{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T22:00:06Z","timestamp":1790114406606,"version":"4.0.1"},"reference-count":31,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Res Protoc"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Adoption of sustainable menstrual products, such as menstrual cups (MCs) and menstrual panties (MPs), remains low in India despite national menstrual hygiene initiatives. Cultural taboos, low awareness, and misinformation are significant barriers. This study develops and evaluates a community-based intervention led by trained community health workers and female teachers to promote sustainable menstrual product use among adolescent girls.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aimed to (1) assess the impact of sensitization and training on the knowledge, attitudes, and practices of community health and education workers; (2) evaluate the effectiveness of their community campaigns in improving girls\u2019 awareness and readiness to adopt MCs and MPs; (3) examine the acceptability and user experience of MCs and MPs over 12 months; and (4) conduct an economic evaluation of MCs and MPs.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This is a mixed methods, 2-phase interventional feasibility study at 2 Indian sites (Kalyani, West Bengal, and Chandigarh and Panchkula, North India), chosen to represent contrasting urban-planned and mixed urban-rural catchments. Phase 1 trains 40 community health and education workers (accredited social health activists, auxiliary nurse midwives, Anganwadi workers, and female teachers), who then deliver structured education to 912 adolescent girls in phase 2. A subset of 406 girls will be allocated to MCs or MPs and followed for 12 months via diaries, home visits, and focus group discussions. Quantitative data will be analyzed in SPSS; qualitative data will undergo reflexive thematic analysis in NVivo, guided by the Behavior Change Wheel and Capability, Opportunity, Motivation\u2013Behavior framework. A cost-utility analysis using EQ-5D-Y and quality-adjusted life-years will assess cost-effectiveness from a societal perspective.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The study is funded by the Indian Council of Medical Research (proposal IIRPSG-2024-01-03552), with funding confirmed in March 2024. Ethics approval was obtained in January 2024 (Postgraduate Institute of Medical Education and Research, Chandigarh) and in April 2024 (All India Institute of Medical Sciences, Kalyani). Phase 1 sensitization was completed at both sites by September 2024, with all 40 workers trained (retention 100%). As of March 2026, 512 of 912 (56%) adolescent girls have completed phase 2 sensitization, and 210 of 406 (52%) have been enrolled and allocated to MCs or MPs in phase 3. Data collection is expected to conclude by December 2026, with analysis in early 2027 and outcome findings to be submitted for publication by late 2027.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n This feasibility study will generate evidence on the acceptability, usability, and cost-effectiveness of a community worker\u2013 and teacher-led model for promoting sustainable menstrual products among adolescent girls, informing scale-up strategies in similar low- and middle-income settings.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/93628","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T21:02:01Z","timestamp":1790110921000},"page":"e93628-e93628","source":"Crossref","is-referenced-by-count":0,"title":["Developing a Community-Based Model for the Adoption of Sustainable Menstrual Products Among Adolescent Girls: Protocol for a 2-Phase Interventional Feasibility Study"],"prefix":"10.2196","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5153-2144","authenticated-orcid":false,"given":"Kapil","family":"Goel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0903-8622","authenticated-orcid":false,"given":"Rekha","family":"Dutt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3877-9956","authenticated-orcid":false,"given":"Madhu","family":"Gupta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1728-142X","authenticated-orcid":false,"given":"Tanvi","family":"Kiran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,9,22]]},"reference":[{"key":"R1","doi-asserted-by":"publisher","DOI":"10.1016\/j.puhip.2022.100352","article-title":"Impact of imparting knowledge and awareness on the usage of menstrual cups: a study based on project \u201cThinkal\u201d at Alappuzha Municipality in