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

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.