Self-management and health literacy in chronic pelvic pain among Somali women

Abstract

Background:
Chronic pelvic pain (CPP) is defined as persistent, non-cyclical pain lasting more than three months, and is associated with cognitive, emotional, sexual and behavioral consequences. CPP constitutes a major public health problem and accounts for approximately 20 % of gynecological consultations worldwide. A systematic review has shown that the global prevalence of CPP ranges from 5,7 % to 26,6 %, reflecting considerable variation and limited population-based data. Although multimodal physiotherapy has shown potential in addressing pelvic floor dysfunction and long-term pain, evidence among Somali women with chronic pelvic pain is scarce. In Norway, Somali women may face both social and structural barriers to care, including language-related challenges, limited access to health information, taboos to pelvic and sexual health, and a high prevalence of low health literacy. These factors may affect health-seeking behavior and long-term management of chronic pain.

Project description:
This PhD project aims to develop and evaluate a multimodal physiotherapy intervention for Somali women with CPP in Norway, situated within the primary healthcare sector. The intervention combines pain education and physical activity, including pelvic floor muscle training, with an emphasis on self-management and health literacy. The project uses a single case experimental design (SCED), including 20 Somali women with CPP, allowing participants to serve as their own controls through repeated measurements over time. Quantitative outcomes include pain-related measures, quality of life, health literacy, self-efficacy, patient-specific functional scale, mental health, perceived change in condition and treatment satisfaction. Qualitative interviews with participants and women’s health physiotherapists will explore feasibility, acceptability and experience of implementing the intervention in clinical practice.

Expected contribution and implications:
With a multimodal physiotherapy intervention, this project seeks to generate knowledge on how pain education and physical activity may influence self-management and health literacy among Somali women with CPP. The findings may inform clinical practice in primary care and provide a foundation for larger studies in the future. By aligning with national priorities on health literacy and equitable access to care, the project underscores the role of physiotherapy in public health work.