A Thematic Analysis and Theoretical Domains Framework Mapping of the Barriers and Facilitators to Chronic Pain Management Among People with Endometriosis

Objectives. Endometriosis pain management has often centred around the use of contraception or surgical procedures to remove or reduce lesions and pain. Whilst these methods have been effective for some, many women have reported continuous pain which together with diagnosis and treatment delays, has resulted in significant psychosocial implications, however interventions to address these has been limited. Therefore, the current study aimed to explore how women with endometriosis managed their pain, and what biopsychosocial barriers and facilitators they faced in relation to obtaining effective pain management. Determinants of behaviour and mechanisms for action were identified through the mapping of the Theoretical Domains Framework (TDF). Design. A qualitative, online questionnaire design. Methods. Online qualitative questionnaires were used to collect responses from 33 women aged between 20 and 48. Thematic analysis conducted at the latent level was used to analyse participant data and TDF domains were mapped onto themes identified throughout the responses. Results. Three superordinate themes were identified across responses that incorporated six biopsychosocial barrier and facilitator subthemes and eight TDF domains: a) Limited treatment options b) Relationship between patients and healthcare practitioners (HCP’s), c) Pain beyond the physical. Conclusions. Effective pain management within endometriosis is complex and driven by factors such as HCP awareness and social support which highlights the need for a holistic approach to endometriosis management. The findings have contributed to the current gap within the understanding of biopsychosocial barriers and facilitators to endometriosis pain management and informed evidence-based implications for future research and practice.