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This is to certify that the

thesis entitled

THE RELATIONSHIP OF MENOPAUSE KNOWLEDGE, PRIMARY SOURCE
OF INFORMATION AND THE LIKELIHOOD OF TAKING
HORMONE REPLACEMENT THERAPY AMONG
LOW-INCOME AFRICAN-AMERICAN WOMEN

presented by

Evelyn Gladney

has been accepted towards fulfillment
of the requirements for

Master of Sciencedegree 111W

0mm 5 KMW‘N

ajor professor

Date May 8, 1997

 

0-7 639 MS U is an Affirmative Action/Equal Opportunity Institution

PLACE N RETURN BOX to move this checkout from your record.
TO AVOID FINES Mom on or before data duo.

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AAA-4 JA- 4

 

THE RELATIONSHIP OF MENOPAUSE KNOWLEDGE, PRIMARY SOURCE
OF INFORMATION AND THE LIKELIHOOD OF TAKING
HORMONE REPLACEMENT THERAPY AMONG
LOW-INCOME AFRICAN-AMERICAN WOMEN

BY
Evelyn Gladney

A THESIS
.Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

MASTER OF SCIENCE

College of Nursing

1997

ABSTRACT
THE RELATIONSHIP OF MENOPAUSE KNOWLEDGE, PRIMARY SOURCE
OF INFORMATION AND THE LIKELIHOOD OF TAKING

HORMONE REPLACEMENT THERAPY AMONG
LOW-INCOME AFRICAN-AMERICAN WOMEN

BY
Evelyn Gladney

The purpose was to EXAMINE relationships between level
of knowledge and, primary sources of information regarding
menopause and the likelihood to take HRT. The study also
examined the relationship of likelihood to take among select
variables including sociodemographic, health background and
prior use of HRT. Study participants were 197 low income
.African American women (LIAAW) ranging between the ages of
40 and 60. A secondary analysis yielded the following
results: 1) level of knowledge-u 7.4 score (30% correct); 2)
primary sources of information: physician and other women
(31 and 30% respectively). Significant relationships
between likelihood to take HRT were found among level of
knowledge, health background variables (hysterectomy and
history of fracture) and current use of HRT. No significant
relationships were found between likelihood to take HRT and.
sociodemographic (income, education and source of payment
for medication), or past use of HRT. Findings indicate a
lack of information regarding menopause and HRT. Further
research is needed to determine interest, and needs of this

population, with respect to decisions about use of HRT.

To my husband, Rufus, for his love, support and
believing in me. To my children, Joshua and Jamila,
for love, understanding and support which went well

beyond their years, even when it seemed that “mama
cared more about the thesis than she does us”. To
my mother, Evelyn D. Thompson, who prayed for me. To
my sisters, brother, other family and friends who
encouraged me to “keep on keeping on”. To the
memory of my father, Arthur Thompson, who taught
me that education and belief in God is
essential to a successful life.

iii

ACKNOWLEDGMENTS

I wish to thank my committee, Georgia Padonu, Marilyn
Rothert, and Brigid Warren. Georgia Padonu, my chair, a
special thank you for keeping me focused and for giving me a
sense of empowerment to complete the goal. Marilyn and
Brigid thank you for guidance in selecting an appropriate
conceptual framework and for clarification of the research
questions.

Jill Kroll, I could never thank you enough for taking
time from your busy schedule to help me with an enormous
amount of numbers.

Thank you, Oren Christmas. Your help and commitment

made it possible for me to understand the data sets.

‘Now unto him that is able to do exceedingly abundantly
above all that we ask or think, according to the power that
worketh in us”.

Ephesians 3:20

iv

Copyright by
EVELYN GLADNEY
l 9 9 7

TABLE OF CONTENTS

LIST OF TABLES . . . . . . . . . . . . . .
LI ST OF FIGURES O O O O O O O O I O O O O O
INTRODUflION O O O I O O O O O O O O O O 0
Background and Relevance . . . . . . .
Research Questions . . . . . . . . . .

CONCEPTUAL FRAMEWORK . . . . . . . . . .
Conceptual Definition

REVIEW OF LITERATURE . . . . . . . . . . .
Knowledge of Menopause and HRT . . . .
Likelihood to take Hormone Replacement
Sources of Information . . . . . . . .
Sociodemographics, Health Background an

of HRT Use . . . . . . . . . . . . .

METHODS . . . . . . . . . . .
Original Study . . . . . . . .
Current Study . . . . . . .
Operational Definitions of Variables

DATA ANALYSIS AND RESULTS . . . . .

Interpretation of Findings by Model and
Existing Literature . . . . . . . . .

IMPLICATIONS FOR ADVANCED PRACTICE NURSE AND PRIMARY

CARE 0 O O O O O O O I O O I O I
Limitations of Secondary Analysis . .
Recommendations for Future Research .

LI ST OF REFERENCES 0 O O O O O O O O O O O

APPENDICES O O O O O O O O O O O O O O O 0

vi

Therapy

d

History

Page
vii

viii

DUI U'IUH

O O O O
p
H

15
15
16
16

. 26
. 3O
. 31

LIST OF TABLES

Page
TABLE 1: Menopause/HRT Knowledge Scores . . . . . . . . . 20

TABLE 2: Correlation Coefficients for Sociodemographic
Variables and Likelihood to take HRT . . . . . 22

TABLE 3: Correlation Coefficients for Health Background
and Likelihood to take HRT . . . . . . . . . . 22

TABLE 4: Correlation Coefficients for History of HRT

use and Likelihood . . . . . . . . . . . . . . 23

vii

LIST OF FIGURES

FIGURE 1: Nola Pender's Health Promotion Model . . . . . 6

FIGURE 2: Adaptation of Pender's Health Promotion . . . . 8
Model

FIGURE 3: Sources of Information . . . . . . . . . . . . 21

viii

INTRODUCTION

The changing demographics of American women have
prompted health care professionals to pay closer attention
to the woman who is completing her reproductive years and
transitioning into menopause (Garner, 1991).

Menopausal women of today are increasingly placing
demands on health care givers to provide health education,
information, and strategies to manage menopause. Increased
attention is being given to hormone replacement therapy
(HRT) and its benefits in the management of menopause for
short and long term. HRT is being used for short-term
management of menopausal symptoms such as hot flashes and
vaginal dryness. From the long-term prospective, HRT use
can reduce increased risk of certain health conditions,
specifically, coronary heart disease (CHD) and osteoporosis.

The decision whether to take or not take'HRT is a
crucial one for menopausal women. The literature identifies
four major factors as women make a decision to take or not
take HRT. These four factors are: 1) menopausal symptoms
(hot flashes), 2) risk of fractures due to osteoporosis, 3)
risk of endometrial cancer and, 4) risk of heart disease
(myocardial infarction). HRT replaces the female hormones

which diminish greatly around the time of menopause. HRT

l

2
eliminates hot flashes, decreases the risk of fractures due
to osteoporosis and decreases the risk of heart attacks.
The type of regimen may also become a factor when deciding
to take HRT.

Even though HRT has many benefits, it is not without
risk. There are two major regimens for HRT, estrogen-only
and estrogen combined with progestogen. Estrogen, taken by
itself, increases the risk of uterine cancer. However, when
estrogen is taken in combination with progesterone the risk
is neither increased nor decreased. The addition of
progestogen takes away the risk associated with taking
estrogen alone (Greendale & Judd, 1993).