Kerala","volume":"5","author":"Varghese","journal-title":"Public Health Pract (Oxf)"},{"issue":"1","key":"R2","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-022-14622-7","article-title":"Menstrual hygiene practices among adolescent women in rural India: a cross-sectional study","volume":"22","author":"Singh","journal-title":"BMC Public Health"},{"issue":"3","key":"R3","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2015-010290","article-title":"Menstrual hygiene management among adolescent girls in India: a systematic review and meta-analysis","volume":"6","author":"van Eijk","journal-title":"BMJ Open"},{"issue":"11","key":"R4","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph15112562","article-title":"Menstrual hygiene management and waste disposal in low and middle income countries-a review of the literature","volume":"15","author":"Elledge","journal-title":"Int J Environ Res Public Health"},{"issue":"Suppl 1","key":"R5","doi-asserted-by":"publisher","first-page":"S637","DOI":"10.4103\/jpbs.jpbs_908_23","article-title":"Knowledge, attitude, perception and practices towards disposal of sanitary napkins among young females: a cross-sectional study","volume":"16","author":"Kattimani","journal-title":"J Pharm Bioallied Sci"},{"issue":"4","key":"R6","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.82780","article-title":"Bridging the knowledge gap: awareness, attitudes, and practices regarding menstrual cup usage among medical students in Chennai, India","volume":"17","author":"Devi R","journal-title":"Cureus"},{"issue":"3","key":"R7","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1515\/ijamh-2023-0185","article-title":"The impact of health education intervention on perceptions of menstrual cup among college going female students in peri-urban Bangalore","volume":"36","author":"James","journal-title":"Int J Adolesc Med Health"},{"issue":"23","key":"R8","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph20237118","article-title":"Period poverty from a public health and legislative perspective","volume":"20","author":"Mann","journal-title":"Int J Environ Res Public Health"},{"issue":"18","key":"R9","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18189766","article-title":"A study of environmentally friendly menstrual absorbents in the context of social change for adolescent girls in low- and middle-income countries","volume":"18","author":"Foster","journal-title":"Int J Environ Res Public Health"},{"issue":"10","key":"R10","first-page":"78","volume":"11","author":"Joesph","journal-title":"Bull Environ Pharmacol Life Sci"},{"issue":"1","key":"R11","doi-asserted-by":"publisher","DOI":"10.1186\/s12905-023-02197-3","article-title":"Reusable period products: use and perceptions among young people in Victoria, Australia","volume":"23","author":"Ramsay","journal-title":"BMC Womens Health"},{"issue":"3","key":"R12","doi-asserted-by":"publisher","first-page":"382","DOI":"10.1111\/ajo.13910","article-title":"Menstrual cup acceptability and functionality in real-world use: a cross-sectional survey of young people in Australia","volume":"65","author":"Hennegan","journal-title":"Aust N Z J Obstet Gynaecol"},{"issue":"2","key":"R13","doi-asserted-by":"publisher","first-page":"918","DOI":"10.18203\/2394-6040.ijcmph20220263","article-title":"Experience and adaptability of menstrual cup as a menstrual hygiene management method among its users in Kerala","volume":"9","author":"C","journal-title":"Int J Community Med Public Health"},{"issue":"1","key":"R14","doi-asserted-by":"publisher","DOI":"10.1186\/s12978-020-01036-0","article-title":"Acceptability and feasibility of using vaginal menstrual cups among schoolgirls in rural Nepal: a qualitative pilot study","volume":"18","author":"Pokhrel","journal-title":"Reprod Health"},{"key":"R15","doi-asserted-by":"crossref","unstructured":"Bisimirwe C Maombi S Nabuki S Mubelelwa L Llosa AE Palacios L . Feasibility and acceptability of menstrual underwear in a conflict and population displacement prone setting of Kalehe, Democratic Republic of the Congo. Research Square. Preprint posted online on Jun 29, 2025. [doi: 10.21203\/rs.3.rs-6938601\/v1]","DOI":"10.21203\/rs.3.rs-6938601\/v1"},{"key":"R16","doi-asserted-by":"publisher","DOI":"10.3389\/fgwh.2024.1497686","article-title":"Suitability, acceptability, feasibility of modern menstrual methods: a qualitative study in Coimbatore district, Tamil Nadu, India","volume":"5","author":"Aparnavi","journal-title":"Front Glob Womens