|
| |
Menopause awareness in Richmond
By Esther Belleli, Que Thanh Lam, Daniel A. Robin, Karina
Stolyarsky, Kelvin K. H. Yap
Internet publication: 4 February, 1996
Work by Monash University Medical students, produced as part of
the health promotion subject offered at year three.
NB: Appendices are not available on the online version.
Belleli E, Lam Q, Robin D, Stolyarsky K, Yap K.
Menopause awareness in Richmond. Internet Journal of Health Promotion, 1996.
URL:
ijhp-articles/1996/1/index.htm.
Abstract
In response to a gap in understanding of menopause and its
related issues, we undertook a project promoting menopause awareness in the
community. Working with Family Planning Victoria (FPV), we targeted women in the
Richmond area [Melbourne, Australia], with three goals:-
-
to stimulate community discussion about menopause,
-
to increase recognition of menopause related symptoms, and
-
to direct women to existing health services for advice,
treatment, and further information.
The preliminary stage involved evaluating the need for a
menopause awareness program by a street survey on a range of facts about
menopause. This ascertained that much confusion exists regarding symptoms,
perhaps due to the low level of formal education on the issue. Next we embarked
on a multi-faceted campaign, involving design and production of pamphlets and
posters, a newspaper article, radio interviews, and finally a Menopause
Awareness Week at FPV. While attendance at Menopause Week was disappointing, a
second street survey undertaken by way of evaluation implied that we had
precipitated some community discussion, that our project had been noticed, and
that we had promoted FPV as an excellent and accessible resource.
Keywords:
Menopause; Menopause Awareness; Health Promotion; Family
Planning Victoria.
Health Issue
Menopause is a natural event affecting all women at some stage
in their lives. While issues associated with the initiation of fertility and
menarche are addressed through the school system, few women ever receive formal
education concerning menopause. The aim of this project was to increase
menopause awareness and promote a wider understanding of this issue.
Priority Population Groups
For the purpose of this project, the target population was adult
women of all ages in the Richmond area, because:
-
Targeting a wider age group does not limit the campaign to a
single cohort of peri-menopausal women; benefits may be seen years to come in
women who are yet to reach menopausal age.
-
Stimulating discussion among adult women enables information
to be passed on by word of mouth to perimenopausal women.
-
For further menopause advice, women could be directed to
Family Planning Victoria - an existing resource to which women in Richmond
would have easy access.
Unfortunately, limitations on our own resources dictated that it
was not feasible to target specific ethnic groups who might be at special risk
for low menopause awareness.
Goals & Targets
The goals of this project were to increase menopause awareness
in the community by:
-
Stimulating community discussion about menopause.
-
Improving recognition of menopausal symptoms.
-
Directing women to additional resources and relevant health
services.
The target was to increase the number of women seeking menopause
information at the Family Planning Victoria (clinic, bookshop, and library).
Strategies & Methods
Introduction
Prior to commencing, we familiarised ourselves with the current
literature and major issues of menopause.
We met Ms Kwai Chee Ho and Dr Mary Westcott (of FPV), who agreed
to be our supervisors.
We decided to work with FPV because:
-
they are a long standing, reputable organisation, with a wide
range of resources (clinic, library, bookshop), including female doctors and
nurses with experience in sexual health issues,
-
they are a non-profit organisation with free services
-
they have limited access to advertising and welcome
additional exposure
Disadvantages included:
-
A lack of ethnic doctors or translators, limiting our scope
for dealing with the ethnic population in Richmond. (An ethnic based health
centre exists nearby.)
-
Doctors specialising in menopause are usually available at
FPV only on Thursdays and generally by appointment.
We then formulated a plan (see Appendix 1, not available
on-line) and a plain language statement (see Appendix 2, not available on-line)
Phase 1 - Evaluating a need
Dr Westcott and Ms Ho felt that there was a definite need to
increase Menopause Awareness in Richmond. To evaluate the extent of menopause
knowledge we conducted a street survey (see Appendix 3 "Survey 1 -
Menopause Questionnaire", not available on-line) investigating the common
beliefs and misconceptions.
The survey (mainly in true / false format), was conducted on
Tuesday 22 August, in the heart of Richmond (corner Bridge Road and Church
Street). It involved 100 adult women of various ages and enabled us to obtain a
quantitative analysis of women's menopausal knowledge.
Of the 95 completed surveys, it was noted that:
-
Most women were unable to correctly identify whether some
factors affect the age at menopause. In particular, only 20% knew that
smoking decreases the age at which menopause occurs.
