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

我们将通过丰富的人种学研究，调查少数民族妇女更年期经历的医疗、社会和文化层面，以便为针对更年期和生命过程后期的保健干预提供指导。我们的出发点是，人们对居住在英国不同种族社区的女性的更年期经历知之甚少，包括她们对医疗保健提供者的看法以及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)与这些妇女就她们的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。西方白人对更年期的研究意味着，少数民族女性经历更年期的不同方式可能不是医生们认识到的。从女性的角度来看，对白人女性在研究中的经历以及她们在患者信息文献中的主导地位的强调可能会阻止她们寻求医疗保健。那些确实参加的人报告说，他们对这些遭遇感到不满。关于这一主题的现有研究有限，这表明需要从妇女及其保健提供者的角度探讨卫生保健的障碍和障碍。这项研究借鉴了以前人类学/社会学研究的见解，并考虑到需要缩小白人和少数族裔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一种文化知情的方法。它承认更年期不是全世界女性都会经历的一种经历，而是结合了生物和文化因素，影响了症状和赋予她们的社会意义。此外，来自英国不同少数民族文化的女性将面临一系列问题，这些问题涉及生命历程、迁移史和文化适应程度等因素，以及围绕阶级、性取向和生活方式的交叉问题，这些问题将影响更年期。这种复杂性需要丰富的定性研究，这些研究必须足够敏感，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名中国女性的半结构化访谈来产生原创性知识，这些女性采用了关于更年期的生命历程和传记视角。我们的样本将通过位于利物浦的一系列妇女和文化中心获得。半结构化访谈将探讨：a)更年期的心理和生理体验；b)更年期对生活其他领域的影响；c)将更年期与生育史联系起来的生命历程叙述；d)生命历程背景下的健康和福祉；e)与保健提供者的互动/对保健提供者的看法。我们将遵循STORMA指南，使用半结构化访谈的输入，开发一份结构化的健康和更年期调查问卷，包括标准问题和这些社区特有的问题。此外，我们将与卫生保健专业人员开展重点小组，从他们的角度探讨向这些妇女提供支持和适当干预方面的障碍和促进者。我们还将邀请妇女参加旨在通过创造性方法捕捉她们更年期经历的焦点小组。这项研究的见解将有助于开发三种工具：a)“文化能力”更年期工具，它将支持卫生保健专业人员认识到不同文化的更年期症状及其对健康的影响，从而向这类妇女提供信息、建议和支持；b)为妇女本身提供文化上适当的指导；c)适合于在类似的少数群体社区中对更年期经历进行更大规模研究的调查工具。

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.