PERCEIVED FAMILY SUPPORT AND SELF CARE PRACTICES AMONG WOMEN OF MENOPAUSAL AGEGROUP ATTENDING GENERAL OUTPATIENT CLINIC, FEDERAL MEDICAL CENTRE, OWO.

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PERCEIVED FAMILY SUPPORT AND SELF CARE PRACTICES AMONG WOMEN OF MENOPAUSAL AGEGROUP ATTENDING GENERAL OUTPATIENT CLINIC, FEDERAL MEDICAL CENTRE, OWO.

SUMMARY

Menopause is a major burden and a daunting challenge among women. The beneficial effect of family support in overall health promotion and care of the patient has been documented. There is virtually no information on integrated health care among Nigerian menopausal women especially in areas of family support, self- care practices and other health related quality of life. Therefore this study was conducted to investigate the role of perceived family support and self-care in women of menopausal age group attending the GOP clinic, Federal Medical Centre Owo.

This was a descriptive cross-sectional hospital based study which utilized systematic sampling technique to select 404 women within ages 40-60 years who attended General Outpatient Clinic Federal Medical Centre Owo. A pre-tested, semi-structured interviewer administered questionnaire was used to obtain information from respondents. Data was analyzed using SPSS version 21.

The mean age of the respondents was 50.5 ±6.3years with the highest among women aged 55 years and above. The knowledge of menopause related symptoms was poor as 64% of the respondent did not know any menopause related symptoms. The prevalence of menopause related symptoms were more among the peri-menopausal and postmenopausal respondents in the 6 symptom domains

assessed. The use of screening services was poor as 4% of the respondents had done half of the 8

“recommended” health related screening within the stipulated period. The perceived family support among the respondents was low as 47.8% of the family had good family support.  There was no significant association between family support and the self-care practices (health screening and treatment options).

This study has revealed gaps in the knowledge of menopause related symptoms, self-care practices and family support among the menopausal women. In addition, perceived family support did not play a role in the self-care practices among menopausal women. Opportunities for public enlightenment and health education interventions is needed to address these gaps among the study population.

   

TABLE OF CONTENTS

DECLARATION………………………………………………………..……………………i

ACKNOWLEDGEMENTS………………………………………..………………………..ii

DEDICATION……………………………………………..…………………………...........iii

CERTIFICATION………………………………..……………………………………….…iv

TABLE OF CONTENTS…………………….………………………………………..…….v

LIST OF TABLES……………….………………………………………………………….vii

LIST OF FIGURES…………………………………………………………………............viii

APPENDICES…………..…………………………………………………………………...ix LIST OF ABBREVIATIONS………………………………………………………….........x SUMMARY………..………………………………………………………………………....1

CHAPTER 1: Introduction………………………………………………………..………….2

  • Rationale for the study…………………….……………………………………..….7

 

  • Aim and Objectives of the study……………………………………………………10

CHAPTER 2  

Literature Review…….………………………………………………………………...13

CHAPTER 3

Materials and Method.…….…………………………………………………………... 46 CHAPTER 4     Results……………………………………………………………….......... 63

CHAPTER 5     Discussion…….……………………………………………………………86      Limitations of the study…..…………….………………………………………………...100

Conclusion………………………………………………………………………….......................

....101

 

Recommendations………………………………………………………………………………...

102

 

References…………………….………………………………………………………...............1

03

                                             

                                                       CHAPTER 1

1.0 INTRODUCTION

Menopause is a physiological process occurring with ovarian failure and marks the end of a woman’s reproductive life. 1 The average age of menopause is 51 ± 3years worldwide.2 Dane and Seigal categorized menopause into three time periods. These are pre-menopausal, peri-menopusal and post-menopausal periods.3 The peri-menopausal period also known as climacteric is immediately prior to the post-menopause, at which time the endocrinological, biological and clinical features of approaching menopause commenced. It precedes the final menses by 2 to 8 years (median of 3.8 years). Postmenopausal state is the complete cessation of menstrual periods for 12 consecutive months, however the term menopause is commonly used for both events.3

 

Natural menopause is a gradual process that occurs for most women between ages of 45- 55 years,4 premature menopause occurs in a woman younger than 40 years and   menopause is considered late if it occurs in a woman older than 55 years.4 Menopause occurs at a point when other life events are taking place simultaneously. The woman is faced with the task of adjusting to the physiological symptoms of the personality changes, job anxiety, career changes, maintaining an economic standard of living, managing a home, adjusting to children growing or leaving home.5

