Table 1 The knowledge-to-action framework for sex, pain & endometriosis

Identify problem, then identify, review, & select knowledge

Our review of research evidence pointed to:

 • The immense physical and psychosocial burden of endometriosis-associated dyspareunia [4, 18] consists of challenges with intimate relationships, poor quality of life, difficulties conceiving and feelings of isolation, embarrassment, and guilt [4].

 • The importance of health literacy as a determinant of health for those who have complex, chronic, conditions [19], but limited opportunities or resources to support the health literacy of those with endometriosis.

 • Improving knowledge about endometriosis-associated dyspareunia has the potential to improve health-seeking behaviour, reduce patient distress, and improve health outcomes [20].

 • No e-health resources existed to communicate sufficient quality information specific to endometriosis-associated dyspareunia.

Adapt knowledge to local context

In our Canadian context we considered that:

 • There is on average a 5.4-year delay from symptom onset to diagnosis and finally surgical-pathological confirmation of endometriosis [11]. Not having a diagnosis can prevent patients from accessing information pertinent to pain management.

 • There is a high level of internet access.

Assess barriers to knowledge use

Access to evidence-based, health related information about symptoms and management is vital for the self-management of endometriosis [21]. We were not able to locate a pre-existing health-related website that is solely focused on providing in-depth, patient-centred information about endometriosis-associated dyspareunia. There is a need to create and deliver accessible and usable information about dyspareunia to support patient self-management.

Common barriers among health websites includes the lack of plain language terms and the limited reliability and usability of the presenting content [22].

We conducted a landscape review of pre-existing websites that provide a broad range of information about endometriosis to identify other barriers to knowledge use.

Select, tailor, implement interventions & monitor knowledge use

We chose to create an online health website because websites provide easily accessible health information that the public can locate and explore as needed. We used a patient-centred approach that included:

 • An initial focus group interview with patient partners to determine the website scope, aesthetics, content, and main messages.

 • An iterative process of obtaining and incorporating patient-partner feedback while creating the preliminary website.

 • Qualitative analysis of interviews with patients that viewed the website for the first time to determine its functionality and usability.

 • Qualitative analysis of interviews with patients that viewed the website for the first time to determine their perspectives of the preliminary website and identify content priorities for future development.

 • A final focus group review of the finished product with the patient partners for approval to launch.

Evaluate outcomes

To evaluate the effectiveness and reach of the final product, we paired the website with Google analytics, which will provide for an ongoing evaluation of key website metrics including the geographics of the audience and behaviour of users (i.e., unique visitors, pages accessed, time spent on each page, engagement rate, and links or interactive features used).

Using the final product, we plan to complete a social media campaign to expand the reach of this website to a larger audience.

Sustain knowledge use

Research in endometriosis has been steadily expanding and we plan to complete yearly revisions to the website to include information from emerging research and resources.