-
Only 60% correctly identified that not all women experience
negative symptoms of menopause.
-
Whilst hot flushes and mood swings were widely known to be
symptoms of menopause (>90%), fewer (50% or less) realised that urinary
problems and loss of libido can be among the other symptoms experienced.
-
Many women falsely believed that baldness and increased
incidence of breast cancer are features of menopause.
-
A significant proportion of women did not understand the
implications of hormone replacement therapy.
-
41% had received no information whatsoever about menopause
confirming the need for increased awareness.
-
Of those who had received some information, more people had
heard about menopause through family and friends rather than more reliable
sources such as GPs and literature.
-
These results appear in graphical format in Appendices 3C(i)
- (iv), and 3D
-
Raw data is shown in Appendix 3A (not available on-line)
Phase 2 - Menopause Awareness Campaign
Once we established the need for increased Menopause Awareness
in Richmond, we staged a multi-faceted campaign in line with our overall goals
incorporating:
-
Pamphlets - Distributed to strategic locations around
Richmond
-
Posters - Targeted to a similar distribution as the pamphlet
-
Print Media - The results of our first survey were compiled
into an article and submitted to both 'The Age' and the local Yarra Leader
Newspaper.
-
Radio - Many local stations were approached to make a brief
announcement and to engage in talk back radio about menopause.
-
Menopause Awareness Week - The focus of the campaign, run at
the FPV.
Pamphlet
-
We designed and produced an original, easy-to-read pamphlet
incorporating:
-
background information about menopause
-
a list of signs and symptoms commonly experienced
-
a note informing that advice and treatment are available
at their GP or FPV
-
an invitation to attend Menopause Awareness Week (11 - 15
September at FPV, Richmond)
-
Graphics for both pamphlet and posters where obtained from
Mariette Perrinjaquet, a prominent Melbourne artist with interests in women's
issues and the environment.
Posters
-
We designed and produced three posters, each with the same
text but different illustrations. As with the pamphlet, we focused on
symptoms, Menopause Week, and FPV. Background information on menopause was
largely omitted.
Distribution
-
The pamphlet was intended as a base upon which further
menopause knowledge could be built; the aim of the poster was to draw
attention to menopause awareness.
-
600 pamphlets and 100 posters (75xA3 size & 25xA4) were
distributed throughout Richmond, between 30 Aug - 8 September.
Print Media
-
An article (based on the results of the evaluation survey)
was submitted to the Yarra Leader Newspaper and to 'The Age'. (see Appendix 8
"90% Believe in Joy of Sex After Menopause", not available on-line)
-
An edited version of this article appeared in the Yarra
Leader Newspaper on September 11 1995, page 10. (See Appendix 9
"Menopause no baldness cause", not available on-line)
Radio
-
We contacted a number of radio stations (3AW, SBS radio, 3LO,
3CR) regarding the possibility of talk back sessions and/or publicity about
menopause and Menopause Awareness Week.
-
We were interviewed by Public Radio News on Thursday 14
September. Subsequently a brief announcement was made on PBS news (106.7 FM)
(and other stations) at 8 am on Friday 15 September.
-
A fifteen minute live interview was conducted for
"Thursday Home Time" - 3CR (855 AM) at 4 pm on Thursday 21
September. (Transcript appears in Appendix 11, not available on-line)
Menopause Awareness Week
Evaluation Plan
We defined a four point evaluation plan:
Process Evaluation:
Evaluating the quality of information presented to the public,
and Menopause Awareness Week.
-
. To assess the readability of our pamphlet, we performed the
"SMOG" test. We found the estimated (US) reading grade required for
comprehension of the pamphlet was 11, fitting the ideal reading grade for
public health promotion work; ie, the pamphlet was appropriate for our
targeting audience.
-
To evaluate Menopause Awareness Week, we asked women
attending to complete a questionnaire (see Appendix 13, not available
on-line).
Process Evaluation:
Evaluation of public awareness of our campaign.
-
A street survey (see Appendix 14 "Survey 3- Project
Evaluation", not available on-line) was undertaken on Tuesday 19
September at Bridge Road, Church Street, and Swan Street. In total, 100 women
were asked whether they had seen any of our promotional/ informational
material and/or whether they were aware of Menopause Awareness Week at the
FPV.
-
In brief, 99 surveys were completed, of these:
-
23% had noticed a pamphlet or poster.
