Understanding the barriers to healthcare for women with chronic pelvic pain

Chronic pelvic pain (CPP) is described as persistent pain perceived in structures related to the pelvis 1, of at least 3 months duration, not occurring exclusively with menstruation, intercourse, or pregnancy2. CPP can be an extremely debilitating condition and have a negative impact on social 3,occupational abilities, 4 emotions, and relationships1 and is linked to reduced quality of life (QOL)5,6.

Women with CPP in the UK wait on average 7-9 years for appropriate treatment7. The reasons as to why women experience such delays and why many symptomatic women do not seek medical help are potentially complex and likely influenced my multiple factors including cultural and ethnic influences8,9.

Currently whilst it is understood that chronic pelvic pain does not discriminate by ethnicity most studies report largely white populations 10 . Additionally, there is limited literature available that explores cultural and ethnic differences in seeking and receiving help for chronic pelvic pain 11.

Therefore, there is a clear and recognised need to understand cultural and ethnic influences in seeking and receiving help for CPP to ensure disparities and inequalities in access to care and care provision can be addressed.

Aim

The aim of this PhD studentship is to understand the barriers to healthcare for women with CPP from different cultures (the cultural focus will be driven by the specific interests of the successful candidate).

The candidate will explore the challenges and difficulties in accessing health care, consider on a local level how services are accessed, qualitatively explore experiences, beliefs and expectations of women and clinicians, and disseminate findings and provide recommendations/ resources to support identified gaps.

The more specific objectives of this project will be to:

1. Systematically review the reported barriers to healthcare.
2. Investigate local prevalence levels for CPP in primary care and the referral patterns to secondary care gynaecological services.
3. Explore the experiences, beliefs and expectations of women attending primary care for CPP and their referral journeys.
4. Consider the experiences, beliefs and expectations of primary care clinicians seeing and referring women for CPP.
5. Triangulate results to provide recommendations and identify/create resources to support women with CPP and clinicians.

Methods

The PhD student will use a qualitative methodological approach. The candidate will also become skilled in literature reviewing. There are four studies proposed as part of this PhD project.

Study 1 (Year 1) will include a literature review identifying the reported barriers to healthcare for women with CPP. The student will through initial scoping searches identify areas of interest that they wish to become the focus of further work. This review will be used as the evidence-base for informing Studies 3 and 4.

Study 2 (Year 1/2) will involve identification and analysis of primary care data that captures of prevalence of chronic pelvic pain within primary care. Further data identification and analysis will come from referral information to secondary care gynaecological services. The candidate will use this data to understand and map disparities in primary care prevalence, referral patterns and routes to secondary care.

Study 3 (Year 2/3) will be a qualitative interview study investigating the beliefs, experiences, and expectations of women with CPP and primary health care providers. Recruitment will be informed by information obtained from Study 1 and 2. The data will be analysed using Reflexive Thematic Analysis. This approach will enable the PhD candidate to build an in-depth understanding of experiences and beliefs in respect to healthcare barriers.

Study 4 (Year 3) will see the PhD candidate triangulate results to assimilate recommendations informed by framework and behavioural change theory. The candidate will work with stakeholders to develop and refine recommendations and dissemination resources.

The PhD candidate will gain skills in systematic review and qualitative research methods, results will help shape and transform current clinical care, information, education, and support for initial management of CPP.