Table 2.
Characteristics of included studies.
| Study ID | Requirement/s for MH addressed | Country | Year of study | Study design | Participants | Study aim, intervention and control conditions | Time to follow up | Outcomes, and methods of assessment |
|---|---|---|---|---|---|---|---|---|
| Single MH requirement addressed | ||||||||
| Al Ajeel 202018 | Care for discomforts and disorders. | Malaysia. | 2017–2018 | CBA |
Total: 480 (Intervention: 268, Control: 212) Adolescent girls (students) with Primary Dysmenorrhea Age 13–18. |
Test effectiveness of Primary Dysmenorrhea (PD) Education on knowledge and self-care. Intervention: Participants received a 30-min health education session covering menstruation, PD and PD self-care methods. Lecture, debate, exchange of experiences and PD information pamphlet were used to deliver the program. Control. No intervention. Booklet provided at end of study. |
2 months post-intervention. |
PD Knowledge: Score on 20-item Knowledge of Primary Dysmenorrhea (KoPD) scale.19,20 PD Self-care: Score on 40 item Adolescent Dysmenorrhea Self-Care scale (ADSCS) (6-subscales: 4 items in searching for knowledge, 6 items for expressing emotions, 4 items in seeking assistance, 7 items in control over external factors, 14 in resource utilisation, 5 items in self-control).21 |
| Bustan 201822 | Care for discomforts and disorders. | Indonesia. | Not reported | CBA |
Total: 96 (Intervention: 48, Control: 48) Female nursing students. Experienced PD in past 6-months. Age 18–19. Rural Setting. |
Test effectiveness of abdominal stretching for decreasing PD pain. Intervention: Participants received instructions on how to conduct abdominal stretching. Participants undertook 10–15 min of abdominal stretching twice weekly for three weeks. Control: No intervention. |
After the 3-week intervention period. | Pain: Self-rated on Likert scale (0–5). |
| Djupri 202223 | Care for discomforts and disorders. | Indonesia. | Not reported | CBA |
Total: 58 (Intervention: 29, Control: 29) Female students. Age 16–17. Urban Vocational School. |
Test effectiveness of pelvic rocking and Buteyko breathing exercises on reducing PD pain. Intervention: Intervention content not reported. Participants received 30-min sessions across two days. Control: Not reported. Assumed no intervention. |
Immediate. | Pain: Self-rated on Likert scale (0–10). |
| Downing 202124 | Materials, facilities, and services. | Vanuatu. | 2019 | RCT |
Total: 192 (136 follow up). Women and girls in disaster effected settings. Age 15–45. One rural and one urban setting. |
Compare experience and preferences for menstrual products for inclusion in MHM kits in disaster settings. Intervention/comparison 1: One packet Maxfree disposable pads were provided. Participants were given 2-months to trial pads. Products were provided along with a kit (containing clothesline and pegs, underwear x 2, soap, and detergent), with verbal information on use from research team. Intervention/comparison 2: One packet of Modess disposable pads were provided. Participants were given 2-months to trial pads. Products were provided along with a kit, and verbal education. Intervention/comparison 3: One packet Mumma's Laef reusable pads were provided. Participants were given 2-months to trial pads. Products were provided along with a kit, verbal education and manufacturers written instructions. Intervention/comparison 4: One packet AFRIpads reusable pads were provided. Participants were given 2-months to trial pads. Products were provided along with a kit, verbal education and manufacturers written instructions. |
2 months post-intervention. |
Acceptability of sanitary product: Assessed using an investigator developed 6-item (fit, comfort, leakage, smell, changing, likelihood of recommending) questionnaire. The study was mixed methods, qualitative feedback on product use experience collected. |
| Juan 201625 | Care for discomforts and disorders. | China. | 2014–2015 | cRCT |
Total: 391 (Intervention 195, Control: 196) Female university students with PD. Age 18–20. |
Test effectiveness of self-management education to improve PD symptoms and quality of life (QoL). Intervention: Participants received self-management education covering knowledge about PD, safe medication, non-pharmacological treatment (massage, pressure points, acupuncture) menstrual care, exercise, diet, social activities, psychological regulation, emotional, and interpersonal management. The intervention was delivered over 2-months, through lectures, group and individual counselling sessions, and a series of workshops. Participants then carried out self-management for 6-months. Control: No intervention. |
