Non-menstruators play an important yet overlooked role in shaping menstrual health. They may be the family budget holders who purchase menstrual materials, receive health information outside the household, or preserve social stigmas. In response, World Vision, supported by UNICEF, implemented a programme to influence non-menstruators among the Rohingya population living in Kutupalong refugee camp, Bangladesh. The intention was to ensure non-menstruators recognise their important role in supporting family members to improve their menstrual health. We evaluated this intervention using a baseline and endline survey of 150 participants based on the Risk-Attitudes-Norms-Ability-Self-regulation (RANAS) approach to behaviour change. Based on the responses, we categorised participants into 'doers' and 'non-doers' of positive behaviours. We then performed multiple linear regression analyses and ANOVA comparison of means tests to understand how psychosocial and contextual factors influence the population's attitudes and behaviours towards menstruation before and after intervention. The regression analyses showed eight psychosocial and contextual factors that had a significant relationship with the desired behaviours. These were the block they lived in, marital status, already having learnt about menstruation from World Vision, how they were introduced to menstruation, who they discuss menstruation with, family members' reaction, perceptions of their role, and their commitment. Additionally, the ANOVA comparison of means between doers and non-doers showed doers were more likely to be confident to carry out the behaviour, perceive their role as important, and discuss menstruation with family. They were also more likely to be married, older, and have first learnt about menstruation from their family. This is the first study to identify which psychosocial and contextual factors significantly influence positive non-menstruator attitudes and conducive behaviours towards menstruation and menstruators. Humanitarian organisations can use these factors to improve the design and targeting of behaviour change programmes to improve menstrual health.

The authors have declared no competing interest.

The study was funded by the UKRI Engineering & Physical Sciences Research Council

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IRB of the University of Leeds gave ethical approval for this work.

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All data produced in the present study are available upon reasonable request to the authors