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NATIONAL POSTGRADUATE MEDICAL COLLEGE OF NIGERIA.
RESEARCH PROPOSAL AND TITLE REGISTRATION ASSESSMENT FORM OF
PART 11 CANDIDATE
1. NAME OF CANDIDATE:- Dr.Oshakuade Temitope Olakunle
2. FACULTY OF CANDIDATE :- Family Medicine
3. NAME OF TRAINING INSTITUTION :- Federal Medical Centre, Owo
4. ADDRESS OF TRAINING INSTITUTION:- P.M.B 1053, Owo, Ondo State
5. NAME OF SUPERVISOR:- Dr. O.O Akinboboye
6. ADDRESS OF SUPERVISOR:- Federal Medical Centre, Owo
7. NAME OF SECOND SUPERVISOR:- Dr. A.M Adebayo
8. MONTH AND YEAR PART 1 WAS PASSED: - November 2010.
9. PROPOSED EXAMINATION DATE: - May 2013.
10. PROPOSED TITLE OF PROJECT: - Perceived Family Support and Self Care
Practices among Women in Menopausal Age group Attending General Outpatient
Clinic. Federal Medical Centre, Owo.
11. Phone No : 08035615474
2
13. INTRODUCTION
Menopause is a physiological event occurring with ovarian failure and marks the end of
women’s reproductive life1. The average age of menopause is 51 ± 3 years worldwide
2. In 1960,
the world population of women aged 60 years and above was below 250 million, but it is
estimated that in the year 2030, 1.2 billion will be peri- or post menopausal and this total will
increase by 4.7 million every year1. The average woman in the developed world expects to spend
an approximately one third of her life in post menopausal state3.
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 4.Owing to lack of estrogen, a woman may experience decrease physical and mental
well -being, that is why post menopausal woman can be considered a population at risk5.
Dane and Seigal medically divided menopause into three time period. These are pre-menopausal,
perimenopausal and postmenopausal periods6.The perimenopausal period is the period
immediately prior to the menopause at which time the endocrinological, biological and clinical
features of approaching menopause commence. Postmenopausal is the complete cessation of
menstrual periods for 12 consecutive months. However the term menopause is commonly used
for both events6. Natural menopause is a gradual process that occurs for most women between
ages of 45- 55 years8. The perimenopause (climacteric), a time of changing ovarian function,
precedes the final menses by 2 to 8 years (median of 3.8 years), some symptoms such as hot
flashes begin in the perimenopausal and increase as women progress through the menopause.9
Menopause occurs at a point in women’s lives 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
3
living, managing a home, adjusting to children growing or leaving home (empty nest syndrome)
etc14
Population based studies have shown that reported health symptoms at 47 years tend to cluster
into 4 main groups: vasomotor symptoms such as hot flashes 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
The overall health and well being of the middle-aged women has become a major public health
issue around the world.15
For the last ten years prior to the cessation of menses, a woman
receives signal that her reproductive organs are changing, the ovary begins to show signs of
impending failure. 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.15
This situation is worsened by women’s overall limited knowledge about the potential
health problems associated with climacteric 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)16
which impede a better overall health related quality of life. 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
Presently in Nigeria, women have higher life expectancy than men7. This implies that women in
their postmenopausal period make up majority of elderly population7. Despite the identified
problems in this age group mentioned inter alia, there is virtually no data on comprehensive
4
health care among Nigerian menopausal women especially in areas of family support, self care
practices and other health related quality of life.
Comprehensive health care is becoming an important issue however, little is known about the
complex relationship between perceived family support, self rated health and psychological
distress in mixed middle aged older primary care patients samples.17
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 a lay network, consultation rates for long term
undifferentiated illness remain high. While most women seem to view menopause as a
biological event and place it within the context of their developmental milestones18
or even
accept it as a marker of old age, where they place it as a time frame within their lifespan19
, a
significant majority nevertheless resort to numerous prescribed and non prescribed self care
actions20
to help see through this transition. 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 education level, attitude towards menopause, psychological and
economic factors and even availability of access to medications20
. Promotion of self care in these
individuals requires an understanding of their self care practices and need to be understood in the
context of health care pluralism.20
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.21
Rogers and Hay22
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.23
Studies have predominantly investigated self
5
management interventions relating to specific diseases or long term conditions particularly
diabetes, asthma, and arthritis23
. 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.24
Family support is an important factor in conceptualizing primary health care patient problems17
.
