‘Don’t be scared,’ how community clubs could better support adolescent menstrual health for physical activity: realist inquiry to inform intervention development

Abstract Background Globally women and girls are less physically active than men and boys. For adolescents this difference is widening with girls less active than boys in most countries, increasing the risk of non-communicable diseases such as diabetes, heart disease and cancer with significant economic health-related costs. Menstrual (period related) symptoms are a recognised barrier to adolescents engaging in physical activity. Programme theories from a previous rapid realist review describe how interventions including: education; appropriate facilities, adapted clothing and period products; menstrual cycle tracking tools; and medical support (if needed) could address these barriers. The aim of this study was to use contextual qualitative data from Welsh community club participants to refine these initial theories and understand what would work, for whom and in what circumstances to inform intervention development. Methods Realist methodology was used to test and refine the initial programme theories (context-mechanism-outcome configurations), structured with self-determination theory constructs (competence, relatedness, autonomy). Adult participants were recruited for interview via a qualitative online survey; adolescents were recruited through the adult participants. Realist interviews were conducted online or in-person, transcribed, anonymised, then analysed in NVIVO15. Explanatory data accounts were extracted as ‘if-then-because’ statements. Weekly team meetings were held to discuss findings. Results Data were included from 19 interview participants ( n = 9 women, n = 10 girls (aged 12–18); n = 10 ethnic communities, n = 9 White Caucasian) and 21 adult survey responses ( n = 20 women, n = 1 man). Refined programme theories describe how tailored context-specific menstrual health support is needed for different settings (land-based, water-based and remote outdoor activities) and for different population groups (ethnic diverse communities and performance athletes). Key mechanisms include: understanding different period product options for water sports; how to manage lack of facilities in remote outdoor settings; cultural respect and trust in ethnic diverse communities; and managing symptoms around training and performance for competitive athletes. Context-specific advice is also needed on how to deliver menstrual health education, encouraging role models, peer support, and creating safe spaces for communication. Conclusion Refined programme theories describe key mechanisms for menstrual health support needed in different contexts to inform intervention development. Interventions developed from these programme theories need robust evaluation.