Low awareness and implementation of free evidence-informed, menstrual health-related education modules in elite sport. A mixed-methods study

Objectives To evaluate the implementation of evidence-based open-access menstrual health-related education modules among elite female athletes and performance support staff. Design Sequential mixed-methods using surveys and focus groups/interviews. Methods The Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) of module implementation were assessed based on the proportion of athletes/staff who: were aware of the modules (R), perceived module effectiveness (E), used the modules (A), shared or discussed module content (I), and repeated module use (M). Framework analysis of focus group/interview data helped understand implementation. Results 78 athletes and 42 staff completed the survey. Twenty-three percent of athletes and 67% of staff were aware of the modules (R). Thirty-three percent of aware athletes (6/18) and 31% of aware staff (13/28) used at least one module (A). Participants reported the modules improved knowledge in athletes (83%) and staff (range 38–77%)(E), and improved staff confidence (69%)(E). Many staff shared (range 77–85%) and discussed (77%) module content (I) and would repeatedly use modules (85%)(M). Focus group/interview (athletes n = 9, staff n = 5) data identified factors influencing module implementation including promotion, relevance, readiness, and perceived roles in education delivery. Conclusions Current module implementation strategies have been largely ineffective in reaching athletes and moderately effective in reaching and facilitating adoption among staff. Regular module promotion via preferred communication channels may improve implementation and ensure female elite athletes receive timely, relevant information. All performance support staff working with elite female athletes should know how to access menstrual health resources and communicate confidently and accurately about menstrual health with athletes or colleagues.