-
Of these 40% remarked that it had increased their
awareness of menopause.
-
31% of women surveyed knew about Menopause Awareness Week,
60% of these from other sources (radio, newspaper, word of mouth, etc).
Impact Evaluation:
Evaluation of whether a change occurred in the frequency of
menopause related attendances at GPs and health centres in the area, eg FPV.
Outcome Evaluation:
Re-evaluation of community knowledge about menopause (longer
term impact).
Due to financial and time constraints, we were only able to
accomplish the first two points of the plan.
Results
Menopause Awareness Week
-
While the display received a lot of positive feedback from
people at the FPV, the number of women specifically attending for Menopause
Week was very low.
-
No conclusions could be drawn from the questionnaires filled
out because of the very small sample size. (n=10)
-
On first appearances the poor turnout was quite discouraging
however,
-
only perimenopausal women are likely to respond to such a
campaign
-
of these, a large proportion would turn to their GP for
menopause advice
-
of the women who would attend the FPV, only a small
proportion would have arranged to attend specifically during Menopause
Week. (see flow chart in "Strategies and Methods)
-
The disappointing attendance of Menopause Week does not imply
a failure of our original objectives - menopause awareness, understanding of
symptoms, putting people in touch with resources.
Project Evaluation Survey
-
This survey more accurately indicated the impact of our
campaign in the Richmond community. The results were quite promising.
-
23% of women interviewed had noticed a pamphlet or poster.
(Although this survey was undertaken in the immediate vicinity of the FPV.)
-
Of these 40% remarked that it had increased their awareness
of menopause. Among the explanations given were
-
"It got me thinking"
-
"I wasn't aware of the symptoms"
-
"I didn't know anything [about menopause]
before"
-
a woman even recalled overhearing on a tram, two teenage
boys speaking behind her:
-
31% of women surveyed knew about Menopause Awareness Week,
60% of these from sources other than the poster and pamphlet (radio,
newspaper, word of mouth, etc)
-
Among the reasons cited for not attending Menopause Week were
-
it is not relevant at present
-
the time was inconvenient
-
the person visits a GP or other women's health centre for
menopause advice
-
We were encouraged by the number of women who said that they
had put aside the pamphlet or FPV information for future reference.
-
67% of women surveyed said they would consider attending the
FPV at some time in the future.
-
The raw data for this survey is shown in Appendix 15.
Discussion
Implications of the findings and their limitations
-
The initial Menopause Questionnaire showed a surprisingly
poor level of public understanding of the symptoms of menopause, but this can
be explained by a lack of formal education. A major concern driving the
project was that women do not recognise when they are going through
menopause, or for reasons of uneasiness are reluctant to seek medical advice.
The consequences of this on quality of life and coping skills are potentially
immense.
-
Our campaign met with mixed responses. Many people would not
complete the street surveys, primarily because of time constraints, some
(especially elderly women) because they were not prepared to discuss the
issue. However, we encountered much interest and provided a setting for (perimenopausal)
women to relate their experiences and express their concerns.
-
The final survey evaluated logistics, finding 31% of women
knew about our Menopause Awareness campaign. These results cannot be
generalised outside the immediate area where we advertised and later
conducted the interviews. Furthermore, the result is not indicative of the
number of women whose grasp of the facts actually improved because of
information we provided. We had hoped to assess this qualitatively in
questionnaires put to women attending Menopause Week.
Link conclusions with goals of the study
-
We succeeded in stimulating community discussion about
menopause.
-
The campaign promoted symptom recognition, but it is
difficult to judge to what degree this was achieved.
-
We were able to direct women to appropriate health services.
-
We were unable to demonstrate an increase in FPV attendance
for menopause advice.
Indirect benefits of the project
-
We increased exposure for FPV
-
The two street surveys, in themselves, stimulated menopause
discussion.
-
We produced three original posters and a pamphlet delivering
information in a format not addressed by existing resources. These can be
adapted for future use.
Limitations of the project
-
Time and financial constraints limited the scope of our
public awareness and media campaign.
-
We encountered many uncooperative storekeepers in the target
area.
-
We were only able to obtain limited radio exposure
-
the higher rating stations were unwilling to lend support
-
the 3CR interview we finally obtained was conducted after
the Menopause Awareness Campaign was officially over and the project
evaluation survey had been completed.
-
In the print media
-
the Yarra Leader article was substantially cut prior to
publishing
-
when it was published, it was printed in association with
another article advertising a different health centre
-
the article was not published in 'The Age'.
