-friendly menstrual products for consumers,
the analysis of concerns about the “use of menstrual pads” and the “motivations to use
eco-friendly menstrual products” analysis results show that consumers attach the highest
importance to “eco-friendliness” and “comfort” of products, which is in line with the
results of expert interviews. When purchasing menstrual products, consumers pursue
comfortable products.
The questionnaire results of consumers’ concerns about the use of eco-friendly men-
strual products were evenly distributed, which made it impossible to analyze the distinction
between significant factors; therefore, the analysis results of expert interviews should be
highlighted. All three experts mentioned that society is not friendly to users of eco-friendly
menstrual products, and it is more difficult to adapt to menstrual cups because there
are high initial costs in finding the most suitable type of menstrual cup, and their use
requires the collection of comprehensive and complex information [4]. Users can use
eco-friendly menstrual products properly only when they have a good understanding of
the physiology [31].

Limitations and Recommendations

The eco-friendly menstrual products referred to in this study are made of materials that
can be reused after cleaning and disinfection and mainly include the cloth menstrual pads,
menstrual cups, and menstrual underpants popular in the market. Women reach menarche
between 12 and 18 years old and menolipsis between 48 and 52 years old. Considering that
subjects have to be economically independent, in order to maximize the average age of
menolipsis of the subjects, and comprehensively learn about the opinions of young, adult,
and middle-aged women with different social and cultural backgrounds, women aged from
18 to 50 years old were included as subjects in this study. The questionnaire used in this
study was a self-compiled scale, and the understanding of it by subjects might be affected
by the expression of its contents; thus, there may be deviations in the feedback. This study
investigated only a limited scope of groups, and the subjects were all Taiwanese; thus,
the results of the questionnaire investigation cannot be applied to groups in other countries.
Relevant brands in the market have explicitly expressed their philosophies on the
products’ added value; thus, the first step is to disclose more information of the products
in the market, which is also an aspect that needs improvement in the future. Adequate
feedback could further reduce consumers’ concerns regarding emerging menstrual prod-
ucts and improve the usage rate of such products [2,3]. While consumers attach higher
importance to the performance and benefits of products, rather than their weaknesses in
use, they have to overcome the social restrictions in use, such as the unfriendly environ-
ment and lack of facilities. Facilities in publicly accessible toilets, as well as in private
enterprises, should be improved to provide users of eco-friendly menstrual products with
a friendly environment to deal with the needs of menstruation [53]. Moreover, society does
not provide adequate education for physiology and sanitation. Although the results of
this study show that most women had positive and open cognition of the body, they are
still at risk of infection due to improper knowledge of the body and inadequate prepara-
tion for when the development of menstrual products reaches its peak in the future [2,3].
Most sanitation education and online media still take disposable menstrual pads as their
main samples, which limits the understanding of menstrual products among the majority
of women to the well-known menstrual pads. Therefore, it is necessary to offer adequate
education on health and sanitation to prepare underage girls for menarche [32,33]. As there
are few legal distributors of menstrual cups in Taiwan and the types are not diversified
enough, this results in difficulties for consumers to find the type of cup that suit their
bodies [2,3,6]. Therefore, we recommend that the government or private organizations
Int. J. Environ. Res. Public Health 2021, 18, 5534 18 of 20

develop solutions to the cost issue and launch more brands and models on the market
to allow women to learn about their physical structure and female consumers to buy the
most suitable menstrual cups at the lowest price [27,38,52]. Compared with disposable
menstrual pads, on average, eco-friendly menstrual products are cheaper if used for the
long term, which is an economic motivation for their use and one of the conditions to
promote them, and can provide a reference basis and serve as an indicator for the future
market of menstrual products.

5. Conclusions
This study investigated the impact of consumers’ lifestyle on their cognition and
attitude regarding eco-friendly menstrual products and focused on the factors affecting the
cognition and motivation to purchase by exploring the differences of the considerations of
different groups to purchase eco-friendly menstrual products. According to the analysis
results of consumers’ cognition of sustainability and menstruation, as well as the attitudes
toward different eco-friendly menstrual products, this study conducted clustering based
on lifestyles.
In the future, women should be provided with more education on the correct knowl-
edge of the body and use of menstrual products, in order to reduce the infection rate due
to inadequate knowledge, and underage girls should be provided with more education
on sanitation and physiology. Moreover, the friendliness of the social environment and
facilities in public toilets should be improved, and the government and private enterprises
should make joint efforts to formulate relevant regulations to reduce costs, which would
allow consumers to buy the most suitable menstrual cups at the lowest price and women to
enjoy the full autonomous rights of their bodies. The analysis results of this study provide
a reference basis for persons and promoters engaging in relevant fields, make important
contributions to the menstrual product market, and provide an approach for relevant
studies in the future.

Author Contributions: Conceptualization, T.-Y.L.; data curation, Y.-T.L.; formal analysis, T.-Y.L.;
investigation, T.-Y.L.; methodology, T.-Y.L.; project administration, J.-C.T. and Y.-T.L.; supervision,
J.-C.T.; validation, Y.-T.L.; writing—original draft, T.-Y.L.; writing—review and editing, J.-C.T. All au-
thors have read and agreed to the published version of the manuscript.
Funding: This research received no external funding.
Acknowledgments: This research is grateful for the help of the students of National Yunlin University
of Science and Technology, Chung-Ho, Su from the Department of Animation and Game Design of
Shu-Te University, and Chao-Ming Wang from the Department of Digital Media Design of National
Yunlin University of Science and Technology.
Conflicts of Interest: The authors declare no conflict of interest.

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