Supporting adolescent menstrual health to improve participation and performance in physical activity: rapid realist review to inform a logic model for intervention development
8 affiliations
- 1School of Medicine, Cardiff University, Cardiff, UK
- 2Women’s Health Research Wales, Cardiff, UK
- 3Glamorgan Valleys Vocational Training Scheme, Cardiff, UK
- 4PRIME Centre Wales, Cardiff, UK
- 5Cardiff University, Cardiff, UK
- 6Health and Care Research Wales Evidence Centre, Cardiff, UK
- 7Swansea University, Swansea, UK
- 8School of Psychology, Cardiff University, Cardiff, Wales, UK
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 initial programme theories (context-mechanism-outcome configurations, CMOCs) 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 (Medline, AMED, Embase, Psycinfo, CINAHL, ERIC, SCOPUS; June 2025) and grey literature searches guided by stakeholder expertise. Articles were selected that met inclusion criteria and contributed to theory development. Explanatory statements were extracted and synthesised into CMOCs using Pawson’s reasoning processes and mapped onto Self-Determination Theory concepts (autonomy, competency, relatedness).Results From 9585 database hits, 63 articles were included. Three generated initial programme theories describe 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 (M), communication and trust (M)—to empower individuals to enhance their own menstrual health (M) and potentially improve participation rates and performance in physical activity (O). Alternative causal pathways describe potential adverse outcomes when processes are not in place to: signpost to medical support if needed (M), support user trust in how and why data are collected and used (M) and enable understanding of the limitations of menstrual health support tools (M). Contextual data are needed to further refine these theories that are presented as a logic model.Conclusion The proposed logic model can be used to inform and evaluate future interventions aimed at overcoming menstrual health related barriers with physical activity.PROSPERO registration CRD420251066742.
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BibTeX
@article{cooper2026supporting,
title = {{Supporting adolescent menstrual health to improve participation and performance in physical activity: rapid realist review to inform a logic model for intervention development}},
author = {Alison Cooper and Ainah Mahaiyuddin and Daniel Sim and Freya Davies and Elizabeth Gillen and Natalie Brown and Adrian Edwards and Jacky Boivin},
journal = {BMJ Open},
year = {2026},
month = oct,
doi = {10.1136/bmjopen-2026-118584},
url = {https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-118584},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Supporting adolescent menstrual health to improve participation and performance in physical activity: rapid realist review to inform a logic model for intervention development
AU - Alison Cooper
AU - Ainah Mahaiyuddin
AU - Daniel Sim
AU - Freya Davies
AU - Elizabeth Gillen
AU - Natalie Brown
AU - Adrian Edwards
AU - Jacky Boivin
PY - 2026
DA - 2026/10/23
JO - BMJ Open
DO - 10.1136/bmjopen-2026-118584
UR - https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-118584
AB - 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 initial programme theories (context-mechanism-outcome configurations, CMOCs) 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 (Medline, AMED, Embase, Psycinfo, CINAHL, ERIC, SCOPUS; June 2025) and grey literature searches guided by stakeholder expertise. Articles were selected that met inclusion criteria and contributed to theory development. Explanatory statements were extracted and synthesised into CMOCs using Pawson’s reasoning processes and mapped onto Self-Determination Theory concepts (autonomy, competency, relatedness).Results From 9585 database hits, 63 articles were included. Three generated initial programme theories describe 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 (M), communication and trust (M)—to empower individuals to enhance their own menstrual health (M) and potentially improve participation rates and performance in physical activity (O). Alternative causal pathways describe potential adverse outcomes when processes are not in place to: signpost to medical support if needed (M), support user trust in how and why data are collected and used (M) and enable understanding of the limitations of menstrual health support tools (M). Contextual data are needed to further refine these theories that are presented as a logic model.Conclusion The proposed logic model can be used to inform and evaluate future interventions aimed at overcoming menstrual health related barriers with physical activity.PROSPERO registration CRD420251066742.
SN - 2044-6055
SN - 2044-6055
ER -