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Women’s Decision Making and Attitudes Towards Hormone Therapy in the Aftermath of the WHI Study

Women’s Decision Making and Attitudes Towards Hormone Therapy in the Aftermath of the WHI Study. Herdís Sveinsdóttir, RN, PhD Associate Professor, Faculty of Nursing University of Iceland Ragnar Ólafsson, PhD cand, Institute of Nursing Research, University of Iceland. Bakground of study.

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Women’s Decision Making and Attitudes Towards Hormone Therapy in the Aftermath of the WHI Study

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  1. Women’s Decision Making and Attitudes Towards Hormone Therapy in the Aftermath of the WHI Study Herdís Sveinsdóttir, RN, PhD Associate Professor, Faculty of Nursing University of Iceland Ragnar Ólafsson, PhD cand, Institute of Nursing Research, University of Iceland Herdís Sveinsdóttir

  2. Bakground of study • Shift in the discourse on menopause in the medical literature from discourse on treatment towards discourse on prevention Herdís Sveinsdóttir

  3. Bakground of study • Discontinuation of the WHI- study in 2002 Herdís Sveinsdóttir

  4. Study Setting • Icelandic Health Care System • Access to Health Care Herdís Sveinsdóttir

  5. Prevalence of Hormone Therapy (HT) in Iceland • 1986 – 1995 5.7 fold increase in use of HT • 1996 – 2001 57% of 52-57 year old women used HT • Long-time use has increased steadily: 1990 – 1995 27% of users had used HT> 5 years 1996 – 1998 49% of users had used HT> 5 years 1999 – 2001 67% of users had used HT> 5 years Herdís Sveinsdóttir

  6. Markmið 1 • Lýsa hvað hefur áhrif á ákvörðun kvenna um að nota tíðahvarfahormóna, líðan þeirra við tíðahvörf, heilsu og lífsstíl, viðhorfum til tíðahvarfa og til notkunar tíðahvarfahormóna, mati þeirra á fræðslu sem þær hafa fengið um tíðahvörf og afstöðu þeirra til ýmissa atriða sem tengjast þekkingu á fyrrnefndri rannsókn. Herdís Sveinsdóttir

  7. Objective 2 This study sought to illuminate how women make decisions about HT by describing the attitudes towards HT (ATHT) and determining the effect of demographic characteristics, attitudes towards menopause, menopausal education, symptom experience, health and lifestyle and knowledge about the findings of the Women’s Health Initiative study on attitudes towards HT. Herdís Sveinsdóttir

  8. Method • Design: Cross-sectional descriptive survey • Population: Women aged 47 – 53, residing in Reykjavík and neighbouring towns • Sample: 1000 women, meeting the criteria, randomly selected from the national registry of Iceland • Data collection method: Posted questionnaire • Response rate: 56.1% Herdís Sveinsdóttir

  9. Instrument Self-administered questionnaire that assessed: • socio-demographics (age, education, marital status) • attitudes towards menopause (Hvas et al., 2003) • ATHT (Hvas et al., 2003) • menopausal status, incl. surgical operations • use of HT • menopausal education (source, perceived adequacy) • awareness of the findings from the WHI study presented in 2002 • symptom experience • use of alternative remedies Herdís Sveinsdóttir

  10. Úrvinnsla • Við lýsandi úrvinnslu gagna voru niðurstöður skoðaðar út frá eftirtöldum breytum: aldri, því hvort viðkomandi væri komin á tíðahvörf, væri ekki komin á tíðahvörf eða vissi ekki af því og út frá notkun tíðahvarfahormóna. Notkun tíðahvarfahormóna var skipt upp í aldrei notað, notað en er hætt og nota núna. Frekari greininga gagna byggði á lýsandi tölfræði og var marktækni mæld með kí-kvaðrat prófi, Fisher exact prófi og dreifigreiningu Herdís Sveinsdóttir

  11. Analysis • Regression models were used to explain ATHT. • ATHT were compared on the study variables using ANOVAs, t-tests or correlations. • Variables showing significant differences or significant relationships with the ATHT scale were entered into a multiple regression model. Herdís Sveinsdóttir

  12. Attitudes towards menopause Responses: Agree, disagree, Neutral Chronbacs alpha 0.72 Mean score on the attitudes towards menopause scale was 1.9 (SD=0.53) – higher score indicative of more positive attitude Herdís Sveinsdóttir

  13. ATHT-Scale Responses: Agree, disagree, Neutral Chronbacs alpha 0.82 Mean score on the attitudes towards menopause scale was 2.2 (SD=0.60) – higher score indicative of more positive attitude Herdís Sveinsdóttir

  14. ) Herdís Sveinsdóttir

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  23. Source of information about menopause (N=561) Herdís Sveinsdóttir

  24. Source of information the WHI study (N=561) Herdís Sveinsdóttir

  25. Receiving information about menopause from a physician was associated with more postitive ATHT (t(514)=3.828;p<0.001) Receiving the information from spouse (t(514=1.971; p<0.05) and other friends than female friends (t(514=2.540; p<0.05) is associated with more negative ATHT Herdís Sveinsdóttir

  26. Receiving information about the WHI-study from a physician was associated with more postitive ATHT (t(346)=2.815;p<0.001) Herdís Sveinsdóttir

  27. Use of hormones Herdís Sveinsdóttir

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  29. ATHT were more favourable among hormone users and previous users than amongst non-users (F(4.539)=27,927; p<0.001). Herdís Sveinsdóttir

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  31. Other friends 6% Mother 3% Nurse 3% Children 2% With whom have you discussed the outcome of the WHI-study (N=561)? Herdís Sveinsdóttir

  32. Having discussed the outcome of the WHI-study with a physician was associated with more postitive ATHT (t(346)=4.174;p<0.001) Herdís Sveinsdóttir

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  34. Use of other methods to relieve symptoms (N=561) Herdís Sveinsdóttir

  35. Users of relaxation (t(494)=-2.346;p<0.05), natural medicine (t(439)=-2.466;p<0.05), and meditation (t(439)=-1.973;p<0.05), showed more negative ATHT than non-users • A user-index of alternative medicines was computed, representing the total number of different alternative remedies used. This scale had a correlation of rho= -0.10 (p=0.022), indicating that use of alternative remedies is negatively related to ATHT therapy. Herdís Sveinsdóttir

  36. Attitudes The Pearson correlation between attitudes to menopause and attitudes to HT was r= -.034 (n.s.). Herdís Sveinsdóttir

  37. Socio demographics • 76% married/cohabitation • 76% participating in the workforce • 32% finished university education with 33% having high school diploma as a final degree • Mean age was 49.8 (+ 2.2) years The correlation of attitudes to HT with age was r=-0.12; (p=0.006) Herdís Sveinsdóttir

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  39. Discussion and conclusion • Physicians have great influence on womens decision regarding use of HT • Physicians consultations regarding HT • Peri-menopausal women do not find menstrual education sufficient to meet their needs • Educate women Herdís Sveinsdóttir

  40. Thank you Herdís Sveinsdóttir

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