Work

Supporting adolescent menstrual health to improve participation and performance in physical activity: rapid realist review to inform a logic model for intervention development

Year: 2026

Type: article

Abstract: Background Insufficient physical activity is higher in women and girls globally with increased risk of non-communicable diseases. Menstrual (period related) symptoms are a recognised barrier to adolescents engaging in physical activity. There is a lack of evidence-based guidance to address this barrier. Objective To develop a set of programme theories (context-mechanism-outcome configurations, CMOs) to describe how existing menstrual health support interventions work, for whom, how and in what circumstances to inform a logic model for intervention development. Design Rapid realist review Methods Formal, double screened, database and grey literature searches (Medline, AMED, Embase, Psycinfo, CINAHL, ERIC, SCOPUS) guided by stakeholder expertise. Articles were selected that met inclusion criteria and contributed to theory development. Explanatory statements were extracted and synthesised into CMOs using Pawson’s reasoning processes, mapped onto Self-Determination Theory concepts (autonomy, competency, relatedness). Results From 9585 database hits, 63 articles were included. Generated programme theories described how four identified intervention domains (education; practicalities including toilet facilities, clothing and free accessible period products; menstrual cycle tracking and screening tools; and medical support if needed) could improve menstrual health confidence and understanding, communication and trust - to empower individuals to enhance their own menstrual health and potentially improve participation rates and performance in physical activity. Adverse outcomes were described when processes were not in place to: signpost to medical support if needed, support user trust in how and why data were collected and used, and enable understanding of the limitations of menstrual health support tools. Conclusion The proposed logic model can be used to inform and evaluate future interventions aimed at overcoming menstrual health related barriers with physical activity.

Source: BMJ Open

DOI: 10.1136/bmjopen-2026-118584