 

In 1960, the world population of women aged 60 years and above was below 250 million, but it is estimated that by the year 2030, 1.2 billion women will be peri- or post menopausal and this total will increase by 4.7 million every year.1 The average woman in the developed world expects to spend an approximately one third of her life in post- menopausal state.6  Presently in Nigeria, women have higher life expectancy than men with  male: female  of 51.63:53.66 years respectively  according to 2014 estimate.7,8 This implies that women in their postmenopausal period make up majority of elderly

population.8

 

Menopause occurs due to regression of ovarian function, leading to decrease in estrogen level with resultant variability in menstrual cycle (peri-menopausal) and permanent caessation of menses (post-menopausal).4 With general increase in life expectancy, many women are likely to live for more than 20 years after menopause, spending about one quarter of their lives or more in a state of estrogen deficiency.9 Owing to lack of estrogen, a woman may experience target organ response involving the cardiovascular, urogenital, central nervous system, bone and skin resulting in decreased physical and mental wellbeing, hence post -menopausal woman could be considered at risk population.10 Most women going through menopause experience one or more of these symptoms in a varying degree of intensity from mild (discomforting), moderate, and severe (extreme and life changing).

 

The overall health and well-being of  middle-aged women have become  major public health issues around the world.11 Ten years prior to the caessation of menses, a woman receives signal that her reproductive organs are changing. More than 80% of women present with physical  symptoms in the years approaching menopause with various distresses in their lives leading to a decrease in quality of life.11 This situation is worsened by women’s overall limited knowledge about the potential health problems associated with menopause and the necessary preventive measures indicated by their low participation in screening programmes for chronic diseases coupled with their unhealthy lifestyle (physical inactivity, low consumption of fruits, vegetables and food rich in calcium) which  impede a better overall health related quality of life.3

Population based studies have shown that reported health symptoms at 47 years tend to cluster into 4 main groups: vasomotor symptoms such as hot flushes and cold night sweat; somatic symptoms such as headaches, muscle and joint pain; psychological symptoms such as anxiety- depression and sexual discomfort. Non-specific somatic and psychological symptoms including tiredness, irritability, insomnia, palpitations, memory or concentration difficulties,  mood swings, or depression have been commonly reported.12 As a result of these predicted changes in population structure, physicians are beginning to see that menopause is not a negligible phenomenon but a major health problem.1

Menopausal status seems to have an impact on attitude. Avis and Mckinlay found that surgical menopausal women held more negative attitude towards menopause than those going through the normal transition.13  Attitude refers to feelings, beliefs and reactions of an individual towards an event, phenomena, object or person, they are not innate attributes of mankind, but are learnt responses.14 Fishbien and Ajzen remarked that attitude is considered to be individualistic, an abstracted entity, a kind of intervening variable imposed in order to explain regularities  in behavioural responses. In this study, attitude is used to explain the behaviours of Nigerian women towards menopause within an individual and influenced by situation and circumstances.14

The decision on how to deal with menopausal symptoms leads to perception and attitude of women towards menopause. If the knowledge of menopause is not enough, it will be perceived wrongly or negatively which can lead to negative or neutral attitude towards menopause. However, if the knowledge about menopause is adequate and understandable, there would be correct or right perception which can lead to positive attitude towards menopause. Perception as regards to this study therefore means ability of women to have the knowledge of menopause, understand menopausal signs and symptoms and to cope with it. Menopausal symptoms are found to be less common in societies where menopause is viewed as a positive rather than negative event.12

Self -care is a key component of current policies to manage long term conditions. Although most people with long term health problems care for themselves within an illness referral system, consultation rates for long term un-differentiated illness remain high. While most women seem to view menopause as a biological event and place it within the context of their developmental milestones15 or even accept it as a marker of old age. Some of these women place it as a time frame within their lifespan,16 a significant majority nevertheless resort to numerous prescribed and nonprescribed self-care actions to relieve  menopause related symptoms  through this transition.16–19 The need and choice of these self -care actions, particularly those that are non-prescribed, however vary from region to region and women to women depending on the educational level, attitude towards menopause, psychological and economic factors and even availability of access to medications.17 Promotion of self-care in these individuals requires an understanding of their selfcare practices and need to be understood in the context of health care pluralism.17