Previous research and recommendations on the risks and
benefits of HRT have focused on white women. Little is
known about low-income African-American woman's (AAW)
likelihood to take HRT or their experience using HRT. It is
important studies focus on the AAW for two reasons: 1)
disparity in the health status of AAW; 2) possible
differential risk in terms of CHD and osteoporosis when
compared to white women.

Only two studies were found documenting AAW's knowledge
of menopause and HRT risk and benefits. LaRocco and Pilot
(1980) report a test of menopause knowledge reflected a
mediocre performance. Padonu et al. (1996) state the
menopause knowledge and HRT risk/benefits among (n=55) AAW

are unclear.

3

A similar lack of findings exist has to how women,
including AAW, obtain information about menopause. Padonu
et al. (1996) report the major sources of menopause
information for (n=55) AWW were books and other women.
Mendham & Rees (1992) showed thirty-four percent of the
forty-four British women in their study, sought information
from a general practitioner, and did not see nurses as an
appropriate information source.

Findings regarding AAW's knowledge of menopause, and
sources of information could assist the APN in primary care
to develop culturally sensitive related interventions for
women of various cultural backgrounds, socioeconomic status,
and ethnicity. Such findings may also give insight to the
women's need for information to support their decision
whether to take or not take HRT. Studies are also needed to
determine possible linkage between sociodemographics, health
background and history of HRT in decision making regarding
HRT.

WW

There are three major reasons for relevance of the
study. The first reason is the possibility of differential
risk. It has been noted that there is a differential risk
between AAW and white women for osteoporosis. Specifically,
AAW tend to have lower risk of developing osteoporosis than
white women (Grady, 1992). Considering CHD as a risk, one
study report AAW and white women have similar risk of

developing CHD, 46.5% and 46.1% respectively. In terms of

4
risk for mortality associated with CHD, studies are
inconsistent. Some studies report the mortality rate for
CHD is higher among AAW when compared to white women
(National Center for Health Statistics, 1991). However, a
longitudinal study (Keil et al., 1993) reported a higher
death rate for AAW, but the difference was not statistically
significant. Evidence support cardioprotective benefits
from HRT for AAW to be similar to that of white women.

The second area of significance for study is the need
to know if LIAAW lack information about the benefits of HRT
for reducing osteoporosis and especially, reducing CHD risk.
A study of LIAAW (n=55) report that the risk of heart
disease was not associated with estrogen decline of
menopause. Perceptions of CHD risk were perceived with
aging, risk factors, and family history by this sample.

The third reason for study relevance is the disparity
in the health status of LIAAW and the influence of
sociodemographics and health background, or interest in
taking HRT. Few studies were available which provided
information about LIAAW's experience with HRT, current use
of HRT or past use of HRT.

Given the tremendous gap in research of AAW, the
purpose of this study is to determine: level of knowledge of
menopause and HRT; most frequent source of information; and
the relationship of variables such as: 1) level of
knowledge; 2) sociodemographics; 3) health background; and

4) history of HRT and the likelihood to take HRT.

W

The research questions for this study are: 1) What is
the level of knowledge regarding menopause and HRT among
AAW; 2) What is the relationship of level of knowledge and
the likelihood of taking HRT; 3) What is the most frequent
source of information regarding menopause; 4) What is the
relationship between sources of information and the
likelihood of taking HRT; 5) What is the relationship
between select sociodemographic variables, health
background, history of HRT use and the likelihood of taking
HRT.

CONCEPTUAL FRAMEWORK

An adaptation of Nola Pender's ”Health Promotion Model"
presents a useful model for predicting and explaining health
promotion behavior. Pender's (1996) model consist of three
main behavioral factors: individual characteristics and
experiences, cognitions and affect and behavior outcome.
The model is a cognitive processing type in which health-
promoting behavior can be enhanced by health care
professionals through changing the cognitive fields of the
patient to align with the desired outcomes.

The best predictor of behavior is the frequency of the
same or similar behavior used in the past (Pender, 1996)
(Figure 1). Every incident of a behavior is accompanied by
emotions or affect. Positive or negative affect occurs

before, during or after the behavior. Prior behavior is

Individual
Characteristics
and Experiences

   

  
   
   

Prior
related
behavior

 

Personal
factors;
biological —>
psychological;
sociocultural

 

 

 

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1

Activity
related
affect

 

 

 

 

 

 

 

 

Behavior-Specific Behavioral
Cognitions and Affect Outcome
Perceived
benefits
of action
Perceived
4 barriers
to action
* Immediate competing
T demands
(low control)
and preferences
4| (high control)

 

Perceived
self-efficacy

 

i

 

4 .

 

 

 

 

 

 

Interpersonal
influences
(family, peers,
providers); norms,
support, models

Commitment V Health
to a plan promoting
of action behavior
e t l

 

 

 

 

 

 

 

Situational
influences;
opfions

demand characteristics

aesthetics

 

 

 

 

 

 

 

 

Figure 1. Nola Fender's (1996) Health Promotion Model.

7
proposed as shaping all behavior-specific cognitions and
affect (Pender, 1996). The APN can help shape a positive
behavioral outcome by helping clients to focus on the
positive benefits of a behavior, through health education
and teaching (Figure 2).

Personal factors that predict a given behavior are
shaped by the nature of the target population of study
(Pender, 1996). Personal factors include biologic,
psychologic and sociocultural variables. For purposes of
this paper, biologic and psychologic personal factors will
be omitted. Personal factors will include
sociodemographics, health background and history of HRT use.
Pender (1996) states personal factors are proposed as
directly influencing behavior-specific cognitions and affect
as well as health-promoting behavior.

Cognitions and affect are thought to be of major
motivational significance (Pender, 1996). The variables of
cognition and affect are the "core" for interventions to
engage in a particular behavior. Women's knowledge about
menopause is an important cognitive factor to engage women
in health promoting behavior. Pender (1996) states the
primary sources of interpersonal influence on behaviors that
promote health are families, peers and health care
providers. Social support to commit to a behavioral plan of
action influence interpersonal affect. Conversation with
others stimulate action to engage in health promoting

behaviors.

Individual Characteristics
and Experience

Personal Factors

5 . l l'

' age

0 income

' education

' source of payment
for medicines

HealthBaelsgmnfl

0 hx of cancer

0 hx of heart disease

' osteoporosis

0 hysterectomy/
oophorectomy

- menopause status

quzLHRfllsc

' Current HRT use

0 Past HRT use

 

 

 

 

 

&
'0
V

 

Cognition Behavioral
and Affect Outcome
Sources of Information
Interpersonal influences

other women)

(APN, health care providers,

 

 

Situational Influences
(printed materials and T.V.

 

 

 

 

 

APN

ab ‘3' .
$9.

 

 

 

f—

 

 

Knowledge Plan of Action

- menoapuse

- HRT take HRT

 

 

—> Likelihood to —>

 

Health Outcome
- Health promotion
,0 Disease prevention

 

 

T

figure; Adaptation of Nola Pender's Health Promotion Model.

 

9

Situational influence may directly affect behaviors by
presenting an environment with strong cues to action
(Pender, 1996).

Health promoting behavior is the end results or action
outcome for the Health Promotion Model. Positive health
outcomes can result in a positive health experience
throughout a person's life span.

When women are provided with factual information that
provides health education, this, in turn, may offer a more
thorough understanding of menopause and guide a woman to a
clearer direction for promoting women's health during this
time in her life. Because it is known that "knowledge is
power”, the health teaching implemented concerning menopause
will enable AAW to know that they can be educated consumers
about their health.

