{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T17:39:29Z","timestamp":1783186769863,"version":"3.54.6"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T00:00:00Z","timestamp":1748563200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T00:00:00Z","timestamp":1748563200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100012143","name":"Clifford B. Kinley Trust","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100012143","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Health Serv Res"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>People experiencing homelessness (PEH) face heightened barriers to menstrual health, including limited access to products, hygiene facilities, and consistent care. Social service providers (SSPs) and healthcare providers (HCPs) are critical in supporting PEH but often work within resource-constrained systems. This study explores SSP and HCP perspectives on the menstrual health needs of PEH in a rural-serving community in the U.S., using the Social-Ecological Model (SEM) to identify multilevel barriers and opportunities for intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted semi-structured interviews with 12 SSPs and HCPs in Tippecanoe County, Indiana. Transcripts were analyzed using thematic analysis to identify key challenges and recommendations related to menstrual health support for PEH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Our analysis revealed complex challenges providers faced in supporting the menstrual health of PEH, including emotional burden, resource scarcity, and limited organizational guidance. They described how stigma, provider discomfort, and systemic gaps in training and infrastructure hindered effective care. Providers also shared that menstrual health was often deprioritized due to competing health needs and structural barriers such as lack of housing, transportation, and product access. Despite these challenges, providers offered actionable recommendations to improve menstrual health support through education, policy change, and more equitable organizational practices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study highlights the multi-level barriers providers face when supporting the menstrual health needs of PEH. Our findings show that meaningful change requires coordinated efforts across all levels of the SEM. Actionable strategies include provider training, improved intake processes, expanded access to menstrual products and hygiene resources, and policy reforms to address housing and insurance gaps. These insights can inform training programs, shelter protocols, and advocacy efforts to promote menstrual health equity and provider sustainability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12913-025-12932-1","type":"journal-article","created":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T06:42:24Z","timestamp":1748587344000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Supporting menstrual health in homeless services: provider-informed strategies for multilevel change"],"prefix":"10.1186","volume":"25","author":[{"given":"Emma","family":"Schnolis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofia","family":"Hrubiak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anukriti","family":"Arora","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kinzie","family":"Gamaleldin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Martinez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Risa","family":"Cromer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yumary","family":"Ruiz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia M.","family":"Rodriguez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea L.","family":"DeMaria","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,5,30]]},"reference":[{"key":"12932_CR1","unstructured":"1. HUD. The 2022 Annual Homelessness Assessment Report (AHAR) to Congress. 2022. Available from: https:\/\/www.huduser.gov\/portal\/sites\/default\/files\/pdf\/2022-AHAR-Part-1.pdf. [cited 2023 Jan 28]."},{"key":"12932_CR2","doi-asserted-by":"crossref","unstructured":"2. Gruer C, Hopper K, Smith RC, et al. Seeking menstrual products: a qualitative exploration of the unmet menstrual needs of individuals experiencing homelessness in New York City. Reprod Health. 2021;18(1):77.","DOI":"10.1186\/s12978-021-01133-8"},{"key":"12932_CR3","doi-asserted-by":"crossref","unstructured":"3. Sommer M, Gruer C, Smith RC, et al. Menstruation and homelessness: Challenges faced living in shelters and on the street in New York City. Health Place. 2020;66:102431.","DOI":"10.1016\/j.healthplace.2020.102431"},{"key":"12932_CR4","doi-asserted-by":"crossref","unstructured":"4. Ballard AM, Hoover AT, Rodriguez AV, et al. Emphasizing Choice and Autonomy in Personal Hygiene, Menstrual Health, and Sexual Health Product Distribution to People Experiencing Homelessness in Atlanta, Georgia During COVID-19. Health Promot Pract. 2021;22(6):764\u2013766.","DOI":"10.1177\/15248399211024996"},{"key":"12932_CR5","doi-asserted-by":"crossref","unstructured":"5. Orsini GD, Tarabay J, Hardy-Johnson PL, et al. The homeless period: a qualitative evidence synthesis. Women Health. 2024;64(3):250\u2013260.","DOI":"10.1080\/03630242.2024.2310716"},{"key":"12932_CR6","doi-asserted-by":"crossref","unstructured":"6. Head A, Lim MSC, Orozco A, et al. \u201cBasically, my answer is, there needs to be options!\u201d Recommendations for the delivery of free menstrual products to the public: A qualitative exploration among marginalised groups in Victoria, Australia. Aust New Zealand J Public Health. 2025;49(1):100219.","DOI":"10.1016\/j.anzjph.2024.100219"},{"key":"12932_CR7","doi-asserted-by":"crossref","unstructured":"7. Rohatgi A, Dash S. Period poverty and mental health of menstruators during COVID-19 pandemic: Lessons and implications for the future. Front Glob Womens Health. 