Numerous examples of how the family system determines the course of chronic illness have
been influential in the development of collaborative medical care.17
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 bio-psysocial model that emphasizes the
relationship among biologic, interpersonal and social factors in health25
.
The beneficial effect of family support in overall health promotion and chronic illness are
reviewed and how to use family as a valuable resource and source of 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.
14. STATEMENT OF THE PROBLEM
Climacteric stage women experience significant biological, psychological and social changes30
.
With the demographic changes being observed in the growing number of climacteric stage
women, it is important to improve their knowledge about the climacteric stage and its potential
associated problems, encourage their participation in screening programmes and promote the
acquisition of healthy life style.30
6
A need arises when one sees a difference between the situation considered as optimal and the
actual observed situation, the difference to be is then the need30
. In the health field, the felt need
relates to the perception people have about their health problems or whatever they want to
receive from the health services. There exist a need that people do not perceive, but it must be
satisfied to maintain, restore or improve their health30
.
Traditionally, climacteric stage women seek medical attention when they perceive health
problems attributed to this stage such as severe climacteric symptoms, osteoporosis related
fractures, symptoms or complication of chronic diseases. Regarding the unfelt need, most
women do not perceive the need to prevent such health problems early16
.These situations result
in delayed health seeking behaviors for these problems which in turn represent a significant
burden for health care system and for the society due to high health cost of health care, decreased
quality of life, and premature death16
.
A vast majority of Nigerian women have limited knowledge about the menopausal period10
.
Recent community based studies31
have revealed that most menopausal symptoms are indeed
prevalent among Nigerian women but because of cultural practices that endanger positive
attitude to menopause in some Nigeria communities,31
women with mild menopausal symptoms
are able to cope with the symptoms without seeking for medical treatment however women with
moderate and severe menopausal symptoms consider them important health concern and seek
treatment for these symptoms.31
Documenting women’s use of self care actions will help better understanding of woman’s
transition through this phase of her life, in addition it may serve as a platform to detect gaps in
the perceived family support and self care practices among this group of women which may
7
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.
15. AIM AND OBJECTIVES
Aim:
To investigate the role of perceived family support and self care practices among women in
menopausal age group attending the General Outpatient (GOP) clinic of Federal Medical Centre,
Owo, Ondo State.
Objectives:
1. To assess the knowledge and attitude to menopause among women aged 40-60 years
attending GOP clinic.
2. To determine the prevalence and pattern of menopause related symptoms among women
aged 40-60 years attending GOP clinic.
3. Identify the perceived self care practices for somatic / vasomotor symptoms and self rated
health among women aged 40-60 years attending GOP clinic FMC Owo.
4. Explore the role of family support among women in the menopausal age group attending
GOP clinic, FMC.Owo.
16. PROPOSED METHODOLOGY
Study location
The study will be conducted at General Outpatient Clinic, Federal medical Centre, Owo. Federal
Medical Owo is a government own tertiary hospital in Ondo- State, South Western Nigeria and
has one of the largest patients attendance in the state. The hospital offers services in different
specialties such as Family Medicine, Internal Medicine, Surgery, Obstetrics and Gynecology,
8
Community Health, Dentistry as well as Ophthalmology. Others include Laboratory Medicine,
Radiology, and Physiotherapy. The hospital serves as primary, secondary and tertiary health care
centre for people in states like Ondo, Ekiti, Edo, Kogi and Osun.
STUDY DESIGN
A cross sectional study will be used to assess the role of family support and the self care
practices in women with menopausal related symptoms attending General Outpatient Clinic
Federal Medical Centre, Owo.
ETHICAL CLEARANCE AND CONSENT
Ethical clearance shall be obtained from the hospital’s Health Research Ethics Committe and
written informed consent from each subject shall be obtained.
Study Population
Female patients aged 40 – 60 years old that attend GOP clinic, FMC, Owo within the study
period. The study is expected to be conducted over a period of three months.