The APN in primary care, because of their recognized
expertise and continuing care of clients, have a unique
opportunity to facilitate positive health outcomes, such as
health promotion and disease prevention. However, in all
efforts to assist clients to make effective pesitive
changes, the need to recognize population diversity will
enable the nurse in advance practice to develop relevant
culturally sensitive health promotion strategies.
WW

Kngn1gdge_gf_uengpause_and_flnm. According to The New
Merriam-Webster Dictionary (1996), knowledge is an

10
understanding gained by actual experience; something learned
and kept in mind; a clear perception (p. 412).

For purposes of this paper, the writer defines
knowledge of menopause as a woman's understanding of
symptoms, risk factors related to estrogen, and the risk and
benefits related to HRT.

W-

Hormone replacement therapy (HRT) is the use of estrogen
alone or estrogen/progesterone in combination (PERT) for
menopausal management of symptoms, and to reduce the risk of
osteoporosis or heart disease (Anderson, 1996). Likelihood
refers to the probability to perform an act.

This writer defines likelihood of HRT as the
probability that a woman will or will not use PERT.

WM
Menopause. According to The New Merriam-Webster Dictionary
(1996), source is defined as: origin; beginning; a supplier
of information (p. 689).

Information according to The New Merriam-Webster
Dictionary (1989) is the communication or reception of
knowledge or instruction; knowledge obtained from
investigation, study or data (p. 382).

This writer defines sources of information regarding
menopause as written materials to include books, magazines,
and pamphlets. Physicians, other women, and television act
as a supplier of information that may or may not influence

the women to take HRT.

ll

Snnindsmngznphics. This writer defines
sociodemographics as personal characteristics of the study
sample to include the variables of education, income and
source of payment.

Health_flagkgrgnnd. The writer defines health
background as the experience of a physical condition of the
study sample to include: hysterectomy, oophorectomy,
fractures, history of cancer and heart disease.

History_gf_HBT. History of HRT will include past and
current use of hormone replacement therapy.

REVIEW OF LITERATURE

The review of literature will provide a point of
reference for this study since only a limited number of
studies included LIAAW. Reviews will deal with knowledge of
menopause and HRT; likelihood to take HRT; sources of
information; sociodemographics, health background and
history of HRT use.

WW

Specific studies of AAW's knowledge of menopause were
not found. One previous study regarding women's knowledge
about menopause was found (LaRocco & Polit, 1980) but the
sample size to include AAW was too small to draw a
conclusion. Three studies were found that identified AAW as
part of the sample in perceptions of menopause, and symptoms
specifically focused on AAW. The following are brief

reviews of those studies.

12

A study of 66 low income clinic patients, showed a
trend of more positive attitudes toward menopause among 18
to 25 year old AAW when compared to a corresponding sample
of white women (Standing & Glazer, 1992). This study was
limited because it lacked insight regarding women closer to
the menopausal age. Frey (1981) conducted a study of
women's perception of menopause which included AAW, but the
sample was too small for analysis. Hot flashes and vaginal
dryness are generally accepted and reported 8/8 of menopause
for the entire female population (Dosey et al., 1980).
Patrick (1970) studied the relationship among life
satisfaction, life changes, life goals, and menopausal
symptoms. The study population consisted of 105 upper-
middle-income White women and 55 low-income Black women.

The results reported no significant difference in the amount
of menopausal symptoms between the two groups. Arthritis of
small joints was included as a menopause symptom in a study
of Nigerian women aged 38 to 65 years of age (Sarrel 8
Bajulaiye, 1984). In other studies AAW with the greatest
number of symptoms were more likely to be less educated and
unemployed (LaRocco & Polit, 1980; Frey, 1981).

In summary, research focusing on AAW's knowledge of
menopause is very limited. The majority of the research has
dealt with educated, middle-income white women. The few
studies that were found are inconclusive because of the use
of inappropriate menopausal age in the sample, and because

the number of AAW included in the sample was too small.

13
Continued research on knowledge of menopause is important so
that the AAW's needs and concerns in relation to menopause
can be meet. '
LWWW

The following studies relate to factors that may
influence women's use of HRT. Leiblum and Swartzman (1986)
found middle class professional women to be evenly divided
for and against HRT because of associated risk. Harris et
al. (1990) in a community survey of 954 women aged 50-60
years, found current use of HRT reported at 32%, (26% took
estrogen unopposed while 6% used combined therapy). Women
who used estrogen replacement therapy (ERT) were younger,
less likely to be obese, lived in smaller household units,
and less likely to be widowed. Ferguson (1989), in a survey
of women taking ERT reported women taking this type therapy
were more likely to: 1) know that decreased levels of
estrogen lead to osteoporosis; 2) perceived menopause to be
a medical condition; 3) believed that natural approaches to
menopause are less preferable to seeing a gynecologist for
care; and 4) believed that women should take ERT for hot
flashes.

A study of (n=106) African American and white nurses
(Ramson et al., 1995) report that AAW were less likely to
believe that ERT was a good idea for other women or a good
personal choice. Sixty-eight percent of the AAW in the

sample were unable to indicate knowledge of ERT's protective

14
cardiovascular role. This study also reports that there is
less acceptance of ERT among AAW than white women.

A study (n=141) of urban American women with 70% of the
sample being AAW, report AAW were not less likely to have
used ERT than comparable white women who were cared for in
the same clinical practice. The majority of AAW and white
women in the same clinic who should have been receiving ERT
according to authoritative guidelines, did not. Thus both
groups had an ERT gap (Jahnige 8 Rieback, 1997).

In summary, reviewed published research indicates
inconsistencies ranging from less acceptance among AAW than
white women to AAW were less likely to use ERT than white
women. Other reviewed studies did not include AAW in the
sample, but reported women were both for and against HRT
because of associated risk.

Senmemnfemtien

Specific studies about sources of information used by
AAW were not found.

A study by Padonu et al. (1996) reports the major
sources of menopause information for low-income AAW are
books and other women. This same study also reports that
health care system was not viewed as a source of
information. The women expressed perceptions of
unsatisfactory interactions with health care providers,
leaving them with the feeling that health care providers see

them as lacking intelligence.

15
. .,. - H .,. - . . : , - - . ; - , . . , . . . . . ; . . .n; : .

While sociodemographics and health background have
shown to be useful variables in examining the health
experience of LIAAW, no studies were found relating these
two variables with the HRT experience of LIAAW. One study
was found which described the history of HRT use (Padonu, et
al., 1996). The only finding of relevance for this study
report twenty-four percent were currently using HRT, and
thirty percent had been given prescriptions for HRT (past
use).

In conclusion, almost no information is available
regarding the above variables. Such information would be
useful in clinical application and contribute to base line
data.

METHODS
Qrininal.£tnd¥

The current research will be secondary analysis of data
collected from "Women's Judgement of HRT". The purpose of
the original research was to conduct a judgement study to
identify and systematically assess factors which impact on
low income AAW's judgements about their likelihood to take
hormone therapy.

A total of 197 (n= 197) predominantly low-income AAW
were recruited from a convenience sample, largely from low-
income housing developments in Saginaw, Michigan. A key
community leader was instrumental in recruiting AAW for the

study. Flyers and radio announcements were also used. The

16
questionnaires were administered in a group setting and
required approximately forty-five minutes to complete as
part of a longer study of judgement processes (total time,
two hours average). Participants were given $25 for the
entire task.

A ninety-two item questionnaire was used to collect
data on the following: demographics, health background, HRT
experience, perceptions of menopause, menopause symptoms,
health promotion practices during menopause, knowledge of
menopause, menopause risk expectations, likelihood of taking
HRT, and source of information regarding menopause.
W

A descriptive correlational study design was used to
examine the level of knowledge, frequent source of
information and likelihood of taking HRT.