 

Individual based care known as self-care can be broadly defined as those that are practiced by the individual and directed at relieving symptoms, maintaining health or preventing ill health. 18  Rogers and Hay19 view self-care activity as a continuum with those efforts made solely by the individual at one end and those shared with professionals at the other. The interactions between sectors of care, particularly self-care/professional care (notably primary care) interface are increasingly demanding attention in research.20 Studies have predominantly investigated selfmanagement interventions relating to specific diseases or long term conditions particularly diabetes, asthma, and arthritis.20 In contrast, self-care practices adopted by people with less well defined health problems are little understood, despite the prevalence of such problems and the challenges they pose to the General Practitioners.21

 

Family support is an important factor in conceptualizing primary health care patient problems. Numerous  examples of how the family system determines the course of chronic illness have been  influential in the development of collaborative medical care.22 By understanding  how the family influence health, the Family Physician has the opportunity to anticipate and reduce the adverse effects of family stress and use the family as a source of care of the patients. Family oriented approach to health care is based on the biopsychosocial model that emphasizes the relationship among biologic, interpersonal and social factors in health.22

 

The beneficial effect of family support in overall health promotion and chronic illness have been reviewed and how to use family as a valuable resource and support in the care of the patient have been discussed. Understanding how family can influence health can assist the Physician in working more effectively with patients and families. Integrated  health care, which involves management and delivery of health services so that clients receive a continuum of preventive and curative services, according to their needs over time and across different levels of the health system is becoming an important issue.23 There is virtually no data on integrated health care among Nigerian menopausal women especially in areas of family support, self- care practices and other health related quality of life despite the identified problems mentioned inter alia in this group and  little is known about the complex relationship between perceived family support and psychological distress in these mixed middle aged  primary care patients.22

 

1.1 RELEVANCE OF THE STUDY

There is paucity of information in the area of family support and self-care practices in menopausal women in Africa including Nigeria. Studies have predominantly investigated self-management interventions relating to specific diseases or long term conditions particularly hypertension, diabetes, asthma, arthritis, but none have addressed areas concerning family support and self-care in menopausal women in Nigeria. There still exist a strong adherence to traditional and cultural practices in Nigeria where the way of life places a lot of demand on the women in the running of the household. Whereas women with mild menopausal symptoms are able to cope with the symptoms without seeking for medical treatment, women with moderate and severe menopausal symptoms consider them important health problems and may seek treatment for these symptoms.24

 

Assessing the awareness, knowledge and perception of menopause will give an idea of the kind of attitude towards ageing and managing symptoms of menopause in these women. It will also identify patient’s expectation and fears about menopause thereby revealing most immediate needs and concern which could be biomedical, cultural or psychosocial.25  It would also identify their coping strategies and areas that would require support from the health care professional in order to improve their health related quality of life in menopause. 25

 

The most reported symptom(s) experienced by these women were based on the menopausal status and factors that affect health promotion, prevention and treatment which could provide most immediate needs and relieve concerns.25 How healthy are the patient’s lifestyle in terms of diets, exercise, smoking, alcohol use, and intake of the counter medications  give an idea of how much thought and effort has been put into taking care of themselves. This would improve patient-doctors relation where common ground are agreed upon in other to facilitate treatment and correct negative perceptions as they transit through menopause. 25 One of the important issues that may vary from one group to another is in determining whether menopause is considered a ‘sickness’ or a natural process of ageing. In many societies, the ‘culture of silence’ about some of the important aspects affecting reproductive health status also gives rise to concern about physiological changes that could be easily explained to the individual to relieve her of unnecessary stress. The way in which the social beliefs and norms have shaped the ideas and reactions of females to the discomfort and apprehension associated with reproductive changes will also affect their treatment seeking behaviour. 26

 

The beneficial effect of family support in health promotion in chronic diseases across the age groups irrespective of gender has been discussed, however the investigator is interested in how the family support promotes self-care practices in these women at menopause. In addition, biopsychosocial effect of family support on un-differentiated non-specific somatic and psychological symptoms  including tiredness irritability, memory and concentration, poor sleep  problem which have been described in most studies but poses challenges in medical practice will be looked unto. This would enable the logical planning and empowerment in areas that would have the greatest impact in promoting self-care practices and health related quality of life in these group of women as the investigator doubts the degree of contributions of the support received from the family, friends and relation including the community in their quest to maintaining health during after their reproductive period.

