Pilot and evaluation of a music and text message intervention for people with endometriosis

Endometriosis, a chronic inflammatory condition, affects approximately 10% of individuals at reproductive age globally (WHO, 2023). People living with endometriosis (PLWE) experience a multitude of symptoms, such as pain (including painful periods, pain during urination, pain during defecation, and chronic pelvic pain), fatigue, infertility, and gastrointestinal symptoms (Mitchell et al., 2024). Alongside the physical symptomology, PLWE commonly experience psychological sequalae including higher rates of depression and anxiety and reduced quality of life (Sullivan-Myers et al., 2021; Szypłowska et al., 2023). These difficulties diminish capacity of PLWE to engage in daily activities, including social activities, work and physical exercise (Armour et al., 2019; Bell et al., 2023; Calvi et al., 2024; Cole et al., 2020). There is high demand for a multidimensional, accessible intervention for people living with endometriosis (PLWE) as a complementary self-management tool to improve psychosocial outcomes. Music interventions are an emerging low cost strategy that has been found to improve stress (de Whitte et al., 2020; Linnemann et al., 2015; Linnemann et al., 2018; Thoma et al., 2012) and pain (Dobek et al., 2014; Feneberg et al., 2021; Nilsson, 2008). However, these interventions have not yet been evaluated in an endometriosis population. A further intervention that provides accessible support is text message interventions. These interventions have demonstrated support for people managing chronic conditions and psychological wellbeing (Agyapong et al., 2020; Dwyer et al., 2021; Singleton et al., 2022). This type of intervention has shown promise in PLWE with the development of EndoSMS (Sherman et al., 2022; 2023; 2024). Using a co-design strategy, positively framed text messages providing patient-centred support and psychoeducation were developed and delivered to PLWE (Sherman et al., 2022). The EndoSMS x Music intervention uniquely combines psychologically supportive text messaging to improve emotional health with the stress and pain-reducing benefits of music in a low-cost, highly accessible format. To establish the foundation for the efficacy and acceptability for this intervention, this project focuses on co-design, feasibility, and acceptability to allow refinement prior to evaluating the efficacy of the intervention (Pearson et al., 2020). This will ensure an intervention tailored to the target population that has been designed and piloted to provide an implementable program. As music interventions have not yet been applied to a PLWE population, the acceptability, feasibility and preliminary efficacy of this approach must first be established in a proof-of-concept study (phase 1). Alongside this, revision of the EndoSMS text message library must be made to incorporate feedback received in the previous pilot trial (phase 2a; Sherman et al., 2024). Once each component has been independently considered, a feasibility, acceptability and preliminary efficacy trial (phase 2b) of the combined intervention must be run to provide a foundation for a full-scale evaluation trial (phase 3). Aims 1. To assess the acceptability, feasibility and preliminary efficacy (on pain, stress, and perceived control) of a music intervention for individuals with endometriosis. 2. To extend and co-develop a psychologically focused text message intervention for individuals with endometriosis. 3. To assess the acceptability, feasibility and preliminary efficacy (emotional health and pain) of a combined music and text message intervention for individuals with endometriosis. 4. As a secondary outcome, to evaluate the preliminary efficacy of a music and text message intervention for individuals with endometriosis, compared to a control group.