Inclusion criteria:-
1. Women that are aged 40 – 60 years old attending General Outpatient clinic.
Exclusion Criteria:-
1. Failure to give consent
2. Acutely and critically ill patients at the time of interview
3. Pregnant and breastfeeding mothers
4. Those on highly active antiretroviral therapy (HAART)
Sample Size Determination
The required sample size will be calculated by using the formula for descriptive study
n = z2 pq/d
2
9
Where n= the desired minimum sample size
z= standard normal deviate at 5% level of significance = 1.96
p = the proportion of the target population estimated to have a particular characteristics
(percentage of menopausal women with good family support =50%11
)
q =1.0 – p
d= degree of accuracy described usually set at 0.05 level
n = 1.962 x0.50 (1 - 0.50)
(0.05)2
= 0.9411
0.0025 = 384.16 = 384 female patients
In order to accommodate for 5% attrition
= 5/100 x 384 = 19.2
The total sample size = 404 female patients.
Sampling Method
Systematic random sampling technique will be used to recruit subjects for this study. On the
average, eight hundred and twenty five (825) women attend General Outpatient clinic in one
month among whom an average of 412 (50%) are within age 40-60 years.
Using systematic random sampling, a sampling interval of 3 is obtained as derived below:
Sampling interval = number of women aged 40-60 years x duration of study / minimum sample
size
= 412 x 3
404
10
Therefore, every third patient that meets the inclusion criteria will be recruited for this study.
DATA COLLECTION AND PROCEDURE:
Data collection and instrument:
A semi-structured interviewer administered questionnaire will be used for data collection. The
questionnaire is divided into various sections based on the objectives. These are socio-
demographic characteristics, house-hold structure and characteristics, knowledge and perception
of menopause, personal and health screening habits, self care practices, family support and
health-related quality of life (QOL) measure. Standardized questionnaires (Family APGAR,
Women health questionnaire and self care questionnaire) will be used to measure family support,
menopause related symptoms and self care actions.
Family APGAR (family Adaptation, Partnership, Growth, Affection, and Resolve.) - A 5 item
measure of perceived family support that was designed as an assessment tool for Physician26
.The
APGAR was chosen for this study because it measures a theoretically important construct in a
brief and easily administrated format. Family physicians trained in other methods of assessment
e.g. (the McMaster model of family functioning) are unlikely to use them in the actual practice27
and reported that they are too busy to use such a protracted and costly approach.
The APGAR has distinguished between patients with and without family distress28
with a lower
scores indicating less satisfying perceived family support. The participant would respond to each
item using a 3 points rating scale ranging from 0 (hardly ever to 2 (almost always)
Women Health Questionnaire (WHQ) - This is a population specific questionnaire that is
applied to women only.WHQ is one of the most frequently utilized measure in the assessment of
QOL in middle-aged women29
. Originally designed to assess symptom perception during the
menopause and for older post-menopausal women, it is within this range (45 – 65 years) that
11
hormone mediated changes such as vasomotor symptoms and vaginal dryness, menstrual
changes and age related bodily changes such as changes in sleep pattern, sexual behavior and
physical health are prevalent.29
The revised 23 item questionnaire investigating 6 dimensions
(Anxiety/Depressed mood, Well being, Somatic symptoms, Memory/Concentration, Vasomotor
symptoms, and Sleep problems) of physical and emotional health rated on four point scale will
be used for this study.
Self care and Routine Health screening - The list of screening would be adapted from health
screening guide for menopausal women34
. This includes breast cancer screening, cervical cancer
screening or Pap test, fasting lipid profile/cholesterol, blood glucose, and thyroid function test.
The use of screening services will be estimated as the sum of the number of screening services
that the woman used, divided by the total number of screening services recommended according
to Mexican Institute of Social Security (IMSS) regulations and multiplied by 10030
Women’s knowledge and perception of menopause - Women’s knowledge and perception of
menopause will be estimated with a questionnaire developed ex profeso30
. The questionnaire
consists of 9 items that assess current menstrual status, ideas and feelings about menopause,
source of information and menopause related symptoms.
The following clinical parameters will be measured: blood pressure, weight, height and basal
metabolic index (BMI).
Accoson mercury sphygmomanometer – This will be used by a medical officer, to take resting
blood pressure (BP) of subjects. The diastolic and systolic blood pressures will be taken and
graded according to the Joint National Committee on Detection, Evaluation and Treatment of
Hypertension (JNC VII).
