{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T16:19:34Z","timestamp":1787847574250,"version":"build-2784847793"},"reference-count":38,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Despite the cost, disposal issues, risk of infections and environmental burden, sanitary pads continue to be the most used method of menstrual hygiene among young women in India. Menstrual cups are a safer, cost-effective and environmentally friendly option, but acceptance is very low because of myths, cultural taboos and absence of organised education. There has been no randomised trial in Sikkim to assess a menstrual cup awareness and use promotion intervention. This study is designed to assess the effect of a Nurse-Led Menstrual Hygiene Management Package (NL-MHMP) on awareness, perception and sustained use of menstrual cups among university students.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>MATERIALS AND METHODS:<\/jats:title>\n                    <jats:p>A randomised active wait list-controlled trial will be conducted among 140 undergraduate female students (18\u201325 years) using proportionate stratified sampling technique from government and private universities in Gangtok, Sikkim and simple randomisation will be used to allocate participants into intervention and wait list groups. The NL-MHMP includes a 15-minute teaching session, audiovisual demonstration, graphical hand-out, clarification session, and the distribution of two ISO-certified menstrual cups with digital follow-up for six menstrual cycles. The primary outcome is sustained adoption of menstrual cup use among sanitary pad users. Secondary outcomes include changes in awareness, attitude, acceptability, adaptability, misconceptions, satisfaction, and preference toward menstrual cups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION:<\/jats:title>\n                    <jats:p>This nurse-led, digitally supported intervention offers a structured and scalable approach to improving menstrual health literacy and promoting sustainable menstrual hygiene practices among young women in Sikkim. Findings may inform university-based health programs and contribute to evidence-based policy initiatives supporting eco-friendly menstrual products.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>TRIAL REGISTRATION:<\/jats:title>\n                    <jats:p>The study is registered on 19\/06\/2025 in the Clinical Trial Registry India with trial ID: CTRI\/2025\/06\/089117, prospectively registered.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/jehp.jehp_4_26","type":"journal-article","created":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T05:00:53Z","timestamp":1780030853000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Nurse-led menstrual hygiene management package to improve menstrual health practices among university students: Randomised waitlist-controlled protocol study"],"prefix":"10.4103","volume":"15","author":[{"given":"Ranjita","family":"Devi","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, Gangtok, Sikkim, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barkha","family":"Devi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Nursing, Sikkim Manipal College of Nursing, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, Gangtok, Sikkim, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rubi","family":"Dey","sequence":"additional","affiliation":[{"name":"Department of Physiology, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, Gangtok, Sikkim, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shraddha","family":"Deokota","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, Gangtok, Sikkim, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,5]]},"reference":[{"key":"R1-20260529","doi-asserted-by":"crossref","first-page":"184","DOI":"10.4103\/2249-4863.154627","article-title":"Menstruation related myths in India: Strategies for combating it","volume":"4","author":"Garg","year":"2015","journal-title":"J Family Med Prim Care"},{"key":"R2-20260529","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1097\/OGX.0000000000000443","article-title":"Menstrual hygiene management in resource-poor countries","volume":"72","author":"Kuhlmann","year":"2017","journal-title":"Obstet Gynecol Surv"},{"key":"R4-20260529","doi-asserted-by":"crossref","first-page":"33032","DOI":"10.3402\/gha.v9.33032","article-title":"Menstrual hygiene management among adolescent schoolgirls in low- and middle-income countries: Research priorities","volume":"9","author":"Phillips-Howard","year":"2016","journal-title":"Glob Health Action"},{"key":"R5-20260529","doi-asserted-by":"crossref","first-page":"223","DOI":"10.2471\/BLT.24.291421","article-title":"Environmental impact of menstrual hygiene products","volume":"103","author":"Aujla","year":"2025","journal-title":"Bull World Health Organ"},{"key":"R6-20260529","doi-asserted-by":"crossref","first-page":"163","DOI":"10.4103\/jehp.jehp_558_24","article-title":"Menstrual hygiene practices among teens and reproductive age group women: A cross-sectional study","volume":"14","author":"Sreeja","year":"2025","journal-title":"J Educ Health Promot"},{"key":"R7-20260529","doi-asserted-by":"crossref","first-page":"140","DOI":"10.4103\/jehp.jehp_2123_23","article-title":"Gamification for pubertal and menstrual health education in adolescent girls: Study protocol","volume":"14","author":"Nazmi","year":"2025","journal-title":"J Educ Health Promot"},{"key":"R8-20260529","doi-asserted-by":"crossref","first-page":"e0290350","DOI":"10.1371\/journal.pone.0290350","article-title":"What socio-demographic factors support disposable vs. sustainable menstrual choices? 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