Exploring the barriers and facilitators to menstrual hygiene management for women experiencing homelessness

Introduction: Menstrual hygiene management (MHM) is often overlooked in research despite being an occupation for many people, including adolescent and adult women as well as transgender and gender non-binary individuals. Available research shows that menstrual symptoms can decrease participation in other occupations, including work and education. The available research also suggests that marginalized groups, such as the homeless population, have limited access to hygiene and environmental resources needed for their MHM. Due to the limited research on MHM needs among the homeless population, the purposes of this study were 1) to learn about facilitators and barriers to MHM among the homeless population and 2) to understand the occupational impact of menstruation and MHM for women experiencing homelessness. Methods: Participants were recruited from three homeless service agencies in the greater St. Louis area to participate in a survey and focus groups. Data were analyzed using qualitative content analysis and descriptive statistics were generated. Results: Five themes were identified, describing participants' experiences with MHM while homeless. Themes were grouped into three categories-barriers, facilitators, and occupational impact of MHM. Themes illuminate factors both intrinsic to participants and within their external contexts that impacted participants' MHM performance and wider occupational engagement. Implications: Women face additional barriers to MHM during homelessness which can further disrupt participation and performance in several areas of occupation such as ADLs, work/school, and social participation. MHM can exacerbate existing issues of occupational injustice for this population. Facilitators to MHM for women experiencing homelessness were identified to inform the development of occupation-based programs for this population.