12
Detecto (England) weight and height scale – This will be used to measure both the weight (Kg)
and height (m) of the subject. The scale will be adjusted before each use to avoid parallel errors
these measurements will be used to calculate the BMI of the patient to detect those that are
underweight and obese.
Trained assistants will be used to carry out the height and weight measurement and data
collection
The research in term of cost will be self sponsored.
DATA ANALYSIS
The data obtained will be analysed using the statistical package for social sciences (SPSS) for
windows evaluation version 18 (SPSS 18, Chicago Illinois). Descriptive data will be presented
using tables, graphs and charts while association between variables will be assessed with chi
square for qualitative variables and t-test as well as correlation coefficient for quantitative
variables as appropriate at 5% level of significance.
17. RELEVANCE AND JUSTIFICATION
There is paucity of information in the area of family support and self care practices in
menopausal women in African setting 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 where there still exist a strong
adherence to traditional and cultural practices and where the way of life places a lot of demand
on the women in the running of the household. This study is therefore aimed to achieve an
13
understanding of the role of family support, self care practices and health related quality of life in
women with menopause related symptoms attending the General Outpatient (GOP) clinic of
Federal Medical Centre Owo, focusing on biosocial aspect of family support, self care practices,
self rated health and common non specific symptoms that are difficult to treat with medical
interventions but which are amenable to self care practices and routine screening. 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.
18. LIMITATION/CONSTRAINT
This cross-sectional study that involves women within the age range of 40-60 years may have to
be sorted by the medical records which may lead to some errors in recruiting the subjects.
However, the estimated sample size has accommodated 5% attrition.
14
19. REFERENCES
1. Jin Yong Lee, Chang Suk Suh. The attitudes of post menopausal women towards
hormone replacement therapy HRT and effects of HRT on lipid profiles. Proceedings of
the first consensus meeting on menopause in east Asian region 1997: May 26-30.
Geneva, Switzerland.
2. Bhavaanns BR, Shhiker RC . Menopausal Hormone Replacement Therapy. J obstetric/
Gynaecol 2005; 27(2): 137-62.
3. Avis NE. Women’s perception of menopause. Euro Menopause J 1996;3:80-4.
4. Bener A, Rizk DE , Shaheen H, MIcAllet R, Osman N, Dunn EV. Measurement of life
satisfaction during menopause in an Arabian Gulf country climacteric 2000; 3: 43 -9.
5. Fuh JL, Wang SJ,Lusr Juan KD. Quality of life and menopause transition for middle
aged women in Kinsmen Island. Quality of life Res 2003;12: 533-61.
6. Doubova SV , Flores-Hernandez S, Rodriquez AL, Peres -Cuevas R . Quality of care
and health related quality of life of climacteric stage women cared for in the family
medicine clinics. Health quality of life outcomes 2010; 8: 20.
7. Saka MJ, Saidiu R, Jimoh A, Akande T et al. Behavioral pattern of menopausal Nigeria
women. Ann Trop Med Public Health 2012;5: 74-9.
8. Greendaleble GA, Lee NP, Arriola ER. The Menopause. Lancet 1999; 286: 571-80
9. Hardly R, Kuh D. Changes in psychological and vasomotor symptom reporting during
menopause. soc sci med 2002; 55: 1975-88.
10. Olawoye JE, Aderibigbe TO, Olarinde S. Reproductive Health issue for Nigerian Women
in Menopause. Gender and Behaviour 2003; 1: 1-15
15
11. Sushmitha RK, Judith AN. Determining bio-psychosocial wellbeing and family support
of menopausal women in selected hospitals of Udipi Distric, Karnataka: International
Journal of Nursing Education 2011; 3(2):114-117.
12. Kenemans P. Menopause, HRT and Menopausal symptom. J epidermal biostart 1999; 4:
141-6.
13. Alexander J. Neurobehavioral impact of menopause on mood. Expert Rev Neurother.
2007 Nov;7(11 Suppl):S81-91.
14. Utian WH. Ovarian function, therapy –Oriented definitions of menopause and
climacteric experimental gerontology 1994; 29(3-4): 245-251.
