Workplace mistrust and barriers to implementing workplace guidelines for endometriosis and chronic pelvic pain a mixed methods intervention study in an Australian University

Danielle Howe, Michelle O’Shea, Sarah Duffy, Mike Armour
In: Discover Public Health · 2026 · vol. 23(1) · doi:10.1186/s12982-026-02018-6 · W7160847522
article OA: diamond CC0
📄 Open PDF View on OpenAlex View at publisher
⚙ AI-generated summary by claude@2026-06, 2026-06-06 ⓘ

This mixed-methods study found that workplace mistrust, fear of discrimination, and managerial uncertainty, rather than policy inadequacy, were the primary barriers to implementing endometriosis and chronic pelvic pain guidelines at an Australian university.

One-sentence paraphrase of the abstract; not a substitute for reading it. No clinical advice. How this works

⚙ AI-generated deep summary by claude@2026-06, 2026-06-06 ⓘ

This mixed-methods pilot study evaluated a three-month trial of Endo@Work, a co-designed workplace guideline package for employees with endometriosis and chronic pelvic pain (CPP) at an Australian university, using online surveys at baseline and follow-up (n=58 then n=36) plus semi-structured interviews (n=10). Quantitative measures included endometriosis health-related quality of life (EHP-30) and work productivity (WPAI), alongside factors shaping disclosure and support, while qualitative analysis examined workplace structural and cultural barriers to guideline uptake. Uptake was low, so formal intervention effects could not be tested, but the study identified mistrust and response bias, including underreporting of symptom burden and high non-response to discrimination items among staff with endometriosis/CPP, contextualized by stigma, fear of discrimination, managerial uncertainty about health conversations, and a workplace culture of competition and overwork. This paper is centrally about endometriosis — it develops and tests (and explains barriers to uptake of) Endo@Work workplace guidelines for employees with endometriosis and CPP.

Read from the paper's body, not the abstract. Not a substitute for reading the paper. No clinical advice. How this works

Abstract

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. To evaluate pre and post implementation experiences of Endo@work among staff with endometriosis and CPP and for managers/supervisors (with and without endo/CPP) in supporting them. A mixed methods design evaluated a three-month trial of the Endo@Work guidelines, which included a tailored policy, staff and manager/supervisor toolkits, a Chronic Pelvic Pain Coordinator role, and webinar. Online surveys, tailored according to participant group and endo/CPP status, 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. 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. Findings point to the need for external evaluation, visible leadership endorsement, and targeted manager training to meaningfully close this gap. Trial registration: This study was registered with Australian New Zealand Clinical Trial Registry (ANZCTR) on 12 June 2024. The study was registered 25 June 2024, registration number: ACTRN12624000773538p.

My notes (saved in your browser only)

Outcome instruments

EHP-30

Condition tags

endometriosischronic_pelvic_pain

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (48)

Source provenance

openalex
last seen: 2026-06-10T17:14:06.276822+00:00
License: CC0 · commercial use OK