Sociodemographics, health background, and history of HRT was

also analyzed.

WWW
Knowledge_ni;nengpause. The previously developed

knowledge measure asked a total of 24 questions about
menopause and HRT using the "Menopausal Information Scale".
(Appendix 1). The questions could be categorized into the
following: process 8 nature of menopause; symptoms 8
management; heart disease & osteoporosis; risk associated
with menopause; and knowledge of menopause. One point was
given for each correct answer of multiple choice or

true/false questions. A total knowledge score was computed

17
for each respondent by summing the number of correctly
answered questions. The lowest score would be zero points
and the highest score would be twenty-four points.

,Likelihggd_tg_take_nnm. ”Likelihood of taking HRT"
(Appendix 2) asked women their likelihood of taking estrogen
replacement therapy (ERT) or estrogen with progestin
replacement therapy (HRT). However, this writer will focus
only on HRT which is the combination of estrogen and
progesterone. ”Likelihood to take HRT" is a self-reported
estimate. These questions were answered on a five point
scale from "very certain would not take" to "very certain
would take". The statistic mean will determine the
likelihood to take HRT.

Sgnzggs_gf_1nfgzmatign. One question with four options
were asked to measure the first and most frequent source of
information regarding menopause (Appendix C). Reported
responses could include: physician, printed material, other
women, and television programs. Descriptive statistics of
percentages will analyze the question.

Sociodemographies. A total of six questions were asked
to include: age, marital status, employment status,
household income, highest grade/class completed in school,
and source of payment for medicines which the physician
prescribed. Only three of the variables; income, education
and source of payment will be analyzed by percentages for
the purpose of this study. These variables were selected

because they could be perceived to support the women in the

18
likelihood to take HRT. For more accurate analysis of the
education variable, "Ph.D./Professional degree” and ”other"
were recoded as ”missing" (Appendix D).

HBAth_Backgrnnnd. For the purpose of this study, the
health background variables are: history of
hysterectomy]oophorectomy, cancer, heart disease and
fractures. These variables were selected because: 1) AAW
have a high percentage of hysterectomies; and 2) because
cancer, heart disease and fractures are factors to be
considered when using HRT.

To obtain the frequencies and percentages, each of the
five variables were recoded to ”Yes" or ”No” (Appendix E).

Histgzy_gf_flnm_usg. Estrogen alone, progestogen alone,
and estrogen] progestogen combined were collapsed and
defined as HRT. Only the variables of ”current" and "past
use of HRT" was used to identify the women's personal
experience in taking HRT. Women who used HRT and
discontinued use for any reason was recoded as ”past use".

Women who reported "never taken" were not part of the
analysis (Appendix F).

Sample. Sixty-six percent of the sample were between
the ages of 40 and 50; 30% were between the ages of 51 and
55. Twenty-four percent of the women were married. Thirty-
five percent were employed either part or full time. Sixty-
two percent of the women had household incomes under
$15,000. Seventy percent had a high school education or

above. Fifteen percent reported paying for medicine out of

19
pocket. Fifty-five percent of the women were
perimenopausal. Twenty-seven percent of the women had
hysterectomies.

Hunan_5nbjegts_2zgtegtign. The project was approved by
the University Committee on Research Human Subjects
(UCRIHS). Participants were free to withdraw from the
original study at any time without retribution. Protection
of the rights and welfare of the human subjects was done by
adhering to the protocol and reporting the data only in the
aggregate form.

DATA ANALYSIS AND RESULTS

Data will be analyzed by each research question. The
level of significance was set to p< 0.05.

Questign_1. What is the level of knowledge regarding
menopause and HRT among AAW?

The mean knowledge score from the 24 item scale was
7.4, (sd= 3.5), median and mode were both 7.0 and a range
from 1 to 17 (Table 1).

Questign_z. What is the relationship of level of
knowledge and the likelihood of taking HRT. '

Pearson's correlation coefficient indicates that there
is a statistically significant relationship between levels
of knowledge and the likelihood to take HRT, (r=.16) at (p8
.026). This shows the menopausal women with higher levels
of knowledge of menopause and HRT express a stronger
likelihood to use HRT than those women who scored lower on

the knowledge scale.

20

Table 1.

WWW

 

 

Score N %
1-7 104 55
8-12 66 35

13-17 _1.8. .19.

TOTAL 188 100

 

M=7.4; sd=3.5

Questign_1. What is the most frequent self-reported
source of information regarding menopause.

Descriptive statistics of percentages was used to
analyzed this question. Physicians (31.3%) and other women
(30.3%) was the most frequent self-reported source of
information. Other sources were printed material (21.5%)
and T.V. (16.9%) (Figure 3).

Questign_4. What is the relationship between sources
of information and the likelihood of taking HRT.

Chi Square statistics indicates that there is no
relationship between source of information and the
likelihood to take HRT (x2 = 11.5 (df=12, p=.476).

Questign_5. What is the relationship between
sociodemographic status, health background, history of HRT
use and the likelihood of taking HRT.

Pearson's correlation coefficient indicates there was

no statistically significance relationship for income (r= -

21

  
    
  

Physicians
3L3%:
Ns61

 
   

 
  
  

Television
169%;
=33

 
 
 
  

 

Pfimwd

   
   

 
 
 

 
   
 

   
 

Material Oth W
21.57 er omen
(N) = 197 N=42° 30.3%
2 Missing N=59

  

EW- Sources of information about menopause.

.024 at p=.737), education (r= .044 at p= .542) or payment
source (r= -.122 at p=.097) and likelihood to take HRT
(Table 2).

Analysis of the health background variables indicated a
significance relationship for hysterectomy (r= -.196 at
p=.007), oophorectomy (r= .243 at p=.001), fractures r- .189
at p=.009). There was no relationship between cancer
history and heart disease and likelihood to take HRT (Table
3).

Analysis of history of HRT use shows there was

statistical significance for current HRT use (r= .164 at

22

 

 

 

Table 2.
o ‘ - o. 0‘ . ‘g : ‘0 o oo‘noo .o. . .o ': .00
R2 Pvalue N
Income -.0243 .737 194
Education .0443 .542 191
Payment -.1227 .097 184
Table 3.

 

 

R2 Pvalue N
Hysterectomy -.196 .007 190
Ooophorectomy .243 .001 184
CAHX -.073 .304 196
Heart Disease -.030 .680 189
FX .189 .009 190

 

p=.021) and likelihood to take HRT. Past HRT use was not
significant (Table 4).
, -.. - . ’.. . ",. .o‘ . v..- ... ,': ,.
An overview of the findings with relevance to Nola
Pender's Health Promotion Model and literature review will

be presented in this section.

23

Table 4.

 

 

R2 Pvalue N
Current HRT Use .164 .021 197
Past HRT Use .020 .778 197

 

Knowledge. A mean knowledge score was 7.4 out of 24
questions (s.d. = 3.5). This is a low knowledge score for
the sample. This finding did not come as a surprise. The
.low score supports the few studies which report AAW: 1)
reflect a mediocre knowledge score; 2) have limited
knowledge of menopause and the risk/benefits of HRT; and 3)
approach menopause not knowing what to expect (Holmes-Rover
et al., 1994; LaRocco & Polit, 1980; Mendham & Rees, 1992;
Padonu et al., 1996).

Pender's health promotion model supports the fact that
women's knowledge about menopause is an important cognition
factor to engage women in health promoting behavior.

