Minority ethnic women's experience of menopause: a mixed methods study

我们将调查，通过丰富的人种学研究，少数民族妇女的更年期的经验，以提供指导，以帮助在更年期和以后的生活过程中有针对性的医疗保健干预措施的医疗，社会和文化层面。我们的出发点是，很少有人知道更年期的经验，妇女来自不同的种族社区生活在英国，包括他们的看法，并与医疗保健提供者的互动。卫生保健提供者报告说，很少（如果有的话）与这些妇女就更年期问题进行互动，而且缺乏这样做的信心和文化能力。因此，可能会失去在更年期症状和中年健康和福祉方面提供支持的机会。以白色西方人为中心的更年期研究表明，少数民族妇女经历更年期的不同方式并不是医生可能认识到的。从妇女的角度来看，强调白色妇女在研究中的经验以及她们在患者信息文献中的主导地位可能会阻止她们寻求医疗保健。那些参加会议的人报告说，他们对这些会议感到不满。关于这一问题的现有研究有限，这表明需要从妇女和其保健提供者的角度探讨保健方面的障碍和阻碍。借鉴以前人类学/社会学研究的见解，并了解到需要缩小白色和少数民族社区之间的健康差距，这种差距随着年龄的增长而扩大，这项研究对更年期采取了文化上知情的方法。它认识到更年期不是全世界妇女都会经历的“一种”经历，而是一种生物和文化因素，影响着症状和赋予它们的社会意义。此外，来自英国不同少数民族文化的妇女将有一系列与生命历程、移民史和文化适应程度等因素有关的问题，以及围绕阶级、性和生活方式的交叉问题，这些问题将影响更年期。这种复杂性需要进行丰富的定性研究，这些研究要敏感到足以捕捉社区之间以及社区内部的差异。因此，我们将通过对30名黑人和30名中国妇女的半结构化访谈，从更年期的生命历程和传记角度产生原始知识。我们的样本将通过位于利物浦的一系列妇女和文化中心进行访问。半结构化访谈将探讨：a）更年期的心理社会和生理经验; B）更年期对生活其他领域的影响; c）生活过程叙述在生殖史范围内的更年期; d）生活过程背景下的健康和福祉; e）与卫生保健提供者的互动/看法。我们将制定一个结构化的健康和更年期问卷，遵守STROMA指南，并包含标准问题和独特的这些社区使用半结构化访谈的输入。此外，我们亦会与医护专业人员进行焦点小组讨论，从他们的角度探讨为这些妇女提供支援和适当介入的障碍和促进因素。我们还将邀请妇女参加焦点小组，旨在通过创造性的方法捕捉她们的更年期经历。从研究中获得的见解将为三种工具的开发提供信息：a）“文化能力”更年期工具，将支持保健专业人员认识到文化上不同的更年期症状及其对健康的影响，从而为这些妇女提供信息、建议和支持，以及B）对妇女本身的文化上适当的指导;（c）适合于在类似少数民族社区进行更大规模的绝经经验研究的调查工具。

We will investigate, through rich ethnographic research, the medical, social and cultural dimensions of minority ethnic women's experience of menopause in order to provide guidance to aid health care interventions targeted both at menopause and later in the life course. Our starting point is that very little is known about the menopause experience of women from diverse ethnic communities living in the UK, including their perceptions of, and interaction with, health care providers. Health care providers report rarely, if ever, interacting with such women about their menopause and of lacking the confidence and cultural competence to do so. Consequently, opportunities to offer support both in terms of menopause symptoms and in terms of mid-life health and wellbeing may be lost. The white western-focused research on menopause means that the different ways in which menopause may be experienced by minority ethnic women is not something doctors may recognise. From the women's perspective, the emphasis on White women's experiences in research as well as their dominance in patient information literature may discourage them from seeking health care. Those who do attend report dissatisfaction with these encounters. The limited existing research on this subject suggests that barriers and obstacles to health care need exploring both from the perspective of women and from that of their health care providers. Drawing on the insights of previous anthropological/sociological research and informed by the need to reduce the health gap between white and minority ethnic communities which grows wider with age, this research takes a culturally informed approach to the menopause. It recognises that menopause is not 'one' experience that women all around the world will experience but combines a biological and cultural element which influences symptoms and the social meanings given to them. Additionally, women from different minority cultures in the UK will have a range of issues relating to factors such as life course, history of migration and degree of acculturation, as well as intersectional issues around class, sexuality and lifestyle, that will impact on menopause. This complexity necessitates rich qualitative research that is sensitive enough to capture differences between, as well as within, communities. Consequently, we will generate original knowledge through semi-structured interviews with 30 Black and 30 Chinese women adopting a life course and biographical perspective of menopause. Our sample will be accessed through a range of women's and cultural centres located in Liverpool. The semi-structured interviews will explore: a) experience of menopause, psychosocially and physiologically; b) impact of menopause on other areas of life; c) life course narratives contextualising menopause within reproductive history; d) health and well-being in a life-course context; e) interaction with/perceptions of health care providers. We will develop a structured Health and Menopause questionnaire adhering to STROMA guidelines and containing both standard questions and ones unique to these communities using the input of the semi-structured interviews. Additionally, we will carry out focus groups with health care professionals to explore the barriers and facilitators, from their perspective, in terms of offering support and appropriate interventions to these women. We will also invite women to focus groups designed to capture their experience of menopause through creative methods. Insights from the research will inform the development of three tools: a) a 'cultural competence' menopause tool which will support health care professionals in recognising culturally diverse symptoms of menopause and its impacts on health and thereby offering information, advice and support to such women and b) culturally appropriate guidance for women themselves; c) a survey instrument suitable for larger scale research on menopausal experience in similar minority communities.