Possible extensions
-
Multilingual approach, to reach a wider audience.
-
Conduction of seminars and discussions groups about menopause
-
A more extensive media campaign, involving other agencies
-
A state-wide or nationwide Menopause Awareness Week
-
By working with an established organisation, future
continuation of this project is possible. Groundwork has been laid upon which
a more widespread Menopause Awareness Campaign can be built.
Acknowledgments
-
Monash University: Dr Bridget Hsu-Hage, Cherry Fuller -
Photocopying.
-
Graphics: Mariette Perrinjaquet
-
Family Planning Victoria: Ms Kwai Chee Ho, Dr Mary Westcott,
Other Staff at the FPV
-
Various Agencies for Information: Jean Hailes Foundation,
Family Planning Victoria, Victorian Centre for Women's Health, Yarra City
Council
Sources of Supports
-
Copyright for graphics: Mariette Perrinjaquet
-
Photocopying: Faculty of Medicine
-
Scanner: Mr Yigal Reuben & Mr Michael Hofman
-
Use of books and library facilities: Family Planning Victoria
-
Laser printing: Dr Bridget Hsu-Hage
References
-
The Menopause: Your Questions Answered. The Jean Hailes
Foundation. Melb: 1995.
-
Council Services Directory - Yarra City Council, 1995.
-
Collingwood/ Richmond Community Information Network: Subject
areas for Collingwood, Abbotsford, and Clifton Hill.
-
Pahuja A. Menopause and Beyond. NSW: Alpha Biomedical
Communications Pty Ltd, 1994.
-
Farrell E, Westmore A. The HRT Handbook: How to decide if
Hormone Replacement Therapy is right for you. Melbourne: Anne O'Donovan Pty
Ltd in association with the Jean Hailes Foundation, 1993.
-
Kelly S, ed. Menopause. Booklet funded by the National
Women's Program for the Women's Health Advisory Committee, ACT Board of
Health (1990) 3rd Reprint Aug 1994.
-
The Royal Women's Hospital : Clinical Services Directory,
1995
-
MacLennan A + MacLennan . Presenting a positive outlook on
the menopause (4th ed) NSW Ayerst Laboratories (Wyeth Australia Pty Ltd), Dec
1994.
-
Stanton, Food for thought; A Dietary Planner for Menopause
and beyond. NSW: Upjohn Pty Ltd.
-
Upjohn, A balanced approach to the Menopause.
-
Ciba Geigy: Managing the Menopause: Advice and Information
for Women and their families who are going through, or about to go through
the 'change of life' NSW; Ciba-Geigy. Dec 92.
-
"Well Woman Program": (Brochure explaining Epworth
Services) Epworth, 34 Erin Street.
-
Gronow M. Hormone Implants: An information booklet for women.
Oreganon (Australia) Pty Ltd.
-
Hawe P, Degeling D, Hall J. Evaluating Health Promotion, a
health workers' guide. Sydney: MacLennon and Petty, 1990.
-
Kaz Cooke, Real gorgeous: The truth about body and beauty,
NSW: A Rathdowne book, Allen & Unwin Pty Ltd. 1994.
-
Larson, G. The Far Side Gallery 2. London: Warner Books.
1992.
-
Anticancer Council of Victoria. What if my pap-test is
abnormal? Melbourne April 94. "Breast Self Examination: A technique for
women, Melbourne, Dec 1993.
-
The Menopause - an overview, Class notes from Human Sexuality
and Reproduction (MED 3011), May 1995. Monash University.
-
Elliot, A. "Being Our Age - older women's voices"
Exploring New Options for women and health workers. Steering Committee -
Older Women's Health Project, 1994. (Health Sharing Women's Health Resources
Services, Women's Health Service for the west)
-
BreastScreen. Over 50? This is a special invitation for you.
Victorian Breast Screening Program. Jointly funded by the Victorian and
Commonwealth Governments. April 1994
-
Menopause. the Family Planning Association of Victoria,
Richmond (brochure)
-
Its easy to forget you next pap test. When does the Pap Test
Registry send reminders? (brochures) Victorian Cervical Cytology Registry.
-
"If every woman in Australia had a pap smear every 2
years, 90% of cancer of the cervix could be prevented". The organised
approach to Preventing cancer of the cervix (Joint Commonwealth and State /
Territory Program).
-
"25 years of Service, 1969-1994" Family Planning
Victoria Inc. Annual Report 1993-1994. FPV.
|