Followed up for 6 months (observation period). |
PD symptoms: Score on Dysmenorrhea Symptom questionnaire based on Dysmenorrhea Symptom Criteria in the Guidelines for Clinical Research on New Chinese medicines.26 Pain: Self-rated on the Visual Analogue Scale (VAS) (0–10) QoL: Score on 8-item Chinese version27 of the SF-36 scale. |
| Nguyen 201528 | Information and education. | Vietnam. | Not reported | Non-randomised trial |
Total: 928 (Intervention: 459, Control: 469) Adolescent school students from 1 urban and 1 rural school. |
Test effectiveness of an Sexual and Reproductive Health (SRH) education session to improve puberty and SRH knowledge. Intervention: 45-min reproductive health education lecture, with opportunities for questions and discussion. Presumed to be delivered by investigators. Menstruation included as part of SRH education. No further details on education content were reported. Outcomes indicate topics included puberty, reproductive systems, fertility, and possibly the menstrual cycle. Control: No intervention. |
2 weeks post-intervention. |
SRH Knowledge: Correct responses to investigator-developed knowledge quiz items (no. items not reported). Knowledge test items related to the menstrual cycle included:
|
| Nik Farid 201829 | Information and education. | Malaysia. | 2013–2015 | RCT |
Total: 209 (Intervention: 101, Control: 108) Adolescent school students. Aged 12. Urban setting. |
Compare effectiveness of SRH Education delivery methods for SRH knowledge and attitudes. Intervention: Module of 17 topics, including menstruation, female reproductive systems, and physical development during puberty delivered online. After an introduction, participants had 1.5-h to navigate the website containing videos, informational graphs, and articles. Comparison: Module of 17 topics, including menstruation, female reproductive systems, and physical development during puberty. Modules were delivered by a public health specialist as a 3-h in-person educational session (conventional method), using flyers and group discussions. |
Immediate. | SRH Knowledge: Score on quiz (no. items not reported) developed by investigators based on WHO illustrative questions for asking young people about SRH. |
| Rejeki 202130 | Care for discomforts and disorders. | Indonesia. | Not reported | RCT |
Total: 130 (Intervention: 65, Control: 65) Female adolescent students. Aged 15–17. Urban and rural settings. |
Test effectiveness of abdominal stretching for reducing PD pain. Intervention: The intervention is not reported. Based on the reported information it is likely that participants undertook abdominal stretching for 10–15 min. Number of sessions not reported. Control: Not reported. Assumed no intervention. |
Not reported. | Pain: Self-rated on Likert scale (0–10). |
| Saruul 202231 | Information and education. | Mongolia. | 2020 | Pre-post |
Total: 86 (71 post-menarchal). Adolescent girls in 8th Grade from two schools. Rural setting. |
Test effectiveness of health education and menstrual hygiene training for improving menstrual knowledge. Intervention: Researchers delivered the health education and menstrual hygiene training using a PowerPoint presentation. Training was reviewed and approved by Health Education teachers. Duration not reported. No control group. |
Immediate. |
MHH Knowledge: Score on investigator-developed 10-item knowledge quiz. Investigators also explored endline experiences of menarche, emotional state during menstruation, and menstrual hygiene practices, but did not compare these outcomes to baseline or a control. |
| Setyowati 201932 | Information and education. | Indonesia. | 2018 | CBA |
Total: 174 (Intervention: 87, control: 87). Premenarchal adolescent girls from Madrasah–Islamic school. Aged 9–12. Acehnese. Rural setting. |
Test effectiveness of a Menarche Preparations Reproductive Health Education booklet on participants' knowledge, emotional response, and attitude towards menarche. Intervention: Researchers provided a booklet containing information on the reproductive organs, physical changes during adolescence, problems during menstruation, management strategies, and menstrual hygiene. Control: No intervention (waitlist). Booklet provided after study completion. |
Not reported. |
Menstruation & Puberty Knowledge: Score on 14-item quiz used in past research.33,34 Emotional response: Score on a 13-item Emotional Responses Scale used in past research.35,36 Attitude towards menstruation: Assessed using the 13-item Adolescent Menstrual Attitude Questionnaire.33,37 |
| Silitonga 202138 | Information and education. | Indonesia. | Not reported (Ethics approval obtained 2019) | CBA |