15. Whelan TJ, Goss PE, Ingle NJ, Tu DS, Pritchard K, et al. Assessment of quality of life in
MA.17: A randomized, placebo controlled trial of tetrozole after 5 years of tamoxifen in
postmenopausal women. clin onclo 2005; 23:6931-40.
16. Doubaou SV, Flores–Hernandez, Rodriquez Aquila et al. Quality of care and health
related quality of life of climacteric stage woman cared for in family medicine clinics.
Health Qual life outcomes 2010; 8: 20.
17. Annmarie Cano, Douglas JS, Robert PS et al .Family support, Self rated Health and
psychological distress. Primary Care Companion J Clin Psychiatry 2003;5(3) 111-117.
18. George T. Menopause; Some interpretation of the result of a study among a non western
group. Maturitas 1988; 109(2):109 –16.
19. Lind AL, Hoffman M, Hammer M, kejellgree K. Women conception of the menopausal
transition- A qualitative study. J clin nursing 2007; 16: 509- 17.
16
20. Gupta S, Forbes N, Kirkman R. Attitudes to menopause and hormone replacement therapy
among Asian and Caucasian women general practitioners. Maturias 2001; 39:16 169- 75.
21. Barofsky I: Compliance, adherence and therapeutic alliance. Steps in the development of
self .Soc sci Med 1978; 12: 369-76.
22. Rogers AH. Self care and access to health care. Opportunities for improving access to care.
NNSE Anglia and oxford Region Milton Leynes 1998;1471-2296.
23. Stevenson FA, Britten N, Barry CA et al. Self treatment and its discussions in medical
consultation. How is medical consultation pluralism managed in practice? Soc sci med 2003;
57(3): 513 -27.
24. Aggarwd VR, Mc Beth J, Zakrzewska JM et al. The epidemiology of chronic syndromes that
are frequently unexplained: do they have a common associated factor. Oxford Journals 2012;
41(3) 467-476.
25. Jane H, Bray and Thomas L Campbell. The family influence on health; Textbook of family
medicine 7th
edition; page 25-26.
26. Smilkstein G. The family APGAR: A proposal for a family function test and its use by
physicians. Fam Prac 1978;6:1231-1239.
27. Bishop DS, Epstein NB, Glibert R, et al. Training family physicians to treat families:
unexpected compliance problems. Fam Sys Med 1984;2: 380-386.
28. Good MJD, Smilkstein G, Good BJ, et al. The family APGAR index: a study of construct
validity. J Fam Pract 1979:8:577-582.
17
29 Hunter M. The Women's Health Questionnaire: A Measure of Mid-Aged Women's
Perceptions of Their Emotional and Physical Health. Psychology and Health 1992;7:45-54.
30. Svetlana VD, Patricia Esoinisa, Sergio P et al. Integrative health care model climacteric
stage women. BMC women health 2011; 11:6.
31 Peter Nkwo, Hyacinth Onah. Positive attitude to menopause and improved quality of life
among Igbo women in Nigeria. International journal of Gynecology and Obstetrics 2008;103
(1):71-72.
32 Agwu UM, Omeora OUJ ,Ejikeme BN: Patterns of menopausal symptoms and adaptive
ability in rural population in south east Nigeria. Journal of obstetrics and gynecology 2008;
28(2):217-21.
33 Hardip–Kaur Dhilon, Nik Mohd Zaki Nik Mahmood, Harbindarjeet Singh. Documentation of
self care actions taken for somatic complaints by postmenopausal Malay women living in
Kelantan Malasia. Maruritas 2007; 58(3): 241-8.
34 Juian Uffner. Menopausal Screening Guide for Menopausal Women. Women Health Source,
www.mainline health.org
18
Appendix I
Application supported by:
a) Head of Department: Name: Dr (Mrs.) O.E. Adeleke.
Year of Fellowship: 2003.
Signature and Date ……………………
b) Supervisor: Name: Dr O.O. Akinboboye
Year of Fellowship: 1991
Signature and Date ………………………
c) Second Supervisor: Name: Dr A.M. Adebayo (FWACP)
Year of Fellowship: 2010
Signature and Date ………………………
d) Name of Candidate: Oshakuade, Temitope Olakunle.
Signature and Date …………………………
For Official Use Only
a) Date of receipt of proposal ……..
b) Date forwarded to Chief Examiner or designated assessor ………
c) Date returned by Chief Examiner or designated assessor ………
d) Approved by Chief Examiner (Yes/No) ………
e) If not approved, objections must be communicated to the candidate.
