Barriers and Facilitators to Healthcare and Treatment Engagement Among Women of Childbearing Age Living with Chronic Pain: A Scoping Study

Background and Purpose: Adult women – particularly those of childbearing age, who experience marked functional impairment from pain – are disproportionately affected by chronic pain diagnoses (e.g., endometriosis and arthritis). Despite this higher burden, women are less likely to start pain treatments and have lower treatment adherence than their male counterparts. Given the high rates of chronic pain and low rates of treatment in this population, understanding the complexities of healthcare utilization is paramount to effective service delivery and improved health outcomes. The primary purpose of this scoping review was to explore barriers and facilitators to healthcare utilization that are unique to this group. Secondarily, we review the impacts of these barriers and facilitators on vulnerable sub-populations: sexual minority women, women of Color, women from low-income households, and women who use drugs. Finally, we discuss the ways in which social workers may intervene on key barriers.

Methods: A scoping study on barriers and facilitators to healthcare utilization among women of childbearing age living with chronic pain was conducted, guided by Arksey & O’Malley (2005) methodology. Five prominent databases (PsychINFO, PubMed, Social Services Abstracts, ScienceDirect, Scopus) were systematically searched for English language articles published in peer-review journals between January 2012 and March 2023. Original research reports, commentaries, and review articles were all considered for inclusion. Database searches returned 2,835 articles. After title review and duplicate removal, 107 articles received abstract review, 38 of which received full text review. Sixteen articles (15 research reports, nine qualitative, six quantitative; one narrative review) met criteria for final inclusion and underwent descriptive analysis.

Results: The scoping study identified significant barriers to receiving a chronic pain diagnosis, receiving treatment options, starting treatment, and adhering to treatment. The most common barriers included: 1) lack of healthcare provider training, 2) dismissal of symptoms by providers, and 3) structural limitations (financial and transportation). Facilitators included having an empathetic provider and financial resources. For the sub-populations search, two articles presented findings specific to women of Color, two discussed the experiences of women from low-income households, and only one study enrolled women who use drugs. No articles touched on the impact of sexual orientation on healthcare utilization.

Conclusions and Implications: The results of this scoping study highlighted central barriers to healthcare utilization for women of childbearing age living with chronic pain and emphasize the importance of intervening on 1) structural barriers (via insurance navigation and transportation assistance), 2) provider biases and sexism (via provider-level behavioral interventions), and 3) limited provider knowledge around chronic pain treatment (via additions to medical school and continuing education curricula). Additionally, there was a dearth of literature that discussed the experiences of women who may be living with multiple stigmatized identities and, as such, are more vulnerable to suboptimal treatment engagement and poorer health outcomes. These findings underscore the need for chronic pain healthcare utilization research directed to these populations. Given the holistic training social workers receive, we are well-placed to both intervene on identified barriers and engage in scientific inquiry to address these research gaps.