2023;4:1128169.","DOI":"10.3389\/fgwh.2023.1128169"},{"key":"12932_CR8","unstructured":"8. Stewart N. \u2018It\u2019s a Time Bomb\u2019: 23 Die as Virus Hits Packed Homeless Shelters. The New York Times. 2020. Available from: https:\/\/www.nytimes.com\/2020\/04\/13\/nyregion\/new-york-coronavirus-homeless.html."},{"key":"12932_CR9","unstructured":"9. Fuller T. Coronavirus Outbreak Has America\u2019s Homeless at Risk of \u201cDisaster\u201d. The New York Times. 2020. Available from: https:\/\/www.nytimes.com\/2020\/03\/10\/us\/coronavirus-homeless.html."},{"key":"12932_CR10","doi-asserted-by":"crossref","unstructured":"10. Wood LJ. Homelessness: the imperative for a public health response. Aust New Zealand J Public Health. 2020;44(5):341\u2013345.","DOI":"10.1111\/1753-6405.13034"},{"key":"12932_CR11","doi-asserted-by":"crossref","unstructured":"11. Rodriguez NM, Lahey AM, MacNeill JJ, et al. Homelessness during COVID-19: challenges, responses, and lessons learned from homeless service providers in Tippecanoe County, Indiana. BMC Public Health. 2021;21(1):1657.","DOI":"10.1186\/s12889-021-11687-8"},{"key":"12932_CR12","doi-asserted-by":"crossref","unstructured":"12. Rodriguez NM, Martinez RG, Ziolkowski R, et al. \u201cCOVID knocked me straight into the dirt\u201d: perspectives from people experiencing homelessness on the impacts of the COVID-19 pandemic. BMC Public Health. 2022;22(1):1327.","DOI":"10.1186\/s12889-022-13748-y"},{"key":"12932_CR13","doi-asserted-by":"crossref","unstructured":"13. Rodriguez NM, Cromer R, Martinez RG, et al. Impact of COVID-19 on People Experiencing Homelessness: A Call for Critical Accountability. Am J Public Health. 2022;112(6):828\u2013831.","DOI":"10.2105\/AJPH.2022.306768"},{"key":"12932_CR14","doi-asserted-by":"crossref","unstructured":"14. Hennegan J, Winkler IT, Bobel C, et al. Menstrual health: a definition for policy, practice, and research. Sex Reprod Health Matters. 2021;29(1):1911618.","DOI":"10.1080\/26410397.2021.1911618"},{"key":"12932_CR15","doi-asserted-by":"crossref","unstructured":"15. Davies A, Wood LJ. Homeless health care: meeting the challenges of providing primary care. Med J Aust. 2018;209(5):230\u2013234.","DOI":"10.5694\/mja17.01264"},{"key":"12932_CR16","doi-asserted-by":"crossref","unstructured":"16. Salem BE, Kwon J, Ames M. On the Frontlines: Perspectives of Providers Working With Homeless Women. West J Nurs Res. 2018;40(5):665\u2013687.","DOI":"10.1177\/0193945916689081"},{"key":"12932_CR17","doi-asserted-by":"crossref","unstructured":"17. Olivet J, McGraw S, Grandin M, et al. Staffing Challenges and Strategies for Organizations Serving Individuals who have Experienced Chronic Homelessness. J Behav Health Serv Res. 2010;37(2):226\u2013238.","DOI":"10.1007\/s11414-009-9201-3"},{"key":"12932_CR18","doi-asserted-by":"crossref","unstructured":"18. Rodriguez NM, Ziolkowski R, Hicks J, et al. Infectious Disease Preparedness for Homeless Populations: Recommendations from a Community-Academic Partnership| Progress in Community Health Partnerships: Research, Education, and Action. 2023 [cited 2023 Aug 10];","DOI":"10.1353\/cpr.2024.a922335"},{"key":"12932_CR19","unstructured":"19. CDC. The Social-Ecological Model: A Framework for Prevention. Centers for Disease Control and Prevention. 2021. Available from: https:\/\/www.cdc.gov\/violenceprevention\/about\/social-ecologicalmodel.html. [cited 2021 Apr 1]."},{"key":"12932_CR20","doi-asserted-by":"crossref","unstructured":"20. DeMaria AL, Martinez R, Otten E, et al. Menstruating while homeless: navigating access to products, spaces, and services. BMC Public Health. 2024;24(1):909.","DOI":"10.1186\/s12889-024-18379-z"},{"key":"12932_CR21","unstructured":"21. ElBanna B, Dell NA, Klier M. Menstrual Hygiene Management among Homeless Women With Mental Illness in St. Louis Metropolitan Area: A Qualitative Study. Women\u2019s Reprod Health. 2022;0(0):1\u201317."},{"key":"12932_CR22","doi-asserted-by":"crossref","unstructured":"22. Clarke V, Braun V. Thematic analysis. J Positive Psychol. 2017;12(3):297\u2013298.","DOI":"10.1080\/17439760.2016.1262613"},{"key":"12932_CR23","doi-asserted-by":"crossref","unstructured":"23. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77\u2013101.","DOI":"10.1191\/1478088706qp063oa"},{"key":"12932_CR24","unstructured":"24. Braun V, Clarke V. One size fits all? What counts as quality practice in (reflexive) thematic analysis?. Qual Res Psychol. 2020;0(0):1\u201325."},{"key":"12932_CR25","doi-asserted-by":"crossref","unstructured":"25. Lucarelli A, Silva AAF da. Analysis to assess menstrual poverty in vulnerable and non-vulnerable populations served in a public service in Brazil. J Health & Biol Sci. 2024;12(1):1\u20135.","DOI":"10.12662\/2317-3076jhbs.v12i1.5587.p1-5.2024"},{"key":"12932_CR26","unstructured":"26. Cooke V. Period Poverty and Women\u2019s Access to Menstrual Products. J Act Scie Technol Educ. 2024;13(1):23\u20138. [cited 2025 Apr 14]."}],"container-title":["BMC Health Services Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12913-025-12932-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12913-025-12932-1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12913-025-12932-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T12:40:11Z","timestamp":1781613611000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12913-025-12932-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,30]]},"references-count":26,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["12932"],"URL":"https:\/\/doi.org\/10.1186\/s12913-025-12932-1","relation":{},"ISSN":["1472-6963"],"issn-type":[{"value":"1472-6963","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,30]]},"assertion":[{"value":"25 March 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 May 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 May 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Purdue University (Approved June 17, 2021. IRB-2021-17). All participants gave verbal informed consent.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"778"}}