WWW
Takg_HBT. It was expected that the level of knowledge would
correlate to the likelihood to take HRT. Even though
overall knowledge scores were low, apparently some of the
women in the sample are knowledgeable of certain information
regarding evidence that HRT could reduces the risk of heart

disease and osteoporosis. Grady et al. (1992) reported

24
evidence that expected cardioprotective benefits from HRT
for AAW are similar to that of white women. The likelihood
to take HRT is a positive plan of action which relates to
Pender's model. The positive benefits of HRT for the AAW is
welcomed information, because until recently, there was
little or no information on the risk and benefits of HRT for
AAW.

Sgnrge_gf_1nfgzmatign. The physician is the most
frequent source of information with other women following
closely. Written material and T.V. were next in that order.
Similar findings to this were reported by Dosey & Dosey,
(1980) with physician, mother, friend, books and magazines
as sources of information. Books and other women were also
sources of information (Padonu et al., 1996, Rothert et al.,
1992).

The model allows for and supports primary sources of
influence (peers, health care providers) and situational
influences which are in the environment (printed material,
T.V.) to impact positive health behaviors or a plan of
action.

No statistical relationship was found between sources
of information and the likelihood to take HRT. Findings
from the current study could indicate that even though the
physician may be the "medical authority" the physician nor
other women influenced the decision of likelihood to take

HRT.

25

However, 46% of the women indicated they "may or may
not” take HRT. This is another opportunity to utilize
Pender's (1996) model related to interpersonal influences.
This could mean that providers, as well as other women
could change the cognitive fields of the patient/peers to
align with the desired behavioral outcome. It is highly
possible that health education about reduced health risk
could increase the likelihood for these women to engage in
positive health behavior.

MW
and_L1kglihggd_tg_takg_fiBT. There is no statistical
significance between the relationship of income, education
or payment source and the likelihood to take HRT. This
indicates that regardless of income, level of education or
ability to pay for medicines, these variables did not
influence the sample to take HRT.

Three variables were found to be statistical
significance. Oophorectomy, hysterectomy, and fractures
were related to likelihood to take of HRT. Heart disease
and history of cancer were not. This could be an indication
that women had received HRT education as a result of these
particular health issues. However, this writer was
surprised that there was statistical significance between
fractures and likelihood to take HRT among this AAW sample.

Heart disease and history of cancer had no statistical

significance for likelihood to take HRT for these AAW.

26

In terms of history of HRT use, only current use was
significant. This is consistent with (Padonu et al., 1996)
in a study of LIAAW (n=55) that nearly twenty percent were
currently using HRT. The findings that past use of HRT
showed no relationship with likelihood to take HRT was
unexpected. This did not support Pender's (1996) model that
the best predictor of behavior is the frequency of the same
or similar behavior used in the past.

Summary. This study has addressed what a sample of 197
low-income AAW know about menopause and HRT, their primary
source of information and variables related to the
likelihood to take HRT. Examination of potential
relationships among the variables based on a health
promotion framework was completed. The findings indicate
that health education is desperately needed to improve
menopause and HRT knowledge, through culturally sensitive
information so that women can be more informed when making
personal choices in the decision to take HRT.

It was this writers intention to provide descriptive
data on these LIAAW with respect to menopause so that health
care providers, such as the APN, may better understand this
population of women and in turn, be able to provide quality,
accessible and affordable care.‘

IMPLICATIONS FOR ADVANCED PRACTICE NURSE AND PRIMARY CARE

Since an increasing number of women will be reaching
the age of menopause and according to this study (n=197)

forty percent report their last menstrual period was more

27
than twelve months ago, the implications are many for
primary care and the advanced practice nurse. Primary care
is comprehensive, coordinated, and continuous care. It is
the primary care provider's responsibility to approach an
individual, family, and community holistically; to gather
and coordinate the right resources for the client with
respect to her culture and ethnicity; and to enhance and
facilitate the responsibility of the individual with health
promotion and disease prevention through health education
and teaching. It is the APN, via his/her role
characteristics which he/she brings to the practice, that
can step forward and act on what this study suggest are the
needs of women during their menopausal years.

A significant factor for the APN is the he/she act as
an educator for these women. This study reflects low
menopause and HRT knowledge scores. Therefore, there is a
strong emphasis on the need for education. Women need to be
aware of what is happening to their bodies doing menopause
and should know that certain health conditions may depend on
race and ethnicity.

For the married women of this sample (23%), joint
visits with the APN, woman, and spouse/partner would provide
an excellent opportunity for teaching and education about
menopause and HRT as well as open lines of communication.
For single women, support groups might provide beneficial
methods to learn about the aspects of menopause and HRT.

The APN could provide capable leadership for these groups.

28

Through menopause education women could become informed
in making decisions regarding HRT. Women may not adhere to
medical advice which has not been fully explained and which
they do not feel is appropriate to their culture or
ethnicity. This is an indication that women experiencing
menopause must be treated on an individual basis with
respect to their personal values. In addition, the APN
should make a strong effort to be accessible to women in
their environment (i.e., neighborhood clinic, neighborhood
church or school).

As educator, the APN becomes a source of information.
Often times the reason women do not seek help is because
they do not know help assist, do not know where to find it,
may feel uncomfortable in certain settings or with some
health care providers where help is available. Education
and knowledge empower patients to control their own self-
care and ultimately health outcomes. The APN can help women
be more aware of the sources of help through assessing what
the woman feels is important to her.

As indicated by this study's findings, the women's
first and most frequent source of information about
menopause and HRT was the physician (31.3%). Even so, 43.8%
of the women, indicated their likelihood to take HRT as "may
or may not”. It is possible that there may be a breakdown
in the information these women are receiving from the
provider. It is possible that the APN and other providers

do not have the adequate knowledge regarding menopause and

29
HRT content. This writer would propose continuing education
programs for all academic institutions with regards to
menopause.

As important as acting as an educator, the APN need to
function as a clinician. From this role the APN formulates
nursing diagnoses and provides direct primary nursing care
based on sound theory and advanced clinical judgement to
clients and families. This may be done in a variety of
settings to promote self-care abilities, maintain health,
prevent disease and manage health issues. The APN should
assess the mid-life woman's over-all health, menopause
symptoms, management of self-care practices and identify
lifestyle habits that place individuals at risk. All these
tasks should be done recognizing diversity among cultures
and knowing that the African-American population is still
plagued by high morbidity and mortality rates when compared
to whites.

Another important role characteristic for the APN is
acting as client advocate. Because low-income AAW tend to
have more undetected diseases, higher disease rates and more
chronic conditions (Leigh, 1994), the APN should seize the
opportunity to empower the woman with knowledge, thereby
assisting the client in exercising her rights and improving
the self-care agent in her. With each client/APN encounter,
participation and sharing of knowledge should be encouraged
by the APN. As an advocate, the APN could suggest that the

woman bring to the next encounter questions she may have to

30
ensure that her concerns and questions are given adequate
attention and are answered in a way that would encourage
positive health behavior.