Total: 24 (Group A: 8, Group B: 8, Group C: 8) Female migrant workers, pre-departure. Age reported as: Adults (63% < 30, 29% 30–35, 8% > 35). Urban setting. |
Compare effectiveness of SRH education including varied illustrative “case” content on SRH knowledge and attitudes. Intervention 1: Four 120-min sessions, twice a week for two weeks. SRH education on topics including reproductive anatomy, pregnancy and abortion, sexuality and sexual abuse, and sexually transmitted infections. MH topics included within the SRH education were female reproductive organs, fertile window, and menstruation. Module included 1–3 cases (assumed by review authors to mean “scenarios”). Intervention 2: The same four 120-min sessions as Intervention 1. Module included 5+ cases. Comparison/Control: The same four 120-min sessions as Intervention 1. No cases. |
Not reported. |
SRH Knowledge and Attitudes: Investigator developed test of 70% knowledge and 30% attitude questions (no. of items not reported). No further information is reported regarding the measures used. The study was mixed methods, qualitative feedback on education sessions collected. |
| Sumarah 201739 | Information and education. | Indonesia. | 2016 | CBA |
Total: 80 (Intervention: 40, Control: 40) Adolescent girls from two schools. Majority Urban. |
Test effectiveness of vaginal hygiene education on vaginal hygiene practice, attitudes and behaviours. Intervention: Participants were given 6-months to access and independently explore an online self-learning module on maintaining general vaginal hygiene (including menstrual practices such as changing panty liners, choosing menstrual pads, and changing menstrual pads). No further information on education content was reported. Control: No intervention. |
6-months post intervention. | Evaluation included broader Vaginal Hygiene outcomes; MHH-related outcomes included: Vaginal Hygiene Behaviour: Correct responses to investigator developed questionnaire (no. questions not reported) capturing:
|
| Van Hung 201940 | Information and education. | Vietnam. | Not reported | RCT |
Total: 400 (Intervention: 200, Control: 200). Male and female ethnic minority students. Age not reported. Rural and mountainous setting. |
Test effectiveness of seminars on puberty and SRH knowledge for improving reproductive health knowledge. Intervention: Three 45-min seminars, run weekly. Participants received a 15-min lecture using videos, pictures and scenarios followed by 15-min small group discussions, and 15-min feedback sessions. Education package designed by Hanoi National University of Education. MH topics included knowledge of the reproductive system, puberty stages, and stages of the menstrual cycle. Control: No intervention. |
6-months post-intervention. |
SRH Knowledge: Correct responses to university developed and approved knowledge test items (no. not reported). Knowledge test items related to the menstrual cycle included:
|
| Weerawatsopon 202041 | Materials, facilities, and services. | Thailand. | 2019–2020 | Randomised Crossover Trial |
Total: 98 (Group A: 49, Group B: 49) Female health care personnel. Age 18–50 (x̄: 32). Urban Hospital setting. |
Compare satisfaction and acceptability of menstrual cups and sanitary pads through a self-delivered intervention. Intervention: Menstrual cups and sanitary pads were provided to all participants to trial over 6-months. Participants selected one of two sized menstrual cups. An instruction manual and an instructional video were provided to all participants. Group A trialled sanitary pads for cycles 1st—3rd and menstrual cups for 4th—6th cycles. Group B trialled the products in the reverse order. |
At 3-months and 6-months (post intervention). |
Product satisfaction: Assessed using an investigator developed 10-item (insertion, removal, leakage, odour prevention, cleaning, on land, in water, daily activities, sleep comfort, overall satisfaction, frequency of changing) questionnaire. Removal for cleaning and adverse reactions reported individually. Acceptability of Menstrual Cup: Assessed at 6 months only. |
| Multiple MH requirements addressed | ||||||||
| Grant 202042 | Information and education. Materials, facilities, and care. Supportive social environment. |
Laos. | 2017–2019 | Pre-post | 10 Schools Total: 292 (Midterm: 291, Endline: 286). Adolescent school students. Aged 10–19. Rural setting. |
