The indigenous meaning of dysmenorrhea: using modified photovoice to document perspectives of traditional health practitioners (THPs) and indigenous knowledge holders (IKHs) [version 2; peer review: 1 approved, 1 approved with reservations]

Background: Globally, health understanding and beliefs vary across sub-cultural groups, depending on geographical location. Increasingly, various parts of the world recognize these perspectives to offer culturally sensitive healthcare services at primary level. Understanding the indigenous perspectives of dysmenorrhea meaning from the custodians of knowledge holders may add to the value of literature that may be used to advocate humanized culturally sensitive healthcare. This article aimed to explore and describe the perspectives regarding the meaning of indigenous dysmenorrhea among Batlokwa traditional health practitioners (THPs) and indigenous knowledge holders (IKHs). Methods: A qualitative, explorative study with a modified photovoice design, which included photographs, interviews and lekgotla discussion was employed to engage THPs and IKHs residing in Botlokwa Limpopo province, South Africa. Initially, a purposive sampling technique was used to select the participants, followed by snowball sampling. The participants themselves analyzed the photographs and described their meaning during individual interview using the acronym “PHOTO”. The researchers employed thematic analysis of interviews and Lekgotla discussion, in which themes were identified, formulated and analyzed from the codified data set. Results: In total, eight women participated in the photovoice study. The findings showed that indigenous understanding of dysmenorrhea stems from the African belief about health and illness with special emphasis on importance of holistic meaning. To the THPs and IKHs dysmenorrhea was a broad and integrated trend of a normal or abnormal process of illness that occurs periodically during menstruation. Conclusions: The THP’s and IKH’s indigenous meaning of dysmenorrhea reflects physical, mental, emotional, social, environmental, political and economic dimensions. Therefore, dysmenorrhea should be understood from a holistic approach. With appropriate partnerships and processes in place, this knowledge may be well represented in dominant healthcare systems and health research.