{"paper_id":"9fff0a84-ec10-4648-b947-76b4e1ba6c8d","body_text":"An Educational Intervention on the Use\nof Acupuncture for Chronic Pelvic Pain\nItem Type text; Electronic Dissertation\nAuthors Augustine, Montana\nCitation Augustine, Montana. (2025). An Educational Intervention on the\nUse of Acupuncture for Chronic Pelvic Pain (Doctoral dissertation,\nUniversity of Arizona, Tucson, USA).\nPublisher The University of Arizona.\nRights Copyright © is held by the author. Digital access to this material\nis made possible by the University Libraries, University of Arizona.\nFurther transmission, reproduction, presentation (such as public\ndisplay or performance) of protected items is prohibited except\nwith permission of the author.\nDownload date 27/05/2026 02:01:10\nItem License http://rightsstatements.org/vocab/InC/1.0/\nLink to Item http://hdl.handle.net/10150/679173\n\nAN EDUCATIONAL INTERVENTION ON THE USE OF ACUPUNCTURE FOR \n \nCHRONIC PELVIC PAIN \n \n \n \nby \n \nMontana Elisei Augustine \n \n________________________ \nCopyright © Montana Elisei Augustine 2025 \n \nA DNP Project Submitted to the Faculty of the \n \nCOLLEGE OF NURSING \n \nIn Partial Fulfillment of the Requirements \n \nFor the Degree of \n \nDOCTOR OF NURSING PRACTICE \n \nIn the Graduate College \n \nTHE UNIVERSITY OF ARIZONA \n \n \n \n \n2 0 2 5 \n\n \n \n2 \n \n \n\n\n \n \n3 \nACKNOWLEDGMENTS \nTo Dr. Locke for guiding me through this process, having an exceedingly amount of patience, \nand believing in my capabilities.  \nI extend my deepest gratitude to Dr Glassman, whose guidance and mentorship have been \ninvaluable throughout my journey. Your unwavering commitment to excellence in medicine and \npatient care has profoundly shaped my understanding of what it means to be a truly great \npractitioner. \nTo my husband, your unwavering support, love, and encouragement has been my greatest source \nof strength throughout this journey. Your belief in me, even during the most challenging \nmoments, has been a guiding light, reminding me of my purpose and fueling my determination to \nsucceed. \nTo my parents, no words can truly capture the depth of my gratitude for your unwavering love, \nencouragement, and sacrifice. From the earliest days of my education to this momentous \nachievement, you have been my foundation—instilling in me the values of perseverance, \nintegrity, and compassion. \n \n\n \n \n4 \nLAND ACKNOWLEDGEMENT \nWe respectfully acknowledge the University of Arizona is on the land and territories of \nIndigenous peoples. Today, Arizona is home to 22 federally recognized tribes, with Tucson \nbeing home to the O’odham and the Yaqui. The University strives to build sustainable \nrelationships with sovereign Native Nations and Indigenous communities through education \nofferings, partnerships, and community service. \n \n\n \n \n5 \nTable of Contents \nList of Figures .................................................................................................................................7 \nList of Tables ..................................................................................................................................8 \nAbstract ...........................................................................................................................................9 \nBackground ..................................................................................................................................11 \nImplementation Model ................................................................................................................14 \nPurpose..........................................................................................................................................15 \nMethods .........................................................................................................................................15 \nSite .....................................................................................................................................17 \nParticipants and Recruitment .........................................................................................18 \nIntervention ......................................................................................................................18 \nEvaluation Measures .......................................................................................................20 \nAnalysis .............................................................................................................................20 \nEthical Considerations.....................................................................................................21 \nIRB Review and Approval ..............................................................................................21 \nResults ...........................................................................................................................................22 \nPre-Survey Results ...........................................................................................................22 \nPost-Intervention Survey Question Results ...................................................................25 \nDiscussion......................................................................................................................................26 \nAlignment With DNP Essentials .....................................................................................29 \nEssential I: Scientific Underpinnings for Practice ..............................................29 \nEssential II: Organizational and Systems Leadership for Quality Improvement \nand Systems Thinking ...........................................................................................29 \nEssential III: Clinical Scholarship and Analytical Methods for Evidence-Based \nPractice ..................................................................................................................29 \nEssential IV: Information Systems/Technology and Patient Care Technology \nfor the Improvement and Transformation of Health Care .................................30 \nEssential V: Health Care Policy for Advocacy in Health Care...........................30 \n  \n\n \n \n6 \nTable of Contents – Continued \nEssential VI: Interprofessional Collaboration for Improving Patient and \nPopulation Health Outcomes................................................................................30 \nEssential VII: Clinical Prevention and Population Health for Improving the \nNation’s Health .....................................................................................................30 \nEssential VIII: Advanced Nursing Practice ........................................................30 \nSustainability ....................................................................................................................31 \nLimitations ........................................................................................................................32 \nConclusion ....................................................................................................................................33 \nImplications for Future Practice ....................................................................................33 \nFunding .........................................................................................................................................34 \nAppendix A: Site Authorization Letter......................................................................................35 \nAppendix B: Evidence Table.......................................................................................................37 \nAppendix C: Consent Document (Disclosure Letter) ...............................................................48 \nAppendix D: Recruitment Materials ..........................................................................................50 \nAppendix E: Evaluation Instruments ........................................................................................52 \nAppendix F: Participant Materials (Acupuncture Media Works Pamphlet) ........................55 \nAppendix G: IRB Approval ........................................................................................................58 \nReferences .....................................................................................................................................61 \n \n \n\n \n \n7 \nList of Figures \nFigure 1 Project Application of the Iowa Model ........................................................................16 \n \n\n \n \n8 \nList of Tables \nTable 1 Pre-Intervention Perceptions of Acupuncture Questions 1-3 ......................................23 \nTable 2 Pre-Intervention Perceptions of Acupuncture Questions 4-5 ......................................24 \nTable 3 Survey Findings on Participant Demographics ...........................................................24 \nTable 4 Age Groups and Duration of Chronic Pelvic Pain ......................................................25 \nTable 5 Post-Survey Likert Scale Summary ..............................................................................26 \nTable 6 Project Budget Table ...................................................................................................34 \n \n\n \n \n9 \nAbstract \nBackground: Chronic pelvic pain (CPP) is a complex and under-researched condition affecting \napproximately one in seven women in the U.S. (Dydyk & Gupta, 2023). Despite its \nmultifactorial nature, treatment often relies on pharmaceutical and surgical interventions, many \nof which have limited long-term efficacy and significant side effects (Gallagher et al., 2018; \nMardon et al., 2021). Acupuncture, a low-risk and cost-effective alternative, has gained \nrecognition in chronic pain management and is now recommended by American College of \nObstetricians and Gynecologists for CPP (Lin et al., 2023; ACOG, 2025). Increasing patient \nawareness of such non-pharmacologic options may help address gaps in women’s health care. \nPurpose: This quality improvement project evaluated whether women with CPP are receptive to \nacupuncture as part of treatment plan, either alongside or instead of traditional pain medications. \nProject aimed to determine if educational materials should be routinely implemented in clinical \npractice to diversify therapeutic options. \nMethods: Pre-existing educational pamphlet on acupuncture for CPP (Acupuncture Media \nWorks) was distributed to women presenting with CPP during three high-volume clinic days. \nAfter reviewing pamphlet, participants completed post-pre survey assessing knowledge, \nattitudes, and willingness to integrate acupuncture into care. Demographic data and survey \nresponses were securely recorded by Project Lead. Descriptive statistics summarized receptivity \nand guided recommendations for integrating acupuncture education into routine practice. \nResults: Twenty-one women participated. Pre-survey data showed limited awareness, 81% \nreporting acupuncture had never been presented as treatment option. Post-intervention, \nparticipants reported significantly improved perceptions. On five-point Likert scale, participants \n\n \n \n10 \nstrongly agreed acupuncture is a valid treatment (M = 4.81), felt well-informed (M = 4.76), \nsupported wider availability (M = 4.67), and were open to trying themselves (M = 4.67). \nProvider encouragement remained low (M = 1.67). Overall mean score (M = 4.20) indicates \nbrochure effectively increased awareness and positive attitudes. \nConclusion: Brief educational intervention improved patient perceptions of acupuncture for \nCPP. Integrating education into routine care may expand safe, non-pharmacologic options. \nSustained implementation requires greater provider engagement and institutional support. \n \n\n \n \n11 \nBackground  \nResearch in women’s health continues to be one of the most underfunded areas in \nmedicine (Mirin, 2021). Historically, healthcare research has predominantly focused on male \nsubjects or on conditions affecting both sexes, with limited emphasis on diseases that primarily \nimpact women (Mirin, 2021). Consequently, many women report feeling unheard and \noverlooked in the diagnosis and treatment of female-specific conditions.   \nChronic pelvic pain (CPP) remains among the most complex conditions to treat due to its \nmultifactorial etiology and poses a significant personal and socioeconomic burden. CPP is a \ncomplex and under-researched condition, affecting approximately one in seven women in the \nUnited States, and is defined as noncyclical pelvic pain lasting longer than six months. (Dydyk & \nGupta, 2023; Meisenheimer & Carnevale, 2025). In the United States, the cost of CPP was \nestimated at $2.8 billion in 1996 and rose to $5.8 billion by 2020 (Lamvu et al., 2021). With \nincreasing health disparities patients with CPP are often subjected to disproportionately high \nrates of gynecological surgeries and increased medication use—estimated to be three to four \ntimes higher than in individuals without CPP (Chang et al., 2024). In addition, 80% of CPP cases \ndo not have a gynecologic origin, however, the condition accounts for 40% of laparoscopies and \n12% of hysterectomies (Lamvu et al., 2021). Thus, the condition remains difficult to manage \neffectively because of persistent challenges in accurately identifying its underlying cause. \nUnderstanding the etiology of chronic pain is essential for effective treatment. CPP can \nbe triggered by a range of conditions, including irritable bowel syndrome, major depressive \ndisorder, chronic cystitis, endometriosis, adhesions, a history of traumatic events, and pelvic \ninflammatory disease (Dydyk & Gupta, 2023). CPP can be either a primary or secondary \n\n \n \n12 \ncondition, depending on the patient’s comorbidities. CPP is frequently associated with \ncomorbidities that lead to nervous system hypersensitivity, necessitating a multidisciplinary \nmanagement approach with a comprehensive history and physical examination to determine \netiology (Meisenheimer & Carnevale, 2025). Recent studies show that women with a history of \npsychiatric illness experience more severe CPP and have higher rates of depression, anxiety, and \ninsomnia (Dydyk & Gupta, 2023). With a higher prevalence of underlying psychiatric illness, \nCPP treatment for women who have been physically or emotionally abused is complex due to \npelvic exams being traumatic, invasive, and triggering past events of trauma (Lamvu et al., \n2021). Endometriosis, adhesions, and chronic cystitis can also contribute to secondary CPP \n(Dydyk & Gupta, 2023). A recent analysis of 270 evidence-based guidelines related to CPP \nrevealed that the majority of recommendations emphasized surgical and pharmaceutical \ninterventions (Mardon et al., 2021). Moreover, over 35% of these recommendations were based \non expert opinion rather than empirical evidence (Mardon et al., 2021). These findings \nunderscore a critical need for more rigorous, evidence-based research on pelvic pain to reduce \nthe health disparities associated with this condition.  \nTraditional therapy for pelvic pain often involves a variety of pharmacological \ninterventions. Current evidence-based treatments for CPP include over-the-counter analgesics, \npelvic floor therapy, cognitive behavioral therapy, SSRIs/SNRIs (anti-depressants) for mood \ndisruption, cyclobenzaprine (muscle relaxer) administration, and hormonal suppression (Dydyk \n& Gupta, 2023). One commonly used medication for treating CPP is Leuprolide acetate, a \ngonadotropin-releasing hormone (GnRH) agonist. This medication induces a hypoestrogenic \nstate, which helps relieve pelvic pain and incites amenorrhea (Gallagher et al., 2018). However, \n\n \n \n13 \nside effects of Leuprolide acetate include depression, memory loss, bone density loss, hot \nflashes, and night sweats (Gallagher et al., 2018). While patients may experience these long-term \nside effects, pharmaceutical companies conducting drug trials tend to focus more on potential \nfuture fertility outcomes than on the long-term effects of the drug (Gallagher et al., 2018). In a \nrecent study including twenty-five women taking Leuprolide acetate for CPP 80% of the women \nreported lasting side-effects greater than six months after discontinuing the medication, and only \n63% reported adequate pain control during administration (Gallagher et al., 2018). \nAnother form of treatment includes MyFembree the newly FDA-approved GnRH \nantagonist with a small percentage of add-back hormones to offset the hormonal suppression side \neffects (Myovant Sciences & Pfizer, 2022). Reported side effects from Pzifer and Myovant \npharmaceuticals include suicidal ideation, hepatic impairment, bone loss, thrombolytic events, \nhypertension, and alopecia (Myovant Sciences & Pfizer, 2022). In addition, MyFembree can \nonly be taken for up to two years, which further encourages alternative modalities of treatment. \n(Myovant Sciences & Pfizer, 2022).  \nVarious forms of medicine are practiced worldwide today. Western medicine is typically \ndefined as conventional and follows a disease-centered approach (Kisling & Stiegmann, 2024). \nIn contrast, Eastern medicine—often referred to as alternative medicine—adopts a holistic view, \nconsidering disease as a manifestation of dysfunction within the entire body (Kisling & \nStiegmann, 2024). One common example of alternative medicine is acupuncture, which involves \nthe insertion of fine needles into specific points on the body to promote healing and balance. The \npopularity of alternative medicine is steadily increasing in today’s healthcare landscape \n(Mortada, 2024). Over the past two decades, the prevalence and availability of alternative \n\n \n \n14 \ntherapies have risen significantly, with usage rates climbing from 9.8% to 76% (Tangkiatkumjai \net al., 2020). \nAcupuncture, a traditional Chinese medicine approach, is used to treat both acute and \nchronic pain. Its benefits include being cost-effective, widely available, and having minimal to \nno side effects. Additionally, acupuncture improves quality of life, alleviates psychological \ndistress, and is often used for patients who have not found relief through traditional medical \ntherapies (Lin et al., 2023). It is believed that acupuncture enhances blood flow and circulation \nby increasing vascularization in the affected areas. In Chinese medicine, chronic illness is \nthought to result from a blockage of energy, with practitioners viewing conditions as systemic \nissues rather than localized problems (Van Hal, 2023). Furthermore, acupuncture is \nrecommended as a modality for the management of chronic pelvic pain by the American College \nof Obstetricians and Gynecologists (2025). Recent reviews of clinical data show that \nacupuncture, even without adjunct therapy, has been effective in relieving chronic pelvic pain \n(Lin et al., 2023). Therefore, women seeking treatment for CPP should be educated on the \nefficacy of acupuncture and provided with a range of treatment options. \nImplementation Model  \nThis quality improvement (QI) project employed The Iowa Model Revised: Evidence-\nBased Practice to Promote Excellence in Health Care. The Iowa Model was chosen because it \nprovides a clear, systematic framework for identifying problems, recognizing the need for \nchange, and integrating improved practices into healthcare systems. The Iowa Model outlines \nseveral key steps in implementing change: identifying the issue, articulating the purpose, \nassembling a team, synthesizing evidence related to the topic, piloting the intervention, \n\n \n \n15 \nintegrating the changes into practice, and sustaining the improvement (Cullen et al., 2022). For \nthe QI project to be put into practice establishing the need for improvement is imperative. \nApplying the Iowa Model flowchart, Figure 1 below depicts an overview of the steps taken in \nthis QI project. Incorporation included identifying the area for improvement, researching what \ncurrent literature states on the topic, and analyzing if participants are open to new treatment \nmodalities.  \nPurpose \nThe purpose of this project is to educate women on the benefits of using acupuncture as a \nnon-pharmacological option for pelvic pain. The project question hopes to answer, “are women \nwith chronic pelvic pain open to receiving acupuncture as an adjunct or alternative approach to \npain management, in comparison to the traditional pharmaceutical approach, for reducing \nchronic pelvic pain?” The main outcomes include understanding whether women are open to \nalternative modalities for CPP. The goal is for the site to incorporate pamphlets on CPP into \npractice after the QI project is completed.  \nMethods \nSeveral variations in patient education handouts educate the patient on their disease, \netiology, treatment options, and prognosis (Bhattad & Pacifico, 2022). For this project, \ndetermining the best education tool was determined by patient population, geographical location, \nand demographics. A pre-existing educational pamphlet by Acupuncture Media Works \n(Appendix F) was chosen for this QI project that details the benefits of acupuncture for CPP.  \n  \n\n \n \n16 \nFigure 1 \nProject Application of the Iowa Model  \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \nNote. Adapted from The Iowa Method of Implementation (Cullen et al., 2022). \n \nIdentifying Triggering Issues/Opportunities: \nCPP is one of the hardest disease processes to treat that requires a multidisciplinary \napproach for treatment. Women's Health research is one of the most underfunded \nareas of research with inconsistant,and outdated guidelines. \nPurpose:\nAre women with CPP open to receiving acupuncture as an adjunct or alternative \napproach to pain management, in comparison to the traditional pharmaceutical \napproach, for reducing chronic pelvic pain?\nTeam Formation: \nInclude pelvic pain specialist and gynecologist, office staff including Medical \nAssistants, front office assistants, and Project Lead. \nThe Evidence in Supporting Literature:\nA peer-reviewed, literature search was conductied using PubMed, NIH, and ACOG \nusing terms \"acupuncture\", \"chronic pelvic pain\", and \"alternative modalities for \nchronic pain\".The evidence table is presented in Appendix C. \nDesign and Pilot Process: \nAdvanced Women's Care educates patients with pamphlets. A pamphlet was created \neducating women on the benefits of acupuncture. The outcome and data was gathered \nby verbal surveys and documented on a password-protected computer if women are \ninterested in adding a secondary approach to treating CPP. \nIntegration to Practice:\nThe Project Lead educates consenting, and informed patients about the effects of \nacupuncture in CPP. The patients are informed this is voluntary and may request to \nnot be apart of the QI project at any time. Preliminary data is gathered at this time \nand based upon statistical analysis.\nDissemination:\nAfter successful integration, and statistical analysis has been completed the data is \ninterpreted. Based upon interpretation, if women are interested in adding a secondary \napproach to chronic pain, the QI project can be incorporated. \n\n \n \n17 \nThe pamphlet educates women on the effectiveness, safety, and indications that \nacupuncture can be implemented in. Chinese medicine utilizes a total body approach to healing \nthat is outlined in the pamphlet educating women on the multimodal indications for acupuncture \ntreatment. \nThe project design involves the systematic distribution of these pamphlets to women \npresenting with CPP to enhance their understanding of acupuncture as a complementary, non-\npharmacological treatment option. The project ran for three days during the month of August. \nData collected over this period was analyzed, and the sample size consisted of patients who \nagreed to participate in the QI project. Since patient allocation is random within the clinic, there \nwas no predetermined sample size as scheduled patients for a given day vary.  \nSite \nThis QI project is situated in Phoenix, Arizona, an urban area within Maricopa County. \nThe clinical site, Advanced Women’s Care, serves a diverse population of women encompassing \nall ages, ethnicities, and socioeconomic backgrounds. The clinic accepts a broad range of \ninsurance types, including Medicare, Medicaid, Marketplace plans, and private insurance, and \naccommodates self-pay patients, ensuring that no individual is denied care due to financial \nconstraints. The clinic shares office space with an obstetrics provider; however, the two practices \noperate independently, with separate patient rosters and staffing. The Advanced Women’s Care \nprovider specializes in pelvic pain management and minimally invasive gynecological surgery \nseeing an average of twenty to thirty patients daily. Key stakeholders involved in this project \ninclude the clinic’s staff, patient population, and the primary physician who has endorsed the \nimplementation of this quality improvement initiative.  \n\n \n \n18 \nParticipants and Recruitment \nThe target population for this quality improvement project included biologically female \nwomen presenting with a primary complaint of CPP. Due to the clinical setting, where patients \nseek care for a variety of reasons, a formal recruitment process was not utilized. Instead, \npotential participants were identified through a collaborative review of the weekly clinic \nschedule by the Project Lead and the attending physician. To maximize participant identification, \nthe Project Lead and physician jointly determined the clinic days with the highest volume of \npatients presenting with CPP. Based on this analysis, three clinic days were selected for project \nimplementation. This selection aimed to capture a diverse patient sample reflective of the clinic’s \nheterogeneous population and varied reasons for visits. As this is not research, no predetermined \nsample size was established. Participation was entirely voluntary, and all eligible patients were \ninformed of the potential benefits of acupuncture as a complementary approach in managing \nchronic pelvic pain. See Appendix C for disclosure letter and Participation Consent.  \nIntervention \nGuided by the Iowa Model of Evidence-Based Practice as the evidence-based framework, \nthe project was initiated in response to a clinical trigger: the desire to explore patient interest in \nalternative therapeutic modalities beyond conventional pharmaceutical approaches. As part of \nthe QI project, the Project Lead supplied the educational pamphlets at no cost to the clinic as \nnoted in Table 6. This contribution is mutually beneficial, as it enhances patient education while \nsupporting the physician’s objective to expand therapeutic options. Pamphlet education included \neducation on the benefits of acupuncture, its cost-effectiveness, and the disease processes it \ntreats. \n\n \n \n19 \nA critical factor in implementing the intervention involved its potential impact on clinic \nworkflow. Given that most patient appointments range from fifteen to thirty minutes, strict \nadherence to these time constraints is essential to respect both patient and provider schedules. \nThe clinic’s waiting area features a prominently displayed wall of educational pamphlets \ncovering topics such as contraception, pharmaceutical therapies, and surgical interventions. It is \ncommon practice for the physician to distribute these materials during treatment discussions. \nBased on these observations of existing clinic flow and patient education methods, the use of an \neducational pamphlet was determined to be the most feasible and minimally disruptive approach \nfor delivering the intervention within the constraints of routine clinical practice. Moreover, \nevidence-based practice indicates that providing patients with written educational materials, such \nas pamphlets, can effectively reduce anxiety related to their health condition by improving \nknowledge and empowering patients in their care decisions (Alvis et al., 2019). \nDuring patient visits, the medical assistants first inquired whether patients presenting \nwith CPP were willing to have a student present for their appointment. If the patient agreed, the \nProject Lead then entered the exam room to observe the appointment with the physician. After \nthe physician concluded the appointment, the Project Lead stayed to explain the QI project and \nask their consent to participating in the project. The Project Lead was the only stakeholder \nproviding education and recruitment. Once participant consent was obtained, the physician left \nthe room to maintain efficiency and minimize disruption to clinic workflow. At this stage, the \nProject Lead took responsibility for introducing the QI project, explaining the pre-post survey \nquestions, and provide education using the pamphlet. This ensured that participants fully \nunderstood the project’s objectives while allowing for smooth data collection. If the patient \n\n \n \n20 \ndeclined participation, the Project Lead did not include them in the project and thanked them for \nallowing observation of their appointment for learning purposes.  \nEvaluation Measures \nAt the end of the pamphlet education, the Project Lead evaluated if women agree or \ndisagree with adding acupuncture as part of their CPP treatment plan. To assess the effectiveness \nof the project, a post-pre survey was conducted after the intervention to collect data, allowing for \na comparative analysis of participant responses before and after the intervention. The evaluation \nincluded both pre and post-surveys. The pre-survey consisted of seven questions focused on \ndemographic information (ethnicity, age), clinical history (duration of CPP), prior exposure to \nalternative medicine, and openness to acupuncture prior to receiving the educational pamphlet \n(see Appendix E). The post-survey included seven statements measured by using a 5-point Likert \nscale, where 1 indicated \"strongly disagree\" and 5 indicated \"strongly agree,\" to assess \nparticipants’ comfort level and willingness to incorporate acupuncture following the pamphlet \nintervention. See Appendix E for detailed participation methods and the post-pre survey \nframework. Demographic questions included in the pre-survey were specifically designed for \nstatistical analysis. Age, ethnicity, and education on their disease are important factors to \nconsider when analyzing the data for trends. The greater the number of affirmative responses \ncollected, the more effectively the QI project will advocate for the incorporation of acupuncture \nas an adjunctive therapeutic intervention.  \nAnalysis \nDescriptive statistics were used to analyze patient receptivity to acupuncture as an \nadjunct treatment for chronic pelvic pain. Summarizing the pre-post survey responses provided \n\n \n \n21 \ninsights into feasibility, guiding clinical decisions on service integration or referral pathways. All \ndata collected from the pre-post surveys was securely stored on a password-protected computer \naccessible only to the Project Lead. Additionally, statistical analysis was used to determine \nwhether project outcomes were met, ensuring data-driven recommendations for enhancing \npatient-centered care. \nEthical Considerations \nThe implementation of acupuncture for managing chronic pelvic pain is designed with \ncareful adherence to the core principles of medical ethics: beneficence, nonmaleficence, justice, \nand autonomy. The project aimed to provide a therapeutic option that may relieve persistent pain, \nthereby promoting patient well-being, while ensuring that the intervention is low-risk and \nminimally invasive, aligning with the principle of nonmaleficence. To support justice, participant \nrecruitment was equitable and inclusive, ensuring fair access to all eligible individuals regardless \nof demographic background. Autonomy was respected by emphasizing that participation is \nentirely voluntary, and participants were free to withdraw at any time without consequence. A \ndisclosure letter (see Appendix C), outlines that no identifiable data was collected. This \ntransparency ensured participants were fully informed, further reinforcing ethical standards \nthroughout the project. \nIRB Review and Approval \nFollowing the successful defense of the project proposal, this initiative was submitted to \nthe University of Arizona Institutional Review Board (IRB) for review (see Appendix G). The \nsubmission request deemed the project \"not research\" under IRB guidelines, as it is intended for \nquality improvement and not conducting new research. The Project Lead completed the required \n\n \n \n22 \nCollaborative Institutional Training Initiative (CITI) training before IRB submission, ensuring \ncompliance with ethical and regulatory standards. Upon receiving IRB approval, the \nimplementation phase of the acupuncture intervention for chronic pelvic pain began, by adhering \nto institutional protocols. \nResults \nPre-Survey Results \nA total of 21 women experiencing chronic pelvic pain participated in the pre-survey. \nParticipant ethnicity was diverse: 47.62% identified as Non-Hispanic White, 23.81% as \nHispanic, 19.05% as Black or African American, 4.76% as Asian, and 4.76% as Other. \nFamiliarity with acupuncture varied, with 38.10% reporting they were “slightly familiar” \nand another 38.10% “very familiar”. Smaller proportions were “not at all familiar” (14.29%) or \n“moderately familiar” (9.52%). Duration of chronic pelvic pain ranged from 0–5 years (33.33%), \n6–10 years (38.10%), 11–19 years (19.05%), to over 20 years (9.52%).  \nWhen examined by age group, most participants were between 26–49 years old \n(85.71%), with chronic pelvic pain durations ranging from 0–5 years (n=6), 6–10 years (n=7), \n11–19 years (n=4), and 20+ years (n=1). Participants aged 18–25 accounted for 4.76% (n=1) and \nreported pain for 0–5 years, while those aged 50–65 made up 9.52% (n=2), all reporting \ndurations of CPP for 20+ years. \nOpenness to acupuncture was generally positive, with 42.86% reporting they were “very \nopen”, 38.10% “somewhat open”, and 19.05% “slightly open”. Most participants (80.95%) \nindicated that alternative medicine had never been presented to them as a treatment for chronic \n\n \n \n23 \npelvic pain, and the same percentage (80.95%) had never heard of acupuncture being used for \nthis condition. \nTable 1 \nPre-Intervention Perceptions of Acupuncture Questions 1-3 \n \n \n  \n7\n8\n4\n2\n4\n8\n9\n2\n3\n8 8\n0\n1\n2\n3\n4\n5\n6\n7\n8\n9\n10\n0--5\n6--10\n11--19\n20+\nSlightly open\nSomewhat open\nVery open\nModerately familiar\nNot at all familiar\nSlightly familiar\nVery familiar\n1 2 3 4\nHow long have you been expieriencing\nChronic Pelvic Pain? (Y)\nHow open are you to trying\nacupuncture?\nHow familiar are you with acupuncture?\nNumber of Participants\nPre-Intervention Perceptions Questions 1-3\n\n \n \n24 \nTable 2 \nPre-Intervention Perceptions of Acupuncture Questions 4-5 \n \nTable 3 \nSurvey Findings on Participant Demographics  \n \n \n \n \n \n \n \n \n17\n4\n17\n4\n0\n2\n4\n6\n8\n10\n12\n14\n16\n18\nN Y N Y\nHas alternative medicine ever been presented as a\ntreatment for CPP?\nHave you ever heard of acupuncture as a treatment for\nCPP?\nNumber of Participants\nPre-Intervention Perceptions Questions 4-5\n4.76%\n19.05%\n23.81%\n47.62%\n4.76%\nEthnicity\nAsian\nBlack or African American\nHispanic\nNon-Hispanic White\nOther\n\n \n \n25 \nTable 4 \nAge Groups and Duration of Chronic Pelvic Pain  \n \n \n \n \n \n \n \n \n \nPost-Intervention Survey Question Results \nFollowing the distribution of an educational brochure on the benefits of acupuncture for \nCPP, 21 women completed a post-intervention using a 5-point Likert scale where 1 = “strongly \ndisagree”, 2 = “disagree”, 3 = “neutral”, 4 = “agree”, 5 = “strongly agree”. Overall, participants \nreported highly positive perceptions of acupuncture. They strongly believed acupuncture is a \nvalid treatment for CPP (M = 4.81) and felt well-informed about how it works (M = 4.76). \nParticipants expressed strong support for wider availability of acupuncture (M = 4.67) and \nopenness to trying it themselves for pelvic pain (M = 4.67). Trust in acupuncture practitioners \nwas moderately high (M = 4.57), and participants were somewhat willing to recommend \nacupuncture to others (M = 4.29). Despite these positive attitudes, very few reported that their \nhealthcare providers had encouraged alternative treatments such as acupuncture (M = 1.67). The \n1\n6\n4\n1\n2\n7\n0\n1\n2\n3\n4\n5\n6\n7\n8\n18-25 26-49 50-65\nNumber of Patients \nPatient Age Range\nDuration of Chronic Pelvic Pain \n0-5\n11-19\n20+\n6-10\nYears of \nChronic \nPelvic Pain  \n\n \n \n26 \noverall mean response across all items was 4.20, indicating that the educational brochure \neffectively increased awareness and positive attitudes toward acupuncture among women with \nCPP as referenced in Table 5. \nTable 5 \nPost-Survey Likert Scale Summary  \n \n \n \n \n \n \n \n \n \nDiscussion \nThis project’s findings depict the critical role of education in enhancing the long-term \nviability of acupuncture within women’s health. Acupuncture has been shown to provide lasting \nrelief for CPP. However, this project revealed a significant gap in patient education: prior to \nintervention, most participants lacked awareness of acupuncture as a viable treatment option. \nFollowing the distribution of an educational brochure, 21 women completed a post-survey using \na 5-point Likert scale. Results showed overwhelmingly positive shifts in perception—\nparticipants strongly agreed that acupuncture is a valid treatment for CPP (M = 4.81) and felt \n4.81 4.76 4.67 4.67 4.57 4.29\n1.67\n0.00\n1.00\n2.00\n3.00\n4.00\n5.00\nI believe\nacupuncture is\na valid\ntreatment for\nCPP.\nI feel well-\ninformed\nabout how\nacupuncture\nworks.\nAcupuncture\nshould be\nmore widely\noffered as a\ntreatment\noption for\npelvic pain.\nI am open to\ntrying\nacupuncture to\nhelp with my\npelvic pain.\nI trust\nacupuncture\npractitioners\nto provide safe\ntreatment.\nI would\nrecommend\nacupuncture to\nothers\nexperiencing\nCPP.\nMy healthcare\nproviders have\nencouraged or\nsupported alt.\ntreatments like\nacupuncture.\nLikert Scale Averages\nPerceptions and Opennes Toward Acupuncture for Chronic \nPelvic Pain\n\n \n \n27 \nwell-informed about how it works (M = 4.76). These findings suggest that educational outreach \nis a sustainable strategy for increasing acceptance and utilization of acupuncture. \nThe pre-intervention data indicates that, prior to receiving the educational brochure, most \nparticipants had limited familiarity with acupuncture as a treatment for CPP. Across racial and \nethnic groups, only a small proportion reported being very familiar with acupuncture, and the \nmajority had never been presented with alternative medicine as a treatment for CPP. Awareness \nof acupuncture specifically for CPP was low, with most participants reporting they had not \npreviously heard of it. Despite limited knowledge, many participants expressed some degree of \nopenness to trying acupuncture, with several reporting being very open or somewhat open to the \nintervention. Duration of chronic pelvic pain varied widely, from less than 5 years to over 20 \nyears, indicating that participants were at different stages in their pain experiences. Overall, the \npre-intervention survey data suggests a general lack of prior exposure and education regarding \nacupuncture.  \nThe post-intervention survey results indicate that the educational brochure effectively \nincreased positive perceptions of acupuncture among women with CPP. Participants strongly \nbelieved that acupuncture is a valid treatment for CPP and reported feeling well-informed about \nhow it works, suggesting that the brochure successfully conveyed relevant and understandable \ninformation. There was notable openness to trying acupuncture for personal pain management \nand strong support for making it more widely available, reflecting a willingness to engage with \nnon-pharmacological interventions. Trust in acupuncture practitioners was moderately high, and \nparticipants were somewhat likely to recommend acupuncture to others, indicating a generally \nfavorable view but some residual hesitancy. Notably, participants reported minimal \n\n \n \n28 \nencouragement from their conventional healthcare providers to explore alternative treatments, \nhighlighting a gap in provider-driven support. Overall, the mean response across all items (4.20) \ndemonstrates a broadly positive attitude toward acupuncture following the educational \nintervention, emphasizing the potential value of educational materials in promoting awareness \nand acceptance of complementary therapies for CPP.  \nAcupuncture is relatively low-cost compared to long-term pharmacologic or surgical \ninterventions. By increasing patient openness to acupuncture (M = 4.67) and trust in practitioners \n(M = 4.57), educational efforts may reduce reliance on more expensive or invasive treatments. \nHowever, the low mean score (M = 1.67) regarding provider encouragement of alternative \ntherapies highlights a systemic barrier. For acupuncture to be sustainable at scale, healthcare \nproviders must be educated and incentivized to discuss integrative options with patients. \nIn hindsight, one of the most impactful revisions would be to expand the educational \ncomponent to include healthcare providers alongside patients. While participants responded \npositively to the educational brochure, reporting increased awareness, trust, and openness toward \nacupuncture, the data revealed a significant gap in provider engagement (M = 1.67). This \nsuggests that even when patients are informed and willing, the lack of provider support may \nhinder actual implementation of alternative therapies like acupuncture. \nLastly, clinic costs are a crucial consideration in dissemination. Table 6 outlines the \nexpenses required to sustain the project post-dissemination. If costs are deemed excessive, an \nalternative pamphlet on acupuncture may be developed.  \n  \n\n \n \n29 \nAlignment With DNP Essentials  \nThe Essentials of Doctoral Education for Advanced Nursing Practice (American \nAssociation of Colleges of Nursing [AACN], 2006) established eight foundational competencies \nfor all Doctor of Nursing Practice candidates. These essentials are relevant to this project \nbecause integrating acupuncture for CPP requires a strong scientific evidence base, \ninterprofessional teamwork, patient-centered policy advocacy, and advanced clinical expertise.  \nEssential I: Scientific Underpinnings for Practice \nThis project applies foundational nursing science and current research to support \nacupuncture as a safe, evidence-based adjunct therapy for CPP, translating theory into practice to \nimprove patient outcomes.  \nEssential II: Organizational and Systems Leadership for Quality Improvement and Systems \nThinking \nImplementation planning incorporated stakeholder engagement, resource allocation, and \nworkflow integration to ensure feasibility and promote sustainable adoption within the clinical \nsystem. Engaging the stakeholders during this project is critical for sustainability. Incorporating \nevidence-based integrative treatments, such as acupuncture, can also potentially lower health \ncare costs by reducing the use of high-priced pharmaceuticals. \nEssential III: Clinical Scholarship and Analytical Methods for Evidence-Based Practice \nA rigorous literature review and synthesis of acupuncture and CPP informed the practice \nchange in this QI project, while data collection and evaluation methods assessed effectiveness in \nthe target population. \n\n \n \n30 \nEssential IV: Information Systems/Technology and Patient Care Technology for the \nImprovement and Transformation of Health Care \nIn this QI project, electronic health records were utilized to access patient records, \nduration of patients’ CPP symptoms as noted by survey results, and previous treatments. \nDocumentation on previous treatments is noted in the EMR.  \nEssential V: Health Care Policy for Advocacy in Health Care \nThe project promotes policy awareness by advocating for increased education and wider \nacceptance of non-pharmacological pain management options. \nEssential VI: Interprofessional Collaboration for Improving Patient and Population Health \nOutcomes \nCare delivery is coordinated among physicians, acupuncturists, nurses, and allied health \nprofessionals to enhance holistic, patient-centered outcomes. To implement quality improvement \nand promote project sustainability, stakeholder collaboration and input from various roles and \nperspectives are imperative. \nEssential VII: Clinical Prevention and Population Health for Improving the Nation’s Health \nBy reducing reliance on opioids, pharmaceutical, and invasive interventions this project \nsupports safer pain management and can contribute to improved public health outcomes. \nEssential VIII: Advanced Nursing Practice \nThe advanced practice nurse serves as a clinical leader in the development and \nimplementation of an evidence-based intervention aimed at improving the assessment and \nmanagement of CPP. This role involves applying specialized clinical expertise, incorporating \n\n \n \n31 \ninterdisciplinary collaboration, and utilizing systems-level thinking to enhance care delivery and \noutcomes for a population frequently underserved in conventional healthcare settings. \nSustainability \nTo ensure the continued integration of acupuncture as a sustainable treatment for CPP at \nthis practice site, several practical strategies should be considered. First, embedding patient \neducation materials such as pamphlets and handouts into the electronic health record (EHR) \nsystem would streamline provider workflow and ensure consistent delivery of information. \nAdding a checkbox within the EHR to prompt providers to offer acupuncture education or \nreferrals could further normalize its use. While hiring an in-house acupuncturist may offer \nconvenience and continuity of care, partnering with a local acupuncture clinic could be a more \ncost-effective solution, especially in early implementation phases. This collaboration could \ninclude shared referral protocols, patient feedback loops, and co-hosted educational events. In \nhindsight, improving feasibility might involve earlier stakeholder engagement, clearer \ndocumentation pathways, and a larger sample size. These steps not only support sustainable care \ndelivery but also reinforce acupuncture’s role as a low-resource, high-impact modality in chronic \npain management. \nThe project will be formally presented to the public and the project committee during the \nfinal defense. This presentation will include a summary of the methodology, results, and \nimplications for practice. The final paper will also be submitted into the University of Arizona \nProQuest DNP Project Repository. An executive summary will be shared with stakeholders at \nthe project site, including clinical leadership and staff. This summary will highlight key findings, \nand recommendations for sustainability. A poster presentation may be developed for submission \n\n \n \n32 \nto regional or national nursing conferences, such as the American Holistic Nurses Association \n(AHNA) or the American Association of Nurse Practitioners (AANP) annual conference. A \nmanuscript may be prepared for publication in a peer-reviewed journal focused on women's \nhealth, integrative medicine, or nursing practices such as Journal of Holistic Nursing or Pain \nManagement Nursing. Consideration will be given to submitting an abstract to interdisciplinary \nforums that promote alternative modalities in chronic pain treatment, thereby reaching a broader \naudience including acupuncturists, physical therapists, and other public health professionals. \nLimitations \nIn hindsight, several factors limited the potential for even more successful outcomes in \nthis project. The most notable constraint was time. The short timeline limited opportunities for \ndeeper engagement with healthcare providers, which could have strengthened the impact of the \nintervention. Feasibility also played a role. While the educational brochure was effective in \nshifting perceptions, logistical limitations prevented the inclusion of hands-on components, such \nas acupuncture demonstrations or facilitated referrals. These additions could have enhanced \nparticipant confidence and uptake. Planning was generally strong, but for future consideration, \nmore emphasis could be placed on stakeholder engagement early in the process, particularly with \norganizational leadership and clinical staff. Their involvement could help align the project with \nbroader quality improvement goals and facilitate integration into existing workflows. \nPotential bias in the project includes response bias, as participants may have felt inclined \nto provide favorable answers after receiving educational materials. The use of a single post-\nsurvey without a pre-survey limits the ability to measure true change in perception. Lastly, many \n\n \n \n33 \nof the participants have been long-term patients of the provider and may have felt pressured into \nagreeing to participate.  \nConclusion \nThis project highlights the critical gap in patient education regarding acupuncture as a \ntreatment for chronic pelvic pain. Despite limited prior awareness, participants demonstrated \nstrong receptivity and positive attitudes following a brief educational intervention. These \nfindings suggest that integrating acupuncture education into routine clinical practice may \nempower patients with more diverse, low-risk treatment options. However, the lack of provider \nengagement underscores the need for broader systemic efforts, including provider education and \ninstitutional support, to fully realize the benefits of integrative pain management in women’s \nhealth. \nImplications for Future Practice \nThis project demonstrated a clear need for increased patient education regarding \nacupuncture as a treatment for chronic pelvic pain. The strong positive shift in perceptions \nfollowing a simple educational intervention highlights the value of integrating such materials \ninto routine care. Sustaining this initiative at the clinical site could empower patients with more \ndiverse, low-risk options and improve satisfaction with pain management. On a broader scale, \nimplementing similar educational strategies across healthcare systems could lead to improved \nhealth outcomes, reduced reliance on pharmaceuticals, and significant cost savings. To support \nwidespread adoption, organizational leadership should prioritize provider education and policy \ndevelopment that encourages integrative approaches. Health policy reforms, including insurance \ncoverage for acupuncture and funding for alternative pain management research, are essential to \n\n \n \n34 \naddress existing gaps. Future efforts should also explore population health strategies and \nspecialty training to ensure both patients and providers are equipped to consider acupuncture as a \nviable, evidence-based option for chronic pelvic pain. \nFunding \nThis QI project incurred the cost of the brochures distributed during the intervention. The \ncost was self-funded by the Project Lead. See Table 6 for cost breakdown. There was no external \nfunding.  \nTable 6 \nProject Budget Table \nItem Description Quantity Unit Cost (USD) Total Cost \n(USD) \nWomen’s Health and \nAcupuncture-Brochure Pamphlet 25 $19.99 + $10.50 \nShipping $30.49 \nTOTAL \n   \n$30.49 \n \n  \n\n \n \n35 \nAppendix A: \nSite Authorization Letter \n \n\n \n \n36 \nList of Appendices (required and optional) \n(Use APA 7th ed. appendix format; decide on your appendices [required listed below] in the \norder in which you mention the materials in your paper. . . .) \nSite Authorization Approval Letter (Required) \nConsent Document (Required) \nRecruitment Materials (Required) \nEvaluation Instruments (Required) \nParticipant Materials (Required?)  \nChart Audit Forms (Optional?) \nProject Timeline (Optional? This seems more like something for them to create in 922-201 but \nnot necessarily include in final paper.) \nEvidence Table (Required—was “Literature Review Grid”) \nOther Documents/Materials as Applicable, such as Budget (Optional)  \n \n\n\n \n \n37 \nAppendix B: \nEvidence Table \n \n\n \n \n38 \nAuthor’s Last \nName & \nPublication Year \nTitle of Publication Type of Study Participants \nMajor Strengths \nand Weaknesses of \nthe Study \nMain Outcomes of \nFindings Relevance to Project \n1. Alvis, M. L., \nMorris, C. E., \nGarrard, T. L., \nHughes, A. G., \nHunt, L., Koester, \nM. M., Yocum, I. \nC., & Tinius, R. A. \n(2019) \nEducational \nbrochures influence \nbeliefs and \nknowledge regarding \nexercise during \npregnancy: A pilot \nstudy \nQuasi-\nexperimental \npre-post  \nWomen who are \npregnant  \nStrengths:  \n-Advocates the need \nfor brochures and \npatient teaching for \nthe overall well-\nbeing of the patient \nWeaknesses:  \n-The QI project is not \nfocused on pregnant \nwomen \nAfter exposure to \neducational brochures, \nsurvey scores were \nsignificantly higher \nthan baseline survey \nscores  \nCurrent literature that \nsupports the use of \npamphlets and power of \neducation in patients  \n2. American \nAssociation of \nColleges of \nNursing. (2006) \nThe Essentials of \nDoctoral Education \nfor Advanced \nNursing Practice \n[PDF] \nGuideline \nPublication \nNA NA -list of guidelines to \nhelp DNP students and \nguide them in their \nproject \n-DNP essentials \nhandbook for DNP \nstudents preparing their \nfinal project \n3. American \nCollege of \nObstetricians and \nGynecologists. \n(2025)  \nChronic pelvic pain Quantitative Women with Pelvic \nPain \nStrengths:  \n -ACOG is the \nguideline for treating \nwomen’s health \nissues -Standard of \ncare  \n-Provider based \nresource  \nWeaknesses:  \n-Not a research study \n-Not a quality \nimprovement study  \n-Does not include a \nliterature review  \n-Data based approach \nand standard of care \nversus finding new \nevidence \n-Lifestyle changes, \nmedications, physical \ntherapy, acupuncture, \nnutrition counseling, \nand surgery are all \ncurrent treatment \noptions for CPP.  \n-Tests to diagnose \nCPP include \ntransvaginal \nultrasound, \nlaparoscopy with \nbiopsy findings, \ncystoscopy, \ncolonoscopy, and \nsigmoidoscopy.  \n-Pelvic pain is difficult \nto diagnose and treat \ndue to a plethora of \n-The quality \nimprovement project \nneeds ACOG data to \nback up the validity of \nacupuncture and current \nevidence-based \ntreatments.  \n\n \n \n39 \nAuthor’s Last \nName & \nPublication Year \nTitle of Publication Type of Study Participants \nMajor Strengths \nand Weaknesses of \nthe Study \nMain Outcomes of \nFindings Relevance to Project \ndisease processes that \ncould be the culprit.  \n4. Bhattad, P. B., & \nPacifico, L. (2022).  \nEmpowering  \nPatients:  \nPromoting  \nPatient  \nEducation and  \nHealth  \nLiteracy \nMixed  \nMethod Study-\nwhich included \nboth qualitative \nand \nquantitative \nresearch \nHealthcare providers \nwere educated \nthrough pre- and \npost-lecture surveys, \nwhich included both \nqualitative and \nquantitative \nquestions regarding \npatient education \npamphlets and their \nlikelihood of \nincorporating them \ninto practice. \nStrengths:  \n-Quality \nimprovement \ntechnique  \nusing PSDA  \n-Incorporation of \nboth qualitative and \nquantitative research \nto ensure quality data  \n-20 pie chart \ndiagrams stating \nclear, concise \nquestions  \nidentifying areas for \nimprovement with \ncompliance from \nproviders  \nWeaknesses:  \n-Number of \nparticipants was not \nclearly stated  \n-How evidence was \npicked and sorted \nthrough was also not \nclearly stated  \n-Bias and risk for \nbias was not \naddressed or \nmentioned \n-Patient education \ntools such as \npamphlets, posters, \nand patient teaching \nexercises improve \npatient satisfaction, \nhealth literacy, and \nshared decision \nmaking.  \n-There is limited time \nduring patient \nappointments to set \naside time for \neducational teaching \ndue to provider \nturnover, staffing, and \ndemands to see a \ncertain number of \npatients each day.  \n-Out of 47 responses \n46.8% said they would \n“definitely” and \n53.2% said they would \n“likely” provide \npatients with printed \neducational tools if \nthey were organized \nwell. 0/47 providers \nstated they would not \nhand out educational \ntools. \n-The DNP project will \nbe implemented by \npassing out pamphlets \neducating women  \non the benefits of  \nacupuncture. I wanted \nto see the effects of \neducational tools and \ncompliance with  \nproviders for \nimplementation long \nterm. -Patient education \nis vital to compliance, \nand patient outcomes.  \n-Organized, time-\nefficient educational \ntools can change the \noutcomes of patient \nsatisfaction. \n\n \n \n40 \nAuthor’s Last \nName & \nPublication Year \nTitle of Publication Type of Study Participants \nMajor Strengths \nand Weaknesses of \nthe Study \nMain Outcomes of \nFindings Relevance to Project \n5. Chang, W. H., \nChou, F. W., & \nWang, P. H. (2024). \nChronic pelvic pain \nand Chinese \nmedicine body \nconstitution deviation \nSystematic \nReview \nWomen with CPP  Strengths:  \n-analyzing clinical \ndata on CPP, which \nis already a weak \narea which indicated \nthe need for the \npaper \nWeaknesses:  \n-not giving any \ncurrent clinical data \nPower of acupuncture \nin women suffering \nwith CPP and \nevaluating current \nguidelines  \nsynthesizes evidence \nfrom multiple practice \nguidelines.  \n-evaluates the quality of \nthe guidelines  \n6. Cullen, L., \nHanrahan, K., \nEdmonds, S. W., \nReisinger, H. S., & \nWagner, M. (2022). \nIowa Implementation \nfor Sustainability \nFramework \n \nMixed-methods \nformative \nevaluation \nMixed groups of \npeople that use the \nIowa Method of \nImplementation \nStrengths:  \n-Excellent data \nshowing the \nrelevance of the Iowa \nMethod, the diversity \nit can be \nimplemented in, and \nhow it brings \nforward organization \nthrough \nimplementation \nWeaknesses:  \n-Does not give \nexamples of the \nchanges it has \nbrought forward into \nevidence-based \npractice \nStrengthen the \neducation of clinician \n(s) and propose its \nusefulness in \nimplementation \nresearch \n-This is the method used \nfor implementation and \ndata to prove its \neffectiveness is needed \n7. Dydyk, A. M., & \nGupta, N. (2023).  \nChronic Pelvic Pain Quantitative Women with chronic \npelvic pain >3-6 \nmonths of pain \nStrengths:  \n-Strong evidence-\nbased data regarding \nthe treatment of CPP \n-Advocating for a \nstrong \n -Chronic pelvic pain \nis associated with IBS, \ndepression, and pelvic \n40edication40y \ndisorder -CPP is seen \nin 4-16% of women -\n50% of endometriosis \nIdentification and \nunderlying etiology of \npelvic pain  \n-Give examples of how \nto treat and evaluate \nchronic pelvic pain  \n\n \n \n41 \nAuthor’s Last \nName & \nPublication Year \nTitle of Publication Type of Study Participants \nMajor Strengths \nand Weaknesses of \nthe Study \nMain Outcomes of \nFindings Relevance to Project \ninterprofessional \nteam  \nWeaknesses:  \n-Not a clinical trial  \n-Not a quality \nimprovement study  \n-No recent, new data \nbeing presented  \npatients suffer with \npelvic pain  \n-Managing CPP can \nbe a lifelong condition \nthat requires a \nmultidisciplinary \napproach -The team \nconsists of physical \ntherapy, cognitive \nbehavioral therapist, \ngynecologic surgeon, \nand pain management \nspecialist depending \non disease process \nCPP is secondary to  \n-Education for future \nproviders on how to \nimprove outcomes of \nchronic pelvic pain \n8. Gallagher, J. S., \nMissmer, S. A., \nHornstein, M. D., \nLaufer, M. R., \nGordon, C. M., & \nDiVasta, A. D. \n(2018). \nLong-Term Effects of \nGonadotropin-\nReleasing Hormone \nAgonists and Add-\nBack in Adolescent \nEndometriosis \nLongitudinal, \nobservational \nfollow-up study \n51 subjects aged 15–\n22 years enrolled in \na 12-month \nlongitudinal \ntreatment trial of \nleuprolide depot. All \nsubjects had \nsurgically confirmed \nendometriosis \ntreated with ablation \nStrengths:  \n-Excellent data \nencompassing the \nnegative side effects \nof medications \n-Multiple tables \ncomparing \nGonadotropin-\nReleasing Hormone \nAgonists and \nGonadotropin-\nReleasing Hormone \nAgonists PLUS add \nback hormone \ntreatment  \nWeaknesses:  \n-Ideally, I wanted all \nmy research to stay \nwithin 5 years (2020-\n-All women reported \nside effects during \ntreatment \n- 80% of women \nreported side effects \nlasting longer than 6 \nmonths after stopping \ntreatment \n- Almost half (9 of 20) \nreported side effects \nthey considered \nirreversible, including \nmemory loss, \ninsomnia, and hot \nflashes \n- Subjects believed \nthat GnRHa used with \nadd-back was effective \nand would recommend \n-I wanted to focus on a \nstudy that talks about \nthe side-effects of some \nof the 41edication on \nthe market for pelvic \npain. This article speaks \nvolumes in my opinion \nbecause even though \nmost of the women said \nthey had side-effects; \nwomen still were \nwilling to put their \nbodies through it to \nhave lasting relief from \npelvic pain. \n-This article gives me \nample opportunity to \nprove my point that \nthere needs to be \n\n \n \n42 \nAuthor’s Last \nName & \nPublication Year \nTitle of Publication Type of Study Participants \nMajor Strengths \nand Weaknesses of \nthe Study \nMain Outcomes of \nFindings Relevance to Project \n2025) for the most \naccurate results  \nit to others, despite \nsignificant side effects \nalternative treatment \noptions for CPP \n9. Kisling, L. A., & \nStiegmann, R. A. \n(2024). \nAlternative Medicine Narrative \nreview \nEducational resource \nthat does not include \nparticipants \nStrengths:  \n-Data has been \ncurated within the \nlast year \n-Strong data that \nshows the need for \nalternative medicine  \nWeaknesses:  \n-Not a clinical trial, \nor evidence that is \nshowing us new data \nThere is an increase in \nevidence around \nalternative medicine \nand more providers \nare willing to \nimplement alternative \nmedicine for their \npatients \n-The QI project needs \ndata that pushes the \nneed for alternative \nmedicine in patients that \nhave not been healed in \nWestern medicine  \n10. Lamvu, G., \nCarrillo,  \nJ., Ouyang, C., &  \nRapkin, A. (2021)  \nChronic Pelvic Pain \nin Women: A Review \nSystemic \nReview  \nWomen with \nChronic Pelvic Pain  \nStrengths:  \n-Quality information \nfor patient education \non CPP  \n-Recent statistical \nanalysis of current \nevidence regarding \nCPP -Financial data \nof the costs of \nsurgery regarding \nCPP which is an \nimportant aspect \nregarding push for \nalternative therapies  \nWeaknesses:  \n-Exploring already \nknown evidence \nversus finding new \nclinical data  \n-Does not include \nany new research for \na quality \n-CPP is mostly caused \nby endometriosis, \ncystitis, irritable bowel \nsyndrome, and \nmyalgia  \n-There is a significant \nhistory of CPP with \nwomen who have \nexperienced abuse, \ntrauma, and mental \nhealth diseases -\nPsychosocial \nadvocation and \nintervention is critical \nin CPP treatment  \n-This is important to tie \ninto my project because \nI want to address the \nmental health aspect in \nCPP  \n-Mental health \nadvocation is critical for \nthe well-being of \nwomen, and overall \nquality of life  \n-If women are feeling \nhopeless because of this \ncondition, it therefore, \ncreates more of a push \nfor the integration of \nsupplemental therapy to \naddress this condition  \n\n \n \n43 \nAuthor’s Last \nName & \nPublication Year \nTitle of Publication Type of Study Participants \nMajor Strengths \nand Weaknesses of \nthe Study \nMain Outcomes of \nFindings Relevance to Project \nimprovement \nintervention  \n11. Lin, K. Y., \nChang, Y. C., Lu, \nW. C.,  \nKotha, P., Chen, Y. \nH., & Tu, C. H. \n(2023).  \nAnalgesic Efficacy of  \nAcupuncture on \nChronic Pelvic Pain: \nA Systemic Review \nand Meta-Analysis \nStudy  \nSystemic \nReview and \nMeta-Analysis \nStudy  \nA total of 1455 CPP \npatients (867 \nfemales and 588 \nmales) were \nincluded into this \nmeta-analysis.  \nStrengths:  \n -Large group of \npatients to gather \nample amount of \nevidence –Studied \nmonotherapy versus \nadjunct therapy to \ndiversify the results  \n-Lists specific \nacupressure points to \nincorporate into the \nstudy  \nWeaknesses:  \n-Study also includes \nmen which is not \nrelevant to project \nproposal  \nAcupuncture used in \nmonotherapy or in \nadjunct to western \nmedicine treatment \nhave both been shown \nto treat CPP \nAcupuncture is \npracticed worldwide \nfor a myriad of \nchronic pain issues \nand widely recognized \nas a modality for \ntreatment  \n-The treatment for \nCPP often doesn’t \nfocus on the etiology \nbut rather just treating \nthe pain -CPP requires \na multidisciplinary \napproach for proper \ntreatment, and \nmanagement  \nAcupuncture even as \nmonotherapy has \nbeneficial, analgesia \neffects  \n-Abdominal \nacupuncture, and ear \nacupuncture have a \nhigher treatment \nefficacy than western \nmedicine treatment  \n-This trial is critical for \nmy defense that there \nare other alternative \ntreatments for pain  \n-I want to make the \nargument that people \nare interested in other \nmodalities than western \nmedicine therapy \n12. Mardon, A. K., \nLeake, H. B.,  \nSzeto, K., Astill,  \nT., Hilton, S., \nMoseley, G. L., & \nChalmers, K. J.  \n(2022).  \nTreatment \nrecommendations for \nthe management of \npersistent pelvic pain: \na systematic review \nof international \nclinical practice \nguidelines \nSystemic \nReview  \nFemales with \npersistent pelvic \npain and clinical \npractice guidelines \nregarding treatment  \nStrengths:  \n-The evidence \nreviews 270 clinical \npractice guidelines \nthat evaluate the best \npractice for CPP \n-Captures subsequent \nhigh-quality \nguidelines  \nWeaknesses:  \n-Data suggests many \nof the \nrecommendations for \nCPP are not evidence-\nbased and purely \nexpert opinion \n-Data suggested \npsychological support \nyet did not suggest \nwhat that looks like \nlong term  \n-This piece of evidence \nis fascinating for the \nquality improvement \nproject because there is \nsuch limited data on \nguidelines for CPP. For \nexample, we know the \nguidelines for HTN, \ndiet, and lifestyle, and \nfirst-line pharmacology \ntreatment. However, \n\n \n \n44 \nAuthor’s Last \nName & \nPublication Year \nTitle of Publication Type of Study Participants \nMajor Strengths \nand Weaknesses of \nthe Study \nMain Outcomes of \nFindings Relevance to Project \n-Not all 270 reviews \nwere broken down \nby condition \nmeaning there was \nmultiple etiologies \nfor CPP \n-Two reviewers were \nused to evaluate data \nwhich leaves room \nfor bias  \n-35% of \nrecommendations \nwere supported only \nby expert opinion not \nevidence-grade data  \n-None of the data was \nbased on low-income \ncountries and focused \nmore on wealth-\ncentered developed \ncountries  \n-There is much room \nfor improvement in \nthe guidelines for CPP \nso there can be a \nstandard of care in \npatient treatment and \noutcomes  \nthere is no such \nguideline for treating \nCPP and each provider \ncould be developing \ntheir own plan. It has \nbeen noted multiple \ntimes how difficult of a \ndisease it is to treat. \nThus, a guideline is \nessential.  \n13.Meisenheimer, \nE. S., & Carnevale, \nA. M. (2025). \nChronic Pelvic Pain \nin Women: \nEvaluation and \nTreatment \nQualitative \nStudy \nWomen suffering \nwith CPP \nStrengths:  \n-interviews women \non their experience \nof CPP \nWeaknesses: \n-does not provide \nnew clinical data like \na RCT would \nprovide \n-Main takeaway is that \nmost women with CPP \nsuffer psychosocial \ncomorbidities  \n-explores patient \nperspectives on \nmanaging CPP \n-analyzes data using \ninterviews  \n14. Mirin A. A.  \n(2021)  \n \nGender Disparity in \nthe Funding of \nDiseases by the U.S. \nNational  \nInstitutes of Health  \nRetrospective \ncohort study \nwith a \nlongitudinal \nfollow-up \nAnalysis of funding \nby the U.S. National \nInstitutes of Health \n(NIH) to identify \npossible gender \ndisparity in funds \nregarding women’s \nhealth \nStrengths:  \n-Ample amount of \nevidence regarding \ngender-based \nfunding  \n-Data collected was \ntaken from >10 years \nof evidence-based \nmedicine  \nWeaknesses:  \n-Some of the most \nunderfunded diseases \nare female-dominant \nand some of the most \noverfunded are male-\ndominant  \n- That is, 74% of the \nnongender-neutral \ndiseases favor males, \nand 26% favor \nfemales. This pattern \n-For a long time, most \nwomen-based diseases \nwere seen as women in \nhysteria, poor life \ndecisions  \n-This evidence shows \nthe need for evidence-\nbased research for CPP. \nEndometriosis is one of \nthe lowest funded \ndiseases that includes an \n\n \n \n45 \nAuthor’s Last \nName & \nPublication Year \nTitle of Publication Type of Study Participants \nMajor Strengths \nand Weaknesses of \nthe Study \nMain Outcomes of \nFindings Relevance to Project \n-Large disparities \nupon funding for \ngender-based \ndiseases \n-Data is mixed \nbetween men and \nwomen, versus just \nfemale  \nwas for all three \nbudget years  \n-Endometriosis is one \nof the most \nunderfunded female-\ndominant diseases, \nwas stereotyped as \nbeing brought on by \nwomen’s life choices \netiology for CPP. \nWomen need to be \nadvocated for and the \nresearch for evidence-\nbased practice  \n15. Mortada E. M.  \n(2024)  \nEvidence-Based \nComplementary and \nAlternative Medicine \nin Current Medical \nPractice \nEvidence-\nBased Review  \nComplementary and \nAlternative medicine \nrates in the US \nincreasing  \nStrengths:  \n-Systemic review \nsearching the \ndatabases on people \nseeking alternative \ntherapies  \n -Data is all within \nfive years \nWeaknesses:  \n-Not a quality \nimprovement study \nthat is providing new \ndata for the guideline \nof CPP  \n-Does not consist of \na trial showing which \nalternative therapies \nare the most helpful  \n-Natural products or \nherbal drugs rank \namong the top 10 most \npopular remedies in \nIM that people in the \nUS use most regularly, \nas many people \nbelieve that herbal \ntherapies are natural, \nsafer, and healthier \nthan allopathic \nmedications \n-Alternative therapies \nare not taught in \nmedical schools and \ndo not have backing \nfrom the FDA \n-With times changing, \nand suspicion \nsurrounding the \nhealthcare system more \npeople are drawn to \nalternative therapy \n-In my clinical practice \nI see more people \nasking for alternative \ntherapy, which is why \nwe need to have \nalternative therapy \noptions for chronic \ndiseases (I want to \npresent this narrative in \nmy project) \n16. Myovant \nSciences, & Pfizer. \n(2022) \nMyovant Sciences \nand Pfizer Receive \nU.S. FDA Approval \nof MYFEMBREE®, \na Once-Daily \nTreatment for the \nManagement of \nModerate to Severe \nPfizer FDA \napproval notice  \nWomen diagnosed \nwith Moderate to \nSevere \nEndometriosis  \nStrengths: \n-Actual \nannouncement from \nthe pharmaceutical \ncompany and their \ndisclosures of the \nmedication \nWeaknesses:  \nMyfembree is \ncurrently one of a few \nmedications approved \nby the FDA for the \ntreatment of \nEndometriosis. We \nknow endometriosis is \nan estrogen sensitive \n-Evidence showing \nfrom the pharmaceutical \nthat manufactures the \ndrug shows significant \nside effects and can \nonly be taken for two \nyears maximum  \n\n \n \n46 \nAuthor’s Last \nName & \nPublication Year \nTitle of Publication Type of Study Participants \nMajor Strengths \nand Weaknesses of \nthe Study \nMain Outcomes of \nFindings Relevance to Project \nPain Associated With \nEndometriosis \n-Not an evidence-\nbased article. Just \nused for supporting \nevidence \ndisease that pain \nanalgesia can be \nmanaged by hormonal \nsuppression  \n17. Tangkiatkumjai, \nM., Boardman, H., \n& Walker, D. M.  \n(2020)  \nPotential factors that \ninfluence usage of \ncomplementary and \nalternative medicine \nworldwide: A \nsystematic review \nSystemic \nReview / \nThematic \nAnalysis  \nLiterature (231 \npublications) on the \nreasons for using or \nnot using \ncomplementary and \nalternative medicine \n(CAM) \nStrengths:  \n-231 pieces of \nevidence were \nanalyzed \n-Countries outside of \nthe US were also \nanalyzed and showed \nthe demand for \nalternative therapy \nsteadily increasing  \nWeaknesses:  \n-This current review \nbegan in 2019 and \nhas reviewed \nrelevant sources \npublished over a 15-\nyear period from \n2003 to 2018 (this is \nnot as updated as I \nwould like)  \n-Alternative medicine \nis used because: \nexpectation of benefits \n(84% of publications), \n(2) dissatisfaction with \nconventional medicine \n(37%) and (3) the \nperceived safety of it \n-Push for alternative \nmedicine because of \nthe lack of outcome of \nwestern medicine  \n-This is another article \nthat proves my quality \nimprovement project \npurpose that the public \nis more interested in \nalternative therapies and \nperceives it is safe and \nworks well  \n-The availability of \nalternative therapies is \nmore readily available \nthan western medicine \nespecially with \ntechnology in current \ntimes \n18. Van Hal, M., \nDydyk, A. M., & \nGreen, M. S.  \n(2023) \nAcupuncture  Systemic/ \nEducational \nOverview  \nAcupuncture  Strengths:  \n-Giving \ninformational facts \nabout acupuncture \nand the history \nbehind how it works  \n-Discusses the \npotential side effects \nof acupuncture which \nis important for \npatient education \n-However, despite \nnumerous studies, the \nmechanism for how \nacupuncture might be \nfunctional \nphysiologically is not \nyet known \n-Functional MRI has \nshown physiologic \nchanges in the central \nnervous system while \n-Most amazing studies \nexplaining the HOW of \nacupuncture are in \nChinese and Oriental / \nTraditional Chinese \nmedicine is a separate \nentity from western \nmedicine that is difficult \nto compare when \nspeaking about the \ndisease process. This is \n\n \n \n47 \nAuthor’s Last \nName & \nPublication Year \nTitle of Publication Type of Study Participants \nMajor Strengths \nand Weaknesses of \nthe Study \nMain Outcomes of \nFindings Relevance to Project \nWeaknesses:  \n-Purely information \nproviding no new \nevidence \n-Does not include \nguidelines or current \npractice guidelines  \n-Finding studies that \nare in English \nregarding the \npathophysiology of \nacupuncture is \ndifficult to find \nundergoing \nacupuncture \nan important aspect to \ndiscuss in the project \nbecause they view \nsystemic issues as a \ntotal body issue rather \nthan a localized issue.  \n \n\n \n \n48 \nAppendix C: \nConsent Document (Disclosure Letter) \n \n\n \n \n49 \nConsent Document (Disclosure Letter) \nHello, my name is Montana Augustine, a DNP Student at the University of Arizona. I am leading \na quality improvement project here at Advanced Women’s Care. I, the Project Lead, am seeking \nif patients have an interest in acupuncture as an option for managing chronic pelvic pain. \nYour participation is completely voluntary. If you choose to participate, I will ask you a few \nbrief questions before and after you review an educational pamphlet about acupuncture. The goal \nis to see whether the information changes how you feel about acupuncture as part of your \ntreatment. \nHere’s what participation involves: \n• You will answer a few questions before reading the pamphlet (pre-survey). \n• You will then read the educational pamphlet about acupuncture for pelvic pain. \n• Afterward, I will ask a couple more questions to gather my information (post-survey). \n• I will record your answers of the surveys on a password-protected computer only the I, \nthe Project Lead have access to. \n• No personal or identifying information will be collected but generalities of ethnicity and \nage will be recorded. \nImportant Information: \n• Participation is voluntary, and you may stop at any time. \n• Your decision will not affect the care you receive. \n• This project is a quality improvement initiative—not a research study—and is designed to \nenhance patient education and care. \n• All information gathered is collected on a password-protected computer only the Project \nLead has access to.  \nThank you for your time and consideration. If you have any questions, please contact me any \ntime.  \nMontana Augustine, RN, BSN, DNP-FNP Student \nmontanaaugustine@arizona.edu  \n602-301-2145 \n \n\n \n \n50 \nAppendix D: \nRecruitment Materials \n \n\n \n \n51 \nRecruitment Materials \nEligibility Criteria: \n• Biologically female woman presenting with a chief complaint or clinical history of CPP.  \n• Able to read and understand English. \n• Willing to participate in a brief pre- and post-survey related to acupuncture education. \n \nRecruitment Process: \n1. Clinic Schedule Review: \nThe Project Lead and attending physician collaboratively reviewed the weekly clinic \nschedule to identify patients likely to present with CPP. Three clinic days with a higher \nanticipated volume of CPP-related visits were selected for project implementation. \n2. Verbal Consent and Enrollment: \nThe Medical Assistant asks permission for a student to be present during examination \nduring intake. If the patient agrees to having a student, the Project Lead enters the room \nwith the physician for the clinical consultation and observes the appointment until \ncompletion. Upon conclusion of the appointment the Project Lead will explain the \nproject’s purpose and obtain consent using a standardized script (see Appendix [C]). \nPatients who agree to participate will be enrolled in the project. \n3. Initial Approach by the Student Lead: \nAfter conclusion of the appointment with the physician, the Project Lead briefly \nintroduces the QI project and askes whether the patient would be open to learning about \nacupuncture as a potential option for managing chronic pelvic pain. If the patient \nexpresses interest, the pre-post survey is conducted. \n4. Survey Administration: \nParticipants completes a brief pre-survey assessing their perceptions of acupuncture \nbefore being given an educational pamphlet to review. Following pamphlet review, a \npost-survey with additional questions will be administered by the Project Lead. \nResponses will be recorded in the password-protected computer only the Project Lead has \naccess too. \n \nVoluntary Participation: \nParticipation is entirely voluntary. Patients could decline or withdraw at any point without \naffecting the care they receive at the clinic. No incentives will be provided, and no identifiable \ndata will be collected. \n \n\n \n \n52 \nAppendix E: \nEvaluation Instruments \n \n\n \n \n53 \nPre-Survey Questions \n• What is your ethnicity? \no Hispanic or Latino \no Non-Hispanic White \no Black or African American \no Asian \no Native American or Alaska Native \no Native Hawaiian or Other Pacific Islander \no Other (please specify): _________ \n• What is your age range?  \no 18-25  \no 26-49  \no 50-65  \no >65  \n• How long have you been experiencing Chronic Pelvic Pain?  \no 0-5 years \no 6-10 years \no 11-19 years \no 20+ years \n• Has alternative medicine ever been presented to you as an option for Chronic Pelvic \nPain? \no Yes / No / Unsure \n• Have you ever heard of acupuncture as a treatment for Chronic Pelvic Pain? \no Yes / No \n• How familiar are you with acupuncture? \no Not at all familiar / Slightly familiar / Moderately familiar / Very familiar \n• How open are you to trying acupuncture as a treatment option for your pelvic pain? \no Not open / Slightly open / Somewhat open / Very open \n \nPost-Survey Questions \nPerceptions and Openness Toward Acupuncture for Chronic Pelvic Pain \nStatement Strongly \nDisagree Disagree Neutral Agree Strongly \nAgree \nI believe acupuncture is a valid treatment for \nchronic pelvic pain. 1 2 3 4 5 \nI feel well-informed about how acupuncture \nworks. 1 2 3 4 5 \nI am open to trying acupuncture to help with \nmy pelvic pain. 1 2 3 4 5 \nI trust acupuncture practitioners to provide \nsafe treatment. 1 2 3 4 5 \n\n \n \n54 \nStatement Strongly \nDisagree Disagree Neutral Agree Strongly \nAgree \nAcupuncture should be more widely offered \nas a treatment option for pelvic pain \npatients. \n1 2 3 4 5 \nMy healthcare providers have encouraged or \nsupported alternative treatments like \nacupuncture. \n1 2 3 4 5 \nI would recommend acupuncture to others \nexperiencing chronic pelvic pain. 1 2 3 4 5 \n \n\n \n \n55 \nAppendix F: \nParticipant Materials (Acupuncture Media Works Pamphlet) \n \n\n \n \n56 \n \n\n\n \n \n57 \n \n \n\n\n \n \n58 \nAppendix G: \nIRB Approval \n\n \n \n59 \nList of Appendices (required and optional) \n(Use APA 7th ed. appendix format; decide on your appendices [required listed below] in the \norder in which you mention the materials in your paper. . . .) \nSite Authorization Approval Letter (Required) \nConsent Document (Required) \nRecruitment Materials (Required) \nEvaluation Instruments (Required) \nParticipant Materials (Required?)  \nChart Audit Forms (Optional?) \nProject Timeline (Optional? This seems more like something for them to create in 922-201 but \nnot necessarily include in final paper.) \nEvidence Table (Required—was “Literature Review Grid”) \nOther Documents/Materials as Applicable, such as Budget (Optional) \n  \n\n\n \n \n60 \n \n  \n\n\n \n \n61 \nReferences \nAlvis, M. L., Morris, C. E., Garrard, T. L., Hughes, A. G., Hunt, L., Koester, M. M., Yocum, I. \nC., & Tinius, R. A. (2019). Educational brochures influence beliefs and knowledge \nregarding exercise during pregnancy: A pilot study. International Journal of Exercise \nScience, 12(3), 581–589. https://doi.org/10.70252/NGXF7418 \nAmerican Association of Colleges of Nursing. (2006). The Essentials of Doctoral Education for \nAdvanced Nursing Practice. \nhttps://www.aacnnursing.org/Portals/42/Publications/DNPEssentials.pdf \nAmerican College of Obstetricians and Gynecologists. (2025). Chronic pelvic pain. \nhttps://www.acog.org/womens-health/faqs/chronic-pelvic-pain \nBhattad, P. B., & Pacifico, L. (2022). Empowering patients: Promoting patient education and \nhealth literacy. Cureus, 14(7), e27336. https://doi.org/10.7759/cureus.27336 \nChang, W. H., Chou, F. W., & Wang, P. H. (2024). Chronic pelvic pain and Chinese medicine \nbody constitution deviation. Taiwanese Journal of Obstetrics & Gynecology, 63(1), 4–5. \nhttps://doi.org/10.1016/j.tjog.2023.11.002 \nCullen, L., Hanrahan, K., Edmonds, S. W., Reisinger, H. S., & Wagner, M. (2022). Iowa \nimplementation for sustainability framework. Implementation science: IS, 17(1), 1. \nhttps://doi.org/10.1186/s13012-021-01157-5 \nDydyk, A. M., & Gupta, N. (2023). Chronic pelvic pain. In StatPearls [Internet]. StatPearls \nPublishing. Available from https://www.ncbi.nlm.nih.gov/books/NBK554585/ \nGallagher, J. S., Missmer, S. A., Hornstein, M. D., Laufer, M. R., Gordon, C. M., & DiVasta, A. \nD. (2018). Long-term effects of gonadotropin-releasing hormone agonists and add-back \nin adolescent endometriosis. Journal of Pediatric and Adolescent Gynecology, 31(4), \n376–381. https://doi.org/10.1016/j.jpag.2018.03.004 \nKisling, L. A., & Stiegmann, R. A. (2024). Alternative medicine. In StatPearls. StatPearls \nPublishing. https://www.ncbi.nlm.nih.gov/books/NBK538520/ \nLamvu, G., Carrillo, J., Ouyang, C., & Rapkin, A. (2021). Chronic pelvic pain in women: A \nreview. JAMA, 325(23), 2381–2391. https://doi.org/10.1001/jama.2021.2631 \nLin, K. Y., Chang, Y. C., Lu, W. C., Kotha, P., Chen, Y. H., & Tu, C. H. (2023). Analgesic \nefficacy of acupuncture on chronic pelvic pain: A systematic review and meta-analysis. \nHealthcare (Basel, Switzerland), 11(6), 830. https://doi.org/10.3390/healthcare11060830 \n  \n\n \n \n62 \nMardon, A. K., Leake, H. B., Szeto, K., Astill, T., Hilton, S., Moseley, G. L., & Chalmers, K. J. \n(2022). Treatment recommendations for the management of persistent pelvic pain: A \nsystematic review of international clinical practice guidelines. BJOG: An International \nJournal of Obstetrics and Gynaecology, 129(8), 1248–1260. \nhttps://doi.org/10.1111/1471-0528.17064 \nMeisenheimer, E. S., & Carnevale, A. M. (2025). Chronic pelvic pain in women: Evaluation and \ntreatment. American Family Physician, 111(3), 218–229. \nhttps://pubmed.ncbi.nlm.nih.gov/40106288/ \nMirin, A. A. (2021). Gender disparity in the funding of diseases by the U.S. National Institutes of \nHealth. Journal of Women’s Health, 30(7), 956–963. \nhttps://doi.org/10.1089/jwh.2020.8682 \nMortada, E. M. (2024). Evidence-based complementary and alternative medicine in current \nmedical practice. Cureus, 16(1), e52041. https://doi.org/10.7759/cureus.52041 \nMyovant Sciences, & Pfizer. (2022). Myovant Sciences and Pfizer receive U.S. FDA approval of \nMYFEMBREE®, a once-daily treatment for the management of moderate to severe pain \nassociated with endometriosis. Sumitomo Pharma America, Inc. \nhttps://www.us.sumitomo-pharma.com/newsroom/press-releases/myovant-sciences-and-\npfizer-receive-us-fda-approval-myfembree/ \nTangkiatkumjai, M., Boardman, H., & Walker, D. M. (2020). Potential factors that influence \nusage of complementary and alternative medicine worldwide: A systematic review. BMC \nComplementary Medicine and Therapies, 20(1), 363. https://doi.org/10.1186/s12906-\n020-03157-2  \nVan Hal, M., Dydyk, A. M., & Green, M. S. (2023). Acupuncture. In StatPearls. StatPearls \nPublishing. https://www.ncbi.nlm.nih.gov/books/NBK532287/","source_license":"CC0","license_restricted":false}