Health"},{"key":"R17","doi-asserted-by":"publisher","DOI":"10.1177\/17455057251407846","article-title":"Perspectives of Indian adolescent girls in promoting menstrual health: a qualitative analysis","volume":"22","author":"Dsilva","journal-title":"Womens Health (Lond)"},{"key":"R18","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-6-42","article-title":"The behaviour change wheel: a new method for characterising and designing behaviour change interventions","volume":"6","author":"Michie","journal-title":"Implement Sci"},{"issue":"6 Pt 2","key":"R19","doi-asserted-by":"publisher","first-page":"2134","DOI":"10.1111\/1475-6773.12117","article-title":"Achieving integration in mixed methods designs-principles and practices","volume":"48","author":"Fetters","journal-title":"Health Serv Res"},{"key":"R20","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i5239","article-title":"CONSORT 2010 statement: extension to randomised pilot and feasibility trials","volume":"355","author":"Eldridge","journal-title":"BMJ"},{"key":"R21","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.e7586","article-title":"SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials","volume":"346","author":"Chan","journal-title":"BMJ"},{"issue":"2","key":"R22","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1111\/j..2002.384.doc.x","article-title":"Design and analysis of pilot studies: recommendations for good practice","volume":"10","author":"Lancaster","journal-title":"J Eval Clin Pract"},{"issue":"4","key":"R23","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1002\/pst.185","article-title":"Sample size of 12 per group rule of thumb for a pilot study","volume":"4","author":"Julious","journal-title":"Pharm Stat"},{"issue":"4","key":"R24","doi-asserted-by":"publisher","first-page":"314","DOI":"10.1007\/s13224-025-02241-2","article-title":"Impact of health education on knowledge, attitude, and practice of menstrual cup use among female medical and allied health science students in South India: a prospective interventional study","volume":"76","author":"Mogallapalli","journal-title":"J Obstet Gynaecol India"},{"issue":"9","key":"R25","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.29690","article-title":"Study of adaptability and efficacy of menstrual cups in managing menstrual health and hygiene: a descriptive longitudinal study","volume":"14","author":"Singh","journal-title":"Cureus"},{"issue":"1","key":"R26","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/26895269.2022.2129597","article-title":"Toward good practice in thematic analysis: avoiding common problems and be(com)ing a researcher","volume":"24","author":"Braun","journal-title":"Int J Transgend Health"},{"key":"R27","unstructured":"Lincoln YS Guba EG . Naturalistic Inquiry. Sage Publications; 1985. ISBN: 9780803924314"},{"issue":"6","key":"R28","doi-asserted-by":"publisher","first-page":"875","DOI":"10.1007\/s11136-010-9648-y","article-title":"Development of the EQ-5D-Y: a child-friendly version of the EQ-5D","volume":"19","author":"Wille","journal-title":"Qual Life Res"},{"issue":"6","key":"R29","doi-asserted-by":"publisher","first-page":"887","DOI":"10.1007\/s11136-010-9649-x","article-title":"Feasibility, reliability, and validity of the EQ-5D-Y: results from a multinational study","volume":"19","author":"Ravens-Sieberer","journal-title":"Qual Life Res"},{"issue":"1","key":"R30","doi-asserted-by":"publisher","DOI":"10.1186\/s41687-026-01028-x","article-title":"The feasibility and validity of the EQ-5D-Y and CHU9D in a challenging context: adolescent mental health in India","volume":"10","author":"Perry","journal-title":"J Patient Rep Outcomes"},{"issue":"1","key":"R31","doi-asserted-by":"publisher","first-page":"773","DOI":"10.1089\/whr.2021.0131","article-title":"Cost-effectiveness and cost-benefit analyses of providing menstrual cups and sanitary pads to schoolgirls in rural Kenya","volume":"3","author":"Babagoli","journal-title":"Womens Health Rep (New Rochelle)"}],"container-title":["JMIR Research Protocols"],"original-title":[],"language":"en","deposited":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T21:02:03Z","timestamp":1790110923000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.researchprotocols.org\/2026\/1\/e93628"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,22]]},"references-count":31,"URL":"https:\/\/doi.org\/10.2196\/93628","relation":{},"ISSN":["1929-0748"],"issn-type":[{"value":"1929-0748","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,22]]},"article-number":"v15i1e93628"}}