Test effectiveness of Menstrual Health and Hygiene (MHH) education as part of a wider WASH program for improving menstrual knowledge, attitudes, social support, and social participation Intervention: Provision of WASH services (i.e.: separate male and female toilets, waste pits, safe drinking water, soap and handwashing stations) and a life-cycle healthy living education program. MH was included as one component of the lifecycle education program. Red Cross Teacher Volunteers and Red Cross Youth are trained in the effective delivery of programming and youth clubs are formed. Participants received a 1-day MHH education workshop including reproductive age, puberty, adolescent reproduction, hormones, physical change in the body. An additional 4-h training on how to sew reusable pads was provided. No control group. |
Varied (Intervention ran in 10 schools between 2017 and 2019. Endline conducted end of 2019). | Evaluation included broader WASH outcomes; MHH-related outcomes included: School absenteeism due to menstruation: Self-reported through a single question. MHH Knowledge and Attitudes: Score on 7-item quiz including knowledge and attitude questions. Supportive environment: Self-reported through investigator developed survey with single questions capturing:
|
| Greaves 201943 | Information and education. Materials, facilities, and services. |
Vanuatu. | 2019 | Pre-post |
Total: 82 (25 follow-up) Female athletes. Age 13–59 (x̄ = 22) (89% 13–29). |
Test uptake and satisfaction with menstrual products and effects of education and products on sport participation. Intervention: Participants received an in-person MHM education session on basic anatomy, the female reproductive system, detailed menstrual cycle education, pain management, period-tracking, myths and taboos, and instruction on use and care for various menstrual products. The duration was not reported. The participants chose from either 2 x pairs of reusable menstrual underwear or 1 pair of reusable menstrual underwear and 1 menstrual cup to use over a period of 4 months. |
After the 4-month trial period. |
Missing sport due to period: Self-reported through a single question. Qualitative feedback on education sessions and product use experience also collected. |
| Su 201644 | Information and education. Care for discomforts and disorders. |
China. | Not reported | CBA |
Total: 128 (116 final sample) (Intervention: 66, Control: 62). Post-menarchal adolescent girls from two schools. Aged 12–15. Urban setting. |
Test effectiveness of culturally and developmentally tailored MH education sessions for improving menstrual knowledge, attitudes, confidence, and health behaviours. Intervention: Investigator delivered grade-level appropriate, interactive sessions guided by Kolb's Experimental Learning Theory including lectures, experience sharing, group discussion, and visual aids through five weekly 45-min education sessions. Topics included menstruation, hygiene practice, nutrition, pain management, and differentiation between normal conditions and problems that might require medical assistance. Participants were able to provide anonymous feedback after each session and the teaching plan was modified accordingly. Control: Wait-list control. |
Immediate. |
Menstrual Knowledge and ability to pursue and use information on menstruation: Score on a 13-item Menstrual Knowledge Questionnaire used in past research.45,46 Menstrual Attitude: Score on 5-item Chinese version of 7-item Menstrual Attitudes Questionnaire (MAQ).47, 48, 49 Confidence for Menstrual Health Care: Score of 5-item Menstrual Health Care Behaviour Questionnaire (MHCBQ).50 Pain Self-Care behaviour: Score on 18-item Dysmenorrhea Related Self-care Behaviour Questionnaire (DRSCBQ).46,51 |
| UnTold Research (UNICEF) 202152 | Information and education. Supportive social environment. | Indonesia. | 2019–2020 | CBA | 25 schools: (Intervention: 20 Control: 5). Student sample: (Baseline: 911, endline 762). Urban setting. |
Test effectiveness of a multi-component MHM program including written resources, peer-leader training, Oky period tracker and educational app, teacher sensitization and community engagement activity on puberty and menstrual knowledge, menstrual hygiene practice, and menstrual product access. Intervention:
|
Immediate. | Evaluation included broader health outcomes; MHH-related outcomes included: SRH Knowledge: Correct responses to investigator developed questionnaire (no. questions not reported) capturing:
MHM: Correct responses to investigator developed questionnaire (no. questions not reported) Mixed methods study, qualitative data also collected through observational surveys, interviews and focus groups. Comfortable talking about puberty with someone. |
CBA: Controlled before-after study; RCT: individually randomized controlled trial; cRCT: cluster randomized controlled trial; x̄: mean.