Academic journal article Women's Studies Quarterly

Changes in Wellness Practices and Health Care Utilization after an Educational Intervention for Perimenopausal Women

Academic journal article Women's Studies Quarterly

Changes in Wellness Practices and Health Care Utilization after an Educational Intervention for Perimenopausal Women

Article excerpt

The perimenopause is a time when women seek health care, not only to assist with the symptoms they may be having, but also to help them answer the questions they have, such as whether to start or continue hormone replacement therapy (HRT), whether alternative therapies are effective or useful, and whether lifestyle changes are advisable (Cobb, 1998; Lemaire & Lenz, 1995). At the same time, many women today are rejecting what they perceive as prescriptive care and instead seeking care that they feel takes their personal values and preferences into account (Hunter, O'Dea, & Britten, 1997). In today's health care environment, physician time to engage in thoughtful dialogue and provide the information and counseling women want is constrained (Kroll et al., 2000). There is a mismatch between women's needs and the ability of everyday outpatient care to meet their needs (Clinkingbeard et al., 1999; Commonwealth Fund, 2000, Randall, 1993).

To address these problems, hospital systems are offering educational programs for perimenopausal women. Only limited evidence is available, however, about the effectiveness of such programs (Wilson, 1998). The purpose of this study was to evaluate the outcomes of a nationally presented, physician-led group education program designed for perimenopausal women. It was hypothesized that a program that included women's own viewpoints, addressed their values, and modeled an optimal patient-provider relationship might be particularly effective in helping perimenopausal women to understand the implications of current research for their health, make positive lifestyle changes, and engage in a more satisfying decision-making process with their physicians.

Background

Patient education can provide the information that women want and can decrease their uncertainty about menopause (LeMaire & Lenz, 1995). A variety of formats has been used, including written materials for self-education, lectures, and small group discussions.

Self-education Programs

A "women's health exchange" sponsored by a pharmaceutical company used a mailed handbook and newsletters to provide education about HRT and menopause. Most information concerned topics other than HRT such as nutrition, osteoporosis, and breast cancer. Women who were enrolled in the exchange were more likely to continue HRT than women who were not (Motheral & Fairman, 1998). In another self-education program, an audiotape was used with an illustrated booklet about HRT to guide decision making. The booklet was designed to help women clarify their personal values about the relative importance of benefits versus risks of HRT before making a decision. The intervention increased knowledge, decreased uncertainty, and helped women feel more supported (O'Connor et al., 1998).

Another self-education program developed a workbook that was mailed to women to aid them in discussing HRT with their health care provider. The workbook covered menopause; HRT; and the risks, detection, and prevention of osteoporosis, heart disease, and breast cancer. Self-assessment inventories were provided for each topic, and case studies of women and how they made their decisions about HRT were included. Of the women receiving the workbook, 52% to 58% completed one or more of the self-assessments and 10% made appointments to discuss HRT with their health care provider. The workbook is available online at http://www.cdc.gov/nccdphp/hrt.htm (Newton et al., 2001).

Group Educational Programs

A program taught by a team of physicians and a nurse provided information about menopause and the pros and cons of HRT and discussed breast cancer, osteoporosis, and urinary incontinence. A lecture format was used, followed by questions and answers. Women attending the program had less uncertainty and more knowledge about menopause after attending the program (Lemaire & Lenz, 1995). Another group program on menopause was designed for small groups of midlife women that met over two sessions. …

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