This study suggest that the APN needs to and can bring
to the primary care setting the role of researcher. As
stated in the background of this research, most of the
literature on menopause, benefits and risk of HRT is
restricted to samples of well-educated, middle-income white
women. The APN is in a position to design studies to
collect data about: 1) menopause in specific racial
(including AAW), ethic, and socioeconomic groups where there
is a complete lack of data; and 2) culture and lifestyle
that may affect menopause. The APN can also be instrumental
in adopting standards of care for how women can manage
menopause to include symptom control, reduce risk of heart
disease and osteoporosis and enhance well-being. These
investigations would foster a inquiry within the profession
to advance nursing knowledge.
LimitatioanLSecendarLAnalxsis

In doing the secondary analysis certain limitations
existed. First, the questions posed in this study were
limited by the questions and data gathered by the parent
study. The knowledge portion of the questionnaire utilized
fixed alternative multiple choice questions along with the
true/false questions. When the subject is asked to choose
one of the given alternatives as is the case in this type of

questioning, there is a chance for the subject to guess at

31
the socially correct response. However these standardized
questions were necessary to ensure the subjects' answers can
be compared objectively. Another concern of this researcher
was the question regarding source of information. The
question asked women to give their "first and most frequent
source of information". This dual response was left to
interruption of the reader. The ”first" source of
information may not have been the ”most frequent" source of
information and vice versa. On the questions concerning
"prior use of HRT" and "current use of HRT", beginning and
canceled dates of use were not able to be determined.

A limitation of this study may be the inability to
generalize the research findings to a larger population of
women of the same ethnicity and culture. The demographics
do not prove to include a high number of well educated
middle income AAW and those women from a rural background.
W

This investigation was designed to be descriptive in
nature in order to provide a better understanding of the
relationship of menopause knowledge, primary source of
information and the likelihood of taking HRT among low-
income AAW.

Further study is needed on the menopausal experience of
AAW and other minority women to develop care-related
interventions tailored to the needs and choices of women

differing socioeconomic, ethnic and cultural backgrounds.

32
This writer also suggests longitudinal studies on
effective menopause strategies, relevant to differ cultures,
which would promote positive health outcomes.
In conclusion, there appears to be the need for further
research of the variables regarding sociodemographics,

health background and history of HRT use.

LI ST OF REFERENCES

LIST OF REFERENCES

American College of Obstetricians and Gynecologists.
(1992). The Menopause Years. (AP047). Washington, D. C.

American College of Obstetricians and Gynecologists.
(1992). Preventing Osteoporosis. (AP048). Washington, D.C.

Anderson, R., Hamburger 8., Liu, J. & Rebar, R.
(1987). Characteristics of menopausal women seeking

assistance . WW
156(12), 428-433.

Bart, P. (1970). Mother Portnoy's complaints.
Transactien1_8 59'74-

Bernhard, L. & Sheppard, L. (1992). Health,
Symptoms, Self-Care, and Dyadic Adjustment in Menopausal

Women. 1eurnal_ef_Qhetetrics.§¥neceles¥1_22(5). 456-461-

Dosey, M. F. & Dosey, M. A. (1980). The climacteric
woman. 2at1ent_Ceunselins_and_nealth_Educatien 14-22.

Edwards, K. (1993) Low-income African-American women's
expression of their health management. Associatign_gf_fllagk
Nursina_£acult¥_lenrnali_4 17-19.

Ferguson, K.J., Hoegh, C. 8 Johnson, S. (1989).
Estrogen Replacement Therapy: A survey of women's knowledge

and attitude. Archixes_ef_Internal_nedicinei_1421 133-136.

Frey, K.A. (1981). Middle-age women's experience and
perceptions of menopause. Hgmgn_§_flea1th‘_§, (1-2), 26-35.

.Garner, C. H., (1991). Midlife women's health.

. '::o o. o g o o 0 Co : -go

Gyneceles¥1_2(4), 473-481.

Giger, J.N. & Davidhizar, R.E. (1991). Transgnltnznl
Nursing, St. Louis, MO: Mosby.

Grady, D., Rubin, S.M., Petitti, D.B., Fox, C., Black,
D., et a1. (1989). Hormone therapy to prevent disease and
prolong life in postmenopausal women. Annuals_gf_1nteznal
Medicine1_111(12). 1016-1040-

33

34

Greendale, G., & Judd, H. (1993). The menopause:
health implications and clinical management. lengnel_ef

WM“) . 426-436-

Harris, R.B., Laws, A., Reddy, V.M., King, A., &
Hasked, W.L. (1990). Are women using postmenopausal
yestrogens? A community survey.

Hgnlth+_&QL 1255-1258-

Holmes-Rover, M., Padonu, G., Breer, L., Kroll, J.,
Rovner, D., Talarczyk, G., & Rothert, M. (In Press).
African American women's attitudes and expectations of
menopause. In press,

Jahnige, H., & Fiebach, N. (1997). Postmenopausal
Estrogen Use Among African American and White Patients at an

Urban Clinic. WAD. 93-101-

Keil, J., Goldberg, J., Brody, T., Stiers, W., & Rimm,
A. (1993). Mortality rates and risk factors for coronary
disease in blacks as compared with White men and women. Neg

Wm). 73-78-

LaRocco, S.A. & Polit, D.F. (1979). Women's knowledge
about the menOPause- MW”). 10-13-

Lieblum, S.R. & Swartzman, L.C. (1986). Women's
attitude toward the menopause: An update. Metnzitee+_8+ 47-
56.

Leigh, W.A. (1994). The health status of women of
color. A Women's Health Report of the Women's Research and
Education Institute. Washington, D.C.

Masling, J. (1988). Menopause: A change for the
better. Nursins_Times_ai(39). 35-38-

Mazade, L., 8 Park, G. (Eds.). (1992). The_MenepeneeL

W Washington. D-C. U- 8-
Printing Office.

McKeon, V.A. (1989). Cruel myths and clinical facts
about menopause. BN+_1§(5), 52-58.

Mendham, C. & Rees, C. (1992). A positive change.
WMHZ) . 34-35-

The New Merriam-Webster Dictionary. (1996).
Springfield: Merriam-Webster, Inc. pp. 382, 412, and 689.

35

National Center for Health Statistics: Health of the
United States. (1991). Hyattsville, MD. 12-32.

Oldenhave, A., 8 Netelenbos, C. (1994). Pathogenesis
of climacteric complaints: ready for the change? The

Lancet1_3411 649-653-

Padonu, G., Holmes-Rover, M., Rothert, M., Schmitt, N.,
Kroll, J., Rover, D., Talarczyk, G., Breer, L., Ransom, S. 8
Gladney, E. (1996). African-American women's perception of

menOPause- American_Ieurnal_ef_Health_Behaxiez1_zn(4). 242-
251.

Patrick, M.L. (1970). A study of middle-aged women and
menopause. Unpublished doctoral, University of California,
Los Angeles.

Pender, N.J. (1996).
preexiee. (3rd ed.). Norwalk, CT: Appleton 8 Lange.

Pender, N.J. (1987).
preetiee. (2nd ed.). Norwalk, Ct: Appleton 8 Lange.

Ramson, S., Guerin, M., Holmes-Rover, M., Dodson, M., 8
Padonu, G. (1995). The impact of ethnicity of attitudes and
beliefs about estrogen replacement therapy among Michigan
nurses. Jeurnal_ef_natienal_Black_Nurse_Asseciatien. 38-
47.

Rankin, S.H. 8 Stallings, K.D. (1996). Patient
- ° ' New York, NY.
Lippincott.

Rothert, M., Padonu, G., Holmes-Rover, M., Kroll, J.,
Talarczyk, G., Rovner, D., Schmitt, N. 8 Breer, L. (1994).
Menopausal women as decision makers in health care.

Exnerimsntal.§erenteles¥1_22(3'4). 463-468-

Sarrel, P.M., 8 Bajulaiye R. (1984). Menstrual signs
and symptoms in Nigerian women. MAIRIILASI_§,174.

Spake, A. (1994). The raging hormone debate. Heelene
1, 47-57.