 

Over the past 2 decades, an expanding body of literature has documented links between a woman’s age at menopause and health.27 Menstrual cycle patterns, as markers of physiologic functions and through their potential associations with the age at menopause, have also been investigated for their links to health outcomes.28 Early menopause has been associated to a number of negative outcomes including a higher risk of cardiovascular diseases, osteoporosis and higher all-cause mortality and the late age of menopause has been associated with higher risk of breast and endometrial cancer.29 Menstrual cycle characteristic most notably, length of inter-menstrual interval have also been identified as risk factors for a variety of health conditions including polycystic ovary syndrome, coronary heart disease, and risk of fracture.30 The concerns expressed 35years ago that "even": a minor shift from self-care to doctor care could make intolerable demands on the general-practitioner on services have continued to be voiced by General Practitioners  and are now being taken a step further by National Health Service (NHS) policies that promote self-care support as a potential mechanism for reducing the element for medical care.22   Documenting women’s use of self-care actions will help better understanding of the menopausal transitions and may serve as a platform to detect gaps in the integrative health care among this group of women. This may provide an opportunity for further studies on the role of family support and self -care practices since very little information is available on this issue in Nigeria, the focus being on family support, self -care practices, and common non-specific symptoms that are difficult to treat with medical interventions but which are amenable to other self-care. This could enable hypothesis generation for further research and to inform the development of methods of supporting women with menopause related symptoms in our environment.

 

1.2 AIM AND OBJECTIVES

Aim: 

The aim of this study is to investigate the role of perceived family support and self-care practices in women of menopausal age group attending the General Outpatient (GOP) Clinic of Federal Medical Centre, Owo, with the purpose of improving the knowledge of menopause related problems and reducing potential health related problems within this age group.

Objectives: 

  1. To determine the knowledge, prevalence and pattern of menopause related symptoms among women of menopausal age group attending GOP clinic, FMC Owo.
  2. To assess the perceived family support among women in menopausal age group attending GOP clinic, FMC Owo
  3. To assess the self-care practices among women in menopausal age group attending GOP clinic, FMC Owo.
  4. To determine the role of family support on self-care practices among women of menopausal age group attending GOP clinic, FMC Owo.

 

 

 

 

 

1.3 SOME DEFINITIONS USED IN THIS STUDY

Menopause- This covers the events of peri-menopausal (climacteric) a time of changing ovarian function to post-menopausal (complete cessation of menstrual period for 12 consecutive months)

Menopausal women-This refer to women that are peri-menopausal and or post- menopausal.  

Menopausal age group-This refer to women aged 40- 60 years in this study irrespective of symptoms or gynaecological history.  

 Menopausal status-This refer to whether the respondent is premenopausal, perimenopausal and post-menopausal in the absence of any medical or gynaecological procedures that can induce menstrual irregularity or complete cessation of menses. Menstrual status- This refers to perceived self-reported menstrual characteristic based on the last menstrual pattern.   

Bio-psychosocial well-being- This involves the biological, psychological and social dimensions of health. It is an integrated mind-body approach which leads to overall health, better treatment outcome, enhanced satisfaction and well- being.  

Biological well-being- These are physical changes a woman undergoes due to cessation of ovarian follicular activity. Biological changes includes hot f1ushes, joint or musculoskeletal pain

Social well-being- This refers to the ability of individual to function in society where she lives. Social change includes lack of interest to new relationship, work satisfaction.

Family support- This refers to the support received by the respondent from spouse, siblings, children, parents and relatives. These include informational support, emotional support and financial assistance as measured by the family APGAR.  

Social support- This refers to the various types of support that people receive from others and is generally classified into three major categories: emotional, instrumental and informational support Family- This is defined in this study as a specific group of people who share common ancestors that may be made up of partners, children, parents, aunts, uncles, cousins and grandparents

PERCEIVED FAMILY SUPPORT AND SELF CARE PRACTICES AMONG WOMEN OF MENOPAUSAL AGEGROUP ATTENDING GENERAL OUTPATIENT CLINIC, FEDERAL MEDICAL CENTRE, OWO.

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