Date approval/objections communicated. ………
19
Appendix II
RESEARCH QUESTIONNAIRE ON THE PERCEIVED FAMILY
SUPPORT AND SELF CARE PRACTICES AMONG WOMEN IN
MENOPAUSAL AGE GROUP ATTENDING GOPD, FMC .OWO
Dear Sir /Madam
This study is designed to determine the role of family support and self care
practices as women transit through their reproductive years.
Your cooperation is needed to truthfully answer the questions below. Any
information provided will be kept in strict confidence and will be used for
academic purposes only. Answering these questions should take only 15-20
minutes of your time. Thank you.
Dr. Oshakuade T.O
Investigator
Identification number……………
20
Serial No.______________________
QUESTIONNAIRE
Perceived Family support and Self Care Practices among Women in menopausal age group attending
GOP, FMC. Owo
This is an interviewer administered questionnaire and the information requested in it is intended for research
purposes only. The following questions are concerned with you, your family and your medical condition.
Please answer all questions.
Section A: Socio-demographic data *code- for data entering
Questions Responses Code
01 Age , (last birthday)
02 Sex M F
1 2
03 What is your highest level of Education?
no formal education primary secondary post primary
1 2 3 4
04 What is the highest level of schooling completed by your spouse
no formal education primary secondary post secondary
1 2 3 4
05 Occupation- patient
unemployed petty trader/laborers/messenger Junior school teacher/driver/artisan senior school teacher/ intermediate grade public servant senior public servant/ professional/manager
1 2 3 4 5
06 Occupation – partner
unemployed petty trader/laborers/messenger Junior school teacher/driver/artisan senior school teacher/ intermediate grade public servant senior public servant/ professional/manager
1 2 3 4 5
07
Ethnicity. .
Hausa Yoruba Igbo others
1 2 3 4
.Section B: Household Structure And Characteristics
08
Which of these best described your marital status?
never married married divorced separated widowed
1 2 3 4 5
09 If married, what type of marriage; monogamous polygamous
1 2
10 If polygamous, number of wives.
21
Section E: Knowledge and Symptoms of Menopause
22 Have you ever heard of menopause
Yes No
1 2
11 How many people eat from the same pot in your house
total= male= adult children female= adult children
12 Perceived head of the family
myself (patient) my spouse/partner others pls specify…
1 2 3
13 How much did all source of household income provide for your house hold in the last 4 weeks?
N
14 In the last 4 weeks how much did your house hold spend in total N
15 In the last 4 weeks how much did your household spend on food items
N
Section C : Self reported and self rated health
16 What medical condition(s) are you currently being treated for in the past 3 months
1.hypertension 2.DM 3.difficulty with breathing 4.cough 5.fever 6.dizziness 7.body pain 8 back pain 9.stomach pain,10 easy fatigue 11vaginal itching/discharge ,12 urinary discomfort 13. palpitation 14.chest pain 15.loose stool,16.headache, others pls specify………
17 How do you consider or rate your health in the past 3 months?
Good Fair Poor I don’t know
1 2 3 4
Section D: Gynecological data
18
How would you describe your current menstrual status?
Regular (menstruate monthly for the past 12 months) Irregular menses within the past 12 months No menses for the past 12 months
1 2 3
19
If irregular or no menstrual period which of the following reason apply to you?
Pregnancy (confirmed) Family planning Previous removal of womb menopausal I don’t know Others ,Pls specify……
1 2 3 4 5 6
20
Have you had any Gynaecological Procedure/Operation?
Yes No
1 2
21.
If yes to question 20 ,What was done?