Standing, T.S. 8 Glazer, G. (1992). Attitudes of low
income clinic patients toward menopause. Hee1§n_eeze_fex
Hemen_1nternatienali_111 271-280-

APPENDIX A

Menopause Information Scale

36

DECISION MAKING IN MENOPAUSE STUDY
Menopause Information

The following quesrionnaire contains questions about menopause. (thechange of
life) a time which signifies the end of the menstrual cycle. In this section we are
interested in your knowledge about the process of menopause. Answers to some of
the questions will depend on whether or not a woman has a uterus. Please answer
all questions assuming the woman has a uterus.

68. What can be said about birth control after menstruation stops?

Birth control should be used for 1 year

Birth control should be used up to 5 years

Birth control should be used as long as sexually active
Birth control is not necessary

= Don't know I ‘

MbUNI—n

69. What causes the symptoms of menopause?

l i=- ‘I‘he pituitary gland stops functioning

2 = The uterus will not allow egg implantation

3 = The fallopian tube becomes blocked

4 = The ovaries produce less estrogen (female hormone)
5 = All of the above .

6 = Don't know

70. Menopause increases the risk for which of the following?

1 = Liver disuse

2 = Eye disuse

3 = Kidney disuse

4 = Lung disuse

5 = Osteoporosis

6 = All of the above
7 = None of the above
8 = Don’t know

0 1992 Michigan State University
College of Nursing

 

 

37

Check your answer sheet. You should now be filling in row number 7 7

71.

73.

74.

75.

What physical changes can occur in the vagina due to menopause?

l = It becomes dryer. shorter and less elastic

2 = lt becomes less easily injured

3 = The vagina remains the same following menopause
4 = Don‘t know

Risk of osteoporosis (brittle bones) can be reduced by:

l = Vitamin C

2 = Estrogen pills

3 = Relaxation exercises
4 = Don‘t know

To help reduce the uncomfortable feelings associated with hot flashes. a person can...

Increase caffeine intake

Take vitamins above recommended daily allowance
Wear several light wraps so one can be removed
lncruse spices and susoning in food

Don't know

““03”.—
ll ll ll II II

Vaginal dryness caused by menopause may lead to...

l = Increased chance ofvaginal infection

2 = Decreased chance of vaginal infection

3 = No change in chance of vaginal infection
4 = Don‘t know

Vaginal dryness can best be relieved by...

l = Using a petroleum jelly lubricant (Vaseline’)
2 = Estrogen replacement therapy

3 = Using cold cum

4 = Don't know

9 1992 Michigan State University
College of Nursing

38

Check your answer sheet. You should now be filling row number 76

76.

After menopause. a woman's risk of heart disease:

I -= Decreases

2 = Increases

3 a Is the same as before menopause
4 = Don‘t know

Estrogen replacement therapy:

l = Increases a woman‘s risk of heart disease

2 =Decreasesawoman'sriskofhcartdisease

3 = Has no effect on a woman's risk ofhurt disuse
4 = Don't know

Please answer questions 78-90 using the following sule:

a

86.

l = True

2 = False

3 = Don't Know
Although many women have menopausal symptoms, approximately 20% seek mediul relief.
Hormone therapy (estrogen) after menopause incruaes the risk of osteoporosis.
Hormonal therapy (estrogen) can be used to help relieve the symptoms of menopause.
Estrogen therapy withoutprogcstogen increases theriskofcancerofthettterus.

If a menopausal woman unexpectedly bleeds or'qrots a year after she completely stops
menstruating she should report this to her physician.

Symptoms most often reported during menopause are hot flashes and night swuts.

Oneeawomanisth‘roughmenopauseshenolonger‘hastobcconcernedwithbrustcaneerorother
femalecancers.

Aslongasawomanisovulatingshecanstillbecomepregnant.

Ovulation may occur without menstrual bleeding occurring.

° I992 Michigan State University
College of Nursing

39

Check your answer sheet. You should now be filling in row 87

87. The addition of a progestational agent (Provera‘) to estrogen replacement therapy frequently results
in monthly menstrual flow.

88. The addition of a progestational agent (Proven') to estrogen replacement therapy increases the risk
of cancer to the uterus.

89. The most common cause of duth among women is breast cancer.

90. A woman‘s chance of dying from cancer of the uterus is greater than her chance of experiencing
osteoporosis fractures.

° 1992 Michigan State University
College of Nursing

40

Check your answer sheet. You should now be filling in row 97

9). Choose the graph below which correctly shows the number of women who die each year from
these mediul problems. Darken the circle on your answer sheet correSponding to the correct
graph. Use the following scale:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

l = Graph 1 400.000 :
2 = Graph 2 g :
3 = Graph 3 g 350'000 :
4 = DOD tKnow 3 3m.“ :
'6 a
§ 250.000 1
c 2
§ 200.000 1
3 11
15 150.000 1
.8 1
5 100.000 3
z :
50.000-5
0 .1
400.000 1 t
§. 350.009 2 ‘ Graph]
a :
3 300.000 1
'6 5 400.000
‘E 7.50130 .. 2
.. ‘ g ‘ 350.000
§ 200.000 . s
’ 3 .2 300.000
:5 150.000 . 3
3 5 . 250.000
§ 100.000 , c
2 50000 3 E 200.000
3 ' E 150.000
0 — . g
I. W“ m 2 100.000
(3th 50.000
.Tfifll 0
MIL"?!

 

Graph3

° I992 Michigan State University
College of Nursing
17

APPENDIX B

Likelihood of Taking HRT

41

How likely are you to take HRT in the form of estrogen/progestogen combined?

1- VerycertainthatyouwouldnottakethisformofHRT.
2 =- Probably would not take HRT.

3 = May or may not take HRT.

4 = Probably would take HRT.

5 = Very certain that you would take HRT.

APPENDIX C

Source of Information

42

Of the four sources listed below, which would you. say is your first and most frequent source of
information regarding menopause?

= Physician
Printed material (e.g., books, magazines, pamphlets)
Other women

I
2
3
4 Television programs

° 1992 Michigan State University
College of Nursing

APPENDIX D

Sociodemographics

43

DECISION MAKING IN MENOPAUSE STUDY
SOCIODEMOGRAPHIC

The following questions ask you to give some background information about yourself. This information
will help us to understand and interpret the study's results. The information will be kept completely
confidential. Please answer each question.

I. How old are you?

A

045

stomawto—
II II II II II II II

2. What is your present marital status?

I = Married

2 = Divorced

3 = Single (never married)
4 = Widowed

5 = Separated

3. What is your principal employment status? (This question refers to work which yen are paid to
do).
1 = Employed fullztims
2 = Employed 2211:0111;

3 = Retired
4 = Not Employed
5 = Other

4. What was your approximate total heuseheld income (before taxes) during the past year?

I = Under $4,999

2 = $15,000 - $29,999
3 = $30,000 - $49,999
4 = $50,000 - $99,999
5 = $100,000 - 200,000
6 = Over $200,000

° I992 Michigan State University
College of Nursing

APPENDIX E

Health Background

44

Check your answer sheet. You should now be filling in row number 5
5. What was the highest grade or class you completed in school?

Less than 12 yurs

High school graduate (includes G.E.D.)
Greater than 12 yurs, but no degree
Technical trade/Community college degree
Bachelor‘s degree

Master‘s degree

Ph.D./Professional degree

Other

MQO‘MAUN—

indicate your religious preferencelaffiliation.

g:

None

Jewish

Protestant (Baptist, Lutheran, Methodist, Presbyterian, etc.)
Catholic

Other

Uta-uto—
II II II II II

7. What is your race?

African-American
Hispanic

American Indian
Cauusian
Asian/Pacific Islander
Other

QU&U’NH

8. What is your source of payment for medicines you take which are prescribed by a physician?

1 = Payment is provided completely out of my pocket

2 = Payment is provided partly out of my pocket and partly by another source (eg, insurance,
government agency);

3 = Payment is provided completely by a source other than me or my family (eg, insurance,
government agency)

4 = Don‘t know

° I992 Michigan State University
College of Nursing

10.

ll.

