{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T14:01:49Z","timestamp":1767794509885,"version":"3.49.0"},"reference-count":58,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T00:00:00Z","timestamp":1755561600000},"content-version":"unspecified","delay-in-days":18,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Flo Health UK Limited","award":["Not applicable"],"award-info":[{"award-number":["Not applicable"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2025,6,9]]},"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Over two billion people menstruate worldwide. Many lack the resources and knowledge to manage their menstruation, which can lead to reproductive health issues and stigma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This longitudinal study set out to describe menstrual health and hygiene (MHH) knowledge levels among adult women across global regions and estimate changes in knowledge from exposure to health information through the mobile application (app) Flo Health. Furthermore, the study quantified changes for psychosocial, menstrual and quality of life outcomes and explored whether these were mediated by improvements in MHH knowledge. At installation of the Flo app, 6165 participants across 52 countries were recruited for a baseline assessment. Follow-up data collection was conducted after at least 3\u2009months of app access. Two study designs were used, following 513 respondents in a pre\u2013post design and recruiting an additional 1346 respondents to match to baseline participants lost to follow-up in a repeated cross-sectional design.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>MHH knowledge was low at baseline, with on average only one-third of knowledge quiz questions answered correctly. Compared with the baseline, MHH knowledge was 18.7% higher in the matched sample, while it increased by 8.1% in the pre\u2013post sample after 3 or more months of access to Flo. Other changes included higher menstrual awareness (matched and pre\u2013post: 9.0%), sexually transmitted infection awareness (matched: 1.7%; pre\u2013post: +3.1%), quality of life (matched: +1.8%; pre\u2013post: +3.5%) and lower menstrual stigma (matched: \u22128.1%) and menstrual impact on daily life (pre\u2013post: \u22126.7%). In the matched sample between 23 and 66% of associations between app access and select outcomes were mediated by MHH knowledge.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The poor MHH knowledge found in this study highlights the opportunities for improvement, which in turn could lead to better psychosocial, menstrual and quality of life outcomes. Mobile apps may represent an important tool for better MHH knowledge and associated benefits at scale.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2025-002822","type":"journal-article","created":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T14:20:23Z","timestamp":1755613223000},"page":"e002822","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of the Flo Cycle Tracking App on menstrual knowledge and health in low-income and middle-income countries: a longitudinal study"],"prefix":"10.1136","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7585-0120","authenticated-orcid":false,"given":"Frederick G B","family":"Goddard","sequence":"first","affiliation":[{"name":"Flo Health UK Limited, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carley","family":"Prentice","sequence":"additional","affiliation":[{"name":"Flo Health UK Limited, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam C","family":"Cunningham","sequence":"additional","affiliation":[{"name":"Flo Health UK Limited, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"April M","family":"Ballard","sequence":"additional","affiliation":[{"name":"Georgia State University School of Public Health, Atlanta, Georgia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liudmila","family":"Zhaunova","sequence":"additional","affiliation":[{"name":"Flo Health UK Limited, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,8,19]]},"reference":[{"key":"2026010703060664000_3.2.e002822.1","unstructured":"UNICEF and WHO . 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