“Will HR Know About This?” Lessons from implementing endometriosis workplace guidelines in an Australian University

Danielle Howe, Howe D, Maria T. O'Shea, O’Shea M, Sarah Duffy, Duffy S, M. Armour, Armour M
In: Research Square · 2026 · doi:10.21203/rs.3.rs-8735748/v1 · W7131270940
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A pilot of endometriosis workplace guidelines at an Australian university revealed low uptake and mistrust in evaluation processes, with silence around health needs being the primary barrier to policy implementation.

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This study piloted Endo@Work, a co-designed workplace guideline for employees with endometriosis and chronic pelvic pain (CPP) in an Australian university, using a three-month mixed-methods evaluation that included a tailored policy, staff and supervisor toolkits, a Chronic Pelvic Pain Coordinator role, and a webinar. Online surveys were administered at baseline and trial end (n=58 to n=36) to assess endometriosis health-related quality of life (EHP-30), work productivity (WPAI), and factors influencing disclosure and support, while ten semi-structured interviews were analysed using reflexive thematic analysis. Due to low guideline uptake, the authors could not formally test intervention effects; they found that internal evaluation was affected by staff mistrust and likely impression-management response bias, including underreporting of symptom burden and high non-response to discrimination items, with interviews attributing these patterns to stigma reinforced by academic competition, restructure, managerial uncertainty, and limited senior leadership engagement. Relevance to endometriosis: the paper’s entire workplace-guideline pilot targets endometriosis/CPP employees and reports how stigma and survey mistrust shaped disclosure and perceived support in that context.

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Abstract

Abstract Background : Endometriosis and chronic pelvic pain (CPP) substantially affect work participation and productivity, yet workplace interventions remain largely unevaluated. This study piloted Endo@Work, a co-designed workplace guideline to support employees with endometriosis/CPP in an Australian university. Methods : A mixed methods design evaluated a three-month trial of the Endo@Work guidelines, which included a tailored policy, staff and supervisor toolkits, a Chronic Pelvic Pain Coordinator role, and webinar. Online surveys were administered at baseline and at end of trial (n=58 and n=36), capturing demographics, endometriosis health-related quality of life (EHP-30), work productivity (WPAI), and factors shaping disclosure and support. Ten semi-structured interviews were analysed using reflexive thematic analysis. Findings : Low guideline uptake prevented formal testing of intervention effects, however, the study generated important insights into staff mistrust of internal evaluation processes. Mixed-methods findings suggest impression management response bias, evidenced by underreporting of symptom burden among staff with endometriosis/CPP and high non-response to discrimination items. Interviews contextualised these patterns, showing how academic competition, compounded by university-wide restructure, reinforced stigma, fear of discrimination, and managerial uncertainty about initiating health conversations, sustaining silence and undermining trust in internal surveys. The primary barrier was not policy inadequacy, but entrenched silence around health needs at work. This silence, shaped by cultures of competition and overwork, managerial uncertainty, and limited senior leadership engagement with chronic health, sustained the gap between policy and practice. Conclusion : Findings point to the need for external evaluation, visible leadership endorsement, and targeted manager training to meaningfully close this gap.
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This study piloted Endo@Work, a co-designed workplace guideline to support employees with endometriosis/CPP in an Australian university. Methods : A mixed methods design evaluated a three-month trial of the Endo@Work guidelines, which included a tailored policy, staff and supervisor toolkits, a Chronic Pelvic Pain Coordinator role, and webinar. Online surveys were administered at baseline and at end of trial (n=58 and n=36), capturing demographics, endometriosis health-related quality of life (EHP-30), work productivity (WPAI), and factors shaping disclosure and support. Ten semi-structured interviews were analysed using reflexive thematic analysis. Findings : Low guideline uptake prevented formal testing of intervention effects, however, the study generated important insights into staff mistrust of internal evaluation processes. Mixed-methods findings suggest impression management response bias, evidenced by underreporting of symptom burden among staff with endometriosis/CPP and high non-response to discrimination items. Interviews contextualised these patterns, showing how academic competition, compounded by university-wide restructure, reinforced stigma, fear of discrimination, and managerial uncertainty about initiating health conversations, sustaining silence and undermining trust in internal surveys. The primary barrier was not policy inadequacy, but entrenched silence around health needs at work. This silence, shaped by cultures of competition and overwork, managerial uncertainty, and limited senior leadership engagement with chronic health, sustained the gap between policy and practice. Conclusion : Findings point to the need for external evaluation, visible leadership endorsement, and targeted manager training to meaningfully close this gap. endometriosis chronic pelvic pain workplace guidelines higher education HR evaluation frameworks Full Text Additional Declarations No competing interests reported. Supplementary Files SDFStafftoolkit.pdf SDFSupervisortoolkit.pdf Cite Share Download PDF Status: Published Journal Publication published 08 May, 2026 Read the published version in Discover Public Health → Version 1 posted Editorial decision: Revision requested 10 Mar, 2026 Reviewers agreed at journal 09 Mar, 2026 Reviews received at journal 09 Mar, 2026 Reviews received at journal 08 Mar, 2026 Reviewers agreed at journal 07 Mar, 2026 Reviewers agreed at journal 02 Mar, 2026 Reviewers invited by journal 20 Feb, 2026 Editor assigned by journal 10 Feb, 2026 Submission checks completed at journal 09 Feb, 2026 First submitted to journal 09 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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