12.

13.

45

HEALTH BACKGROUND
How many months ago was your last natural menstrual period (unrelated to hormone therapy)?

Still have natural menstrual periods~
Less than 3 months ago

3 to 12 months ago

more than 12 months ago

= Not Sure

l
2
3
4
5

Using the scale below, indicate how severe you think your menstrual problems are or were prior
to menopause.

No Problems

Minor Problems

= Moderate Problems
Severe Problems
Very Severe Problems

Lasso-Hu—
II II

Do you currently consider yourself to be experiencing menopausal symptoms?

No, have never experienced menopausal symptoms

Yes, currently experiencing menopausal symptoms

Not presently experiencing menopausal symptoms but have in the past
Not sure

bWNt-fi

Have you had a hysterectomy (an operation where the doctor removed all or part of your uterus)?

1 = Yes
2 = No
3 = Not Sure

Have one or both of your ovaries been removed?

Yes, both ovaries removed
Yes, one ovary removed
No

Not sure

ALAN-
IIIIII

° 1992 Michigan State University
College of Nursing

14.

15.

16.

46

Have you ever had cancer?

1 = Yes, breast cancer

2 - Yes, endometrial cancer (cancer of the uterus or womb)
3 8 Yes, other cancer

4 = No

Have you ever had hcert disease?

l=Yes
2=No

Have you ever had fractures due to osteoporosis?

APPENDIX F

History of HRT Use

47

For items 17-21, plcase indicate your experience with hormone replacement therapy (HRT) by choosing
one response for the type of HRT listed in cach question.

17.

Plcase indicate your experience with estrogen pills and progestogen pills (e.g., prernarin and
provera) by choosing one of the following responses.

1 = I am currently taking this.

2 = I have never taken this.

3 = l have taken this in the past but discontinued it because of side effects.

4 = I have taken this in the past but discontinued it because 1 no longer needed it for symptoms.
5 = I have taken this in the past but discontinued it bemuse I re-evaluated the safety of taking it.
6 =1 have taken this in the past but discontinued it because my hcalth care provider recommended
I discontinue it.

7 = I have taken this in the past but discontinued it for reasons not listed above.

° 1992 Michigan State University
College of Nursing

l8.

19.

20.

48

Please indicate your experience with estrogen patch and progestogen pills by choosing one of the
following responses.

I am currently taking this.
I have never taken this.
I have taken this in the past but discontinued it because of side effects.

I have taken this in the past but discontinued it because I no longer needed it for symptoms.
I have taken this in the past but discontinued it because I re-evaluated the safety of taking it.
I have taken this in the past but discontinued it because my hcalth care provider recommended

I discontinue it.
7 = I have taken this in the past but discontinued it for reasons not listed above.

1
2
3
4
5
6

Please indicate your experience with progestogen pills alone by choosing one of the following
responses.

I am currently taking this.
I have never taken this. '
I have taken this in the past but discontinued it because of side effects.

I have taken this in the past but discontinued it because I no longer needed it for symptoms.
I have taken this in the past but discontinued it because I re-evaluated the safety of taking it.
I have taken this in the past but discontinued it because my hcalth care provider recommended

I discontinue it.
7 = I have taken this in the past but discontinued it for reasons not listed above.

1
2
3
4
S
6

Please indicate your experience with estrogen patch alone by choosing one of the following
responses.

I am currently taking this.
I have never taken this.
I have taken this in the past but discontinued it because of side effects.

I have taken this in the past but discontinued it because I no longer needed it for symptoms.
I have taken this in the past but discontinued it because I re-evaluated the safety of taking it.
I have taken this in the past but discontinued it because my health care provider recommended

discontinue it. '
= I have taken this in the past but discontinued it for reasons not listed above.

1
2
3
4
5
6
I
.7

° 1992 Michigan State University
College of Nursing

21.

49

Please indicate your experience with estrogen pills (e.g., premarin) alone by choosing one of the
following responses. ‘

l = I am currently taking this.

2 = I have never taken this.

3 = I have taken this in the past but discontinued it because of side effects.

4 = I have taken this in the past but discontinued it because I no longer needed it for symptoms.
5 = I have taken this in the past but discontinuw it because I re—evaluated the safety of taking it.
6 =1 have taken this in the past but discontinued it because my health care provider recommended
I discontinue it.

7' = I have taken this in the past but discontinued it for reasons not listed above.

° 1992 Michigan State University
College of Nursing

APPENDIX G

 

OFHCEOF
RESEARCH
AND
GRADUATE
STUDIES

University Committee on
Research Involving
HumanSuMec
(UCRIHS)

Human State University
245 Aim'n'stranon BUlidng
East Lansing Michigan

48824-1046
517355-2180
FAX 517/432-1171

"ls M-cnrgan State Ummsrty
{05.1 is Irishman)! Dmtslfy
fiammrnkma

MSU :3 an Wartime-action.
swmnmmwonwuot

50

MICHIGAN STATE

 

UNIVERSITY
March 17,1997
TO: Georgia Padonu _ _
A230 Life SCiences Building
RE: IRE”: 97-188
TITLE: THE RELATIONSHIP BETWEEN LEVEL OF KNOWLEDGE OF

MENOPAUSE AND HORMONE REPLACEMENT THERAPY;
SOURCES OF INFORMATION AMONG AFRICAN-AMERICAN

WOMEN
REVISION REQUESTED: N/A
CATEGORY: - E
APPROVAL DATE: 03/14/97

The University Committee on Research Involving Human Subjects'lUCRIHS)

review of this project is complete.

rights and

I am pleased to adVise that the
welfare of the human subjects appear to be adequately

rotected and methods to obtain informed consent are appropriate.

gherefore,
above.

RENEWAL :

REVISIONS:

PROBLEMS/
CHANGES:

If we can be of any future hel ,
at (517)355-2180 or FAX

Sincerely,

    
 

 
 

DEW : bed

aVld E. Wright,
UCRIHS Chair

the UCRIHS approved this project and any reViSions listed

UCRIHS approval is valid for one calendar year, beginning with
the approval date shown above. Investigators planning to
continue a project beyond one year must use the green renewal
form (enclosed with t e original agproval letter or when a
project is renewed! to seek u date certification.
maXimum of four such expedite renewals
wishing to continue a prOject beyond the
again or complete review.

. There_is a
ossible. Investigators
time need to submit it

UCRIHS must review any changes in procedures involving human
subjects, rior to initiation of t e change. If this is done at
the time o renewal, please use the green renewal form. To
reVise an approved protocol at any other time during the year,
send your written request to the CRIHS Chair, requesting revised
approval and referencing the project's IRB 8 and title. Include
in your request a description of the change and any revised
instruments, consent forms or advertisements that are applicable.

Should either of the following arise during the course of the
work, investigators must noti y UCRIHS promptly: (1) roblems
(unexpected Side effects, comp aints, etc.) involving uman
subjects or (2) changes in the research environment or new
information indicating greater risk to the human sub'ects than

existed when the protocol was previously reviewed an approved.

lease do not hesitate to contact us

(517)4 2- 171.

   

\yéi GladneyIEvelyn

MICHIGAN STATE UNIV. LIBRQRIES
llHIM"millHIWilliWWWHIHHIIIIWII
31293015814464