CPP Among Somali Women in Norway: SCED

Assessed using an 11-point Numeric Rating Scale (NRS; 0-10), we ask for severity of pain today. For each scale, 0 indicates "no pain" and 10 indicates "worst imaginable pain". Higher scores indicate greater symptom burden.

Measured up to three times per week during single-case experimental design phases: baseline (A) and intervention (B). It will also be measured once at different time points: pre-intervention, post-intervention and at follow-up.

The participant can choose to use the Norwegian or the Somali version of the question.

Assessed using an 11-point Numeric Rating Scale (NRS; 0-10), we ask for distress of pain today. For each scale, 0 indicates "no distress" and 10 indicates "extreme pain-related distress". Higher scores indicate greater symptom burden.

Measured up to three times per week during single-case experimental design phases: baseline (A) and intervention (B). It will also be measured once at different time points: pre-intervention, post-intervention and at follow-up.

The participant can choose to use the Norwegian or the Somali version of the question.

Assessed using an 11-point Numeric Rating Scale (NRS; 0-10), we ask for interference of pain today. For each scale, 0 indicates "no interference" and 10 indicates "inability to perform activities". Higher scores indicate greater symptom burden.

Measured up to three times per week during single-case experimental design phases: baseline (A) and intervention (B).

It will also be measured once at different time points: pre-intervention, post-intervention and at follow-up.

The participant can choose to use the Norwegian or the Somali version of the question.

Assessed using domains 2 (Having sufficient information to manage my health), 3 (Actively managing my health), 4 (Social support for health), and 8 (Ability to find good health information) of the Health Literacy Questionnaire (HLQ), comprising a total of 19 items.

Domains 2, 3, and 4 are rated on a 4-point agreement scale, while domain 8 is rated on a 5-point difficulty scale. Each domain is scored and interpreted separately according to the HLQ scoring guidelines.

The participant can choose to use the Norwegian or the Somali version of the questionnaire.

Health-related quality of life will be assessed using the EQ-5D-5L descriptive system. The questionnaire measures five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Each dimension has five response levels ranging from no problems to extreme problems/unable to perform the activity.

The participant can choose to use the Norwegian or the Somali version of the questionnaire.

Overall health will be assessed using the EQ Visual Analogue Scale (EQ VAS) of the EQ-5D-5L. Participants rate their overall health today on a vertical visual analogue scale ranging from 0 (the worst health the participant can imagine) to 100 (the best health the participant can imagine).

The participant can choose to use the Norwegian or the Somali version of the questionnaire.

Patient-specific functional ability will be assessed using the Patient-Specific Functional Scale (PSFS). Participants will identify three personally meaningful activities affected by chronic pelvic pain and rate their ability to perform each activity on an 11-point scale from 0 (unable to perform the activity) to 10 (able to perform the activity without difficulty). Higher scores indicate better functional ability. At the initial assessment, a brief interviewer-assisted process will be used to support participants in identifying relevant activities. Subsequent assessments will use the same individually selected activities. The participant can choose to answer in Norwegian or Somali.

Self-efficacy for managing chronic pelvic pain will be assessed using a study-specific single-item question. Participants will rate their confidence in their ability to manage their pelvic pain independently in daily life on an 11-point scale ranging from 0 (no confidence in my ability to manage my pelvic pain independently) to 10 (very high confidence in my ability to manage my pelvic pain independently). Higher scores indicate greater perceived self-efficacy.

The participant can choose to use the Norwegian or the Somali version of the question.

Perceived change in chronic pelvic pain will be assessed using a study-specific single-item question based on the Global Rating of Change (GROC) scale. Participants will rate how their pelvic pain has changed compared with the start of the study on an 11-point scale ranging from -5 (very much worse), 0 (no change), to +5 (completely pain-free). Higher scores indicate greater perceived improvement.

The participant can choose to use the Norwegian or the Somali version of the question.

Treatment satisfaction will be assessed using four study-specific single-item questions rated on an 11-point scale ranging from 0 (completely dissatisfied) to 10 (completely satisfied). Participants will rate their satisfaction with pain education, general physical activity, pelvic floor muscle training, and overall satisfaction with the intervention. Higher scores indicate greater satisfaction. The participant can choose to use the Norwegian or the Somali version of the questions.

Psychological distress will be assessed using the Hopkins Symptom Checklist-5 (HSCL-5), a five-item self-report questionnaire assessing symptoms of anxiety and depression during the previous two weeks. Items are rated on a 4-point scale ranging from 1 (not at all) to 4 (extremely). Higher scores indicate higher levels of psychological distress. The participant can choose to use the Norwegian or the Somali version of the questionnaire.

Individual semi-structured interviews will be conducted with participants receiving the intervention. Interviews will use open-ended questions, and interviews will be conducted in their preferred language when needed.

The interviews will explore experiences, perceptions, and acceptability of the intervention, including understanding and management of chronic pelvic pain, health literacy, and bodily and emotional experiences related to overall health and quality of life. The interview guide will be informed by relevant domains from the Health Literacy Questionnaire (HLQ) and inspired by questions from the Conversational Health Literacy Assessment Tool (CHAT).

Individual semi-structured interviews will be conducted with physiotherapists delivering the intervention. Interviews will use open-ended questions and will explore the physiotherapists' experiences of delivering the intervention, including perceived feasibility, acceptability, and possibilities of implementation in clinical practice.