1.Uterine curettage 2. Removal of fibroid 3 IUCD-cuT 4. removal of womb 5 Others pls specify
22
23 If yes to Q22, What is your main source of information
Books/magazine Internet Friends/relatives TV Healthcare providers Others pls specify
1 2 3 4 5 6
24 What do you understand by menopause?
Beginning of menses Cessation of menses Heavy vaginal bleeding Lower abdominal pain Other Pls specify…
1 2 3 4 5
25
What is your feeling about menopause
No more periods and no more worry about contraception. Menopause marks a new life phase. Loss of fertility and loss of youthful self Beginning of old age for women A taboo Others please specify………
1 2 3 4 5 6
26 Do you know some symptoms associated with menopause?
Yes No
1 2
27 If yes to Q26 above ,Please tick as appropriate
1. hot flashes 2. inability to sleep 3. depression 4. irritability 5. night sweats 6 .Muscle/joint pain
7. Vaginal dryness 8. Easy fatigue 9. Reduced libido 10. Crawling sensation 11. pain on urination 12. Others pls specify
28 Do you have any of the following symptom(s) within the past 3months Please tick as appropriate
1. hot flashes 2. inability to sleep 3. depression 4. irritability 5. night sweats 6 .Muscle/joint pain
7. Vaginal dryness 8. Easy fatigue 9. Reduced libido 10. Crawling sensation 11. Pain on urination
Section F: PERSONAL HABITS AND HEALTH SCREENING
29 Did you examined your breast yourself in the last 1 month
Yes No
1 2
30 If yes to Q 29, why?
pain discomfort/discharge lump others
1 2 3 4
31 Have you examined your breast with a physician in the last 1 year?
yes no
1 2
32 If yes to Q31 , what was your reason? pain discomfort lump others
1 2 3 4
33 Have you ever heard of Cervical Pap smear? Yes No
1 2
34
If yes to Q33, have you done this test in the last 3 years Yes No
1 2
23
35 Have you ever heard of Mammogram/breast x ray?
Yes No
1 2
36 If yes to Q35, have you done this test before? Yes No
1 2
37
Have you ever heard of Blood sugar test/ diabetes: Yes No
1 2
38 If yes to Q37, have you done this test in the last 3 years yes No
1 2
39 Have you ever heard of Cholesterol or Fasting lipids? Yes No
1 2
40 If yes Q39, have you done this test in the last 3years
Yes No
1 2
41 Have you ever heard of been overweight? Yes No
1 2
42 If yes to Q41, have you voluntarily weighed yourself in the last 1 year
Yes No
1 2
43 Have you ever heard high blood pressure/hypertension
Yes No
1 2
44 If yes to Q43, have you voluntarily done this test in the last 1 year Yes No
1 2
Section G : Life Style And Habits Please tick as appropriate 45 Do you smoke tobacco? Yes
No
1 2
46 If yes to Q45,how many sticks per day
1-5 5-10 >10
1 2 3
47 Do you drink alcohol orbeer? Yes no
1 2
48 If yes to Q47, how many bottles per day
Occasional Rarely or <once /week Moderate 1-14 drinks /week Heavy > 14 drinks /week
1 2 3
49 Are you on any special diet Yes no
1 2
50
If yes to Q49, which one fruits and vegetables Reduce yam and cassava intake Reduce salt intake Others pls specify…
