Developing a Community-Based Model for the Adoption of Sustainable Menstrual Products Among Adolescent Girls: Protocol for a 2-Phase Interventional Feasibility Study.

Background: 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. Objective: 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' 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. Methods: 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-Behavior framework. A cost-utility analysis using EQ-5D-Y and quality-adjusted life-years will assess cost-effectiveness from a societal perspective. Results: 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. Conclusions: This feasibility study will generate evidence on the acceptability, usability, and cost-effectiveness of a community worker- and teacher-led model for promoting sustainable menstrual products among adolescent girls, informing scale-up strategies in similar low- and middle-income settings.