1 2 3 4
51 How often do you exercise At least three times a week Occasionally Rarely Never
1 2 3
52 What activity(ices) Brisk walking Jogging Other please specify
1 2 3
53 For how long?
1-10min 10-20min 20-30min 30-1hr
1 2 3 4
24
Section H: Self care practices for self reported somatic /vasomotor symptoms
54 Backache
1 absent, 2 mild, 3 moderate, 4 severe
1 no action, 2 taking HRT, 3 taking traditional/alternative medicine…… 4 self medication/OTC drugs…………………. 5 prescribed medication……. 6 if any other pls state
55 Musculoskeletal aches and pains
1 absent, 2 mild, 3 moderate, 4 severe
1 no action, 2 taking HRT, 3 taking traditional/alternative medicine……… 4 self medication/OTC drugs…………………. 5 prescribed medication……… 6 if any other pls state
56
Hot flashes
1 absent, 2 mild, 3 moderate 4 severe
1 no action, 2 taking HRT, 3 taking traditional/alternative meds ………………. 4 self medication/OTC drugs…………………. 5 prescribed medication 6 if any other pls state
57
Tiredness 1 absent, 2 mild, 3 moderate 4 severe
1 no action, 2 taking HRT, 3 taking traditional/alternative meds………… 4 self medication/OTC drugs…………………. 5 prescribed medication………. 6 if any other pls state
58
Decrease level of concentration
1 absent, 2 mild, 3 moderate 4 severe
1 no action, 2 taking HRT, 3 taking traditional/alternative meds……….. 4 self medication/OTC drugs…………………. 5 prescribed medication………. 6 if any other pls state
Section I: Family APGAR Please explain how you feel about your family 59 I am satisfied that I can turn to my family for help
when something is troubling me. Almost always some of the time never
1 2 3
60 I am satisfied with the way my family talks over things with me and shares problems with me
Almost always some of the time never
1 2 3
61 I am satisfied that my family accepts and supports my wishes to take on new activities or directions
Almost always some of the time never
1 2 3
62 I am satisfied with the way my family expresses affection and responds to my emotions such as anger, sorrow or love
Almost always some of the time never
1 2 3
63 I am satisfied with the way my family and I share time together
Almost always some of the time Never
1 2 3
25
Section J: Women Health Questionnaire© Professor Myra Hunter, King’s College London, UK
Please indicate how you are feeling now, or how you have been feeling THE LAST FEW DAYS, by putting a tick
in the correct box in the answer to each of the following items :
Yes,
definitely
Yes,
sometimes
No,
not much
No,
not at all
64 I wake early and then sleep badly for the rest
of the night.................................................... 1 2 3 4
65. I get very frightened or panic feelings for ..
apparently no reason at all .......................... 1 2 3 4
66. I feel miserable and sad ................................ 1 2 3 4
67. I feel anxious when I go out of
the house on my own ................................... 1 2 3 4
68. I have lost interest in things ......................... 1 2 3 4
69. I get palpitations or a sensation of "butterflies"
in my stomach or chest ................................ 1 2 3 4
70. I still enjoy the things I used to .................... 1 2 3 4
71. I feel life is not worth living ........................ 1 2 3 4
72. I feel tense or "wound up" ........................... 1 2 3 4
73. I have a good appetite .................................. 1 2 3 4
74. I have headaches .......................................... 1 2 3 4
75. I feel more tired than usual .......................... 1 2 3 4
76. I have dizzy spells ........................................ 1 2 3 4
77. I suffer from backache or pain in my limbs 1 2 3 4
78. I have hot flushes ......................................... 1 2 3 4
79. I am more clumsy than usual ....................... 1 2 3 4
80. I feel sick or nauseous .................................. 1 2 3 4
81. I have feelings of well-being ....................... 1 2 3 4
82. I suffer from night sweats ............................ 1 2 3 4
83. I have difficulty in getting off to sleep ........ 1 2 3 4
84. I feel physically attractive ............................ 1 2 3 4
85. I have difficulty in concentrating................. 1 2 3 4
86. My memory is poor ...................................... 1 2 3 4
Section k: Physical Examination
87 BP (mmHg)……………
88 Weight (kg)
89 Height (m)……………..
90 BMI {wt/h2}
91 Last menstrual period (weeks/month/years)
26
Appendix III
SUBJECT INFORMATION SHEET
1. My name is Oshakuade,Temitope Olakunle.
2. Participation in this study is voluntary and non-participation attracts no penalty or loss
of benefits due to subjects.
3. Subject is free to withdraw at anytime with no penalty or loss of benefit
4. The research is a cross sectional study on Perceived Family Support And Self Care
Practices Among Women in Menopausal Age Group Attending General Outpatient
Clinic, Federal Medical Centre, Owo. The study will span three months and subjects
are expected to truthfully answer questions in the administered questionnaire.
Information obtained will be treated with utmost confidentiality.
5. There is no risk associated with taking part in this study
6. I can be reached at the department of Family Medicine, Federal Medical Centre, Owo
and on phone number 0803-561-5474.
27
Appendix IV
INFORMED CONSENT FORM
I .............................................................of....................................... hereby agree to participate
in this study on Perceived Family Support And Self Care Practices Among Women in
Menopausal Age Group Attending General Outpatient Clinic, Federal Medical Centre, Owo.
I confirm that I have read the patient information sheet and/or the details of the study have
been explained to me. I have had opportunity to ask questions about the study and to receive
satisfactory answers to my questions.
I understand that the data from this study will be secured against unauthorized use and that I
will not be identifiable from published results.
.................................................... ........................
Signature/thumb print of participant Date
........................................... ....................
Signature of interviewer: Date
