Emily Lees

Decision making, beliefs, and attitudes toward hysterectomy: a focus group study with medically underserved women in Texas.

Variations in hysterectomy rates have been associated with assorted physician and patient characteristics, and the disproportionate rate of hysterectomies in African American women has been attributed to a higher prevalence of leiomyomas. The role of womens beliefs and attitudes toward hysterectomy and participation in decision making for medical treatment has not been explored as a source of variance. The purposes of this qualitative study were to explore these constructs in a triethnic sample of women to understand beliefs, attitudes, and decision-making preferences among underserved women; to facilitate development of a quantitative survey; and to inform development of interventions to assist women with such medical decisions. Twenty-three focus groups were conducted with 148 women from community sites and public health clinics. Thirteen self-identified lesbians participated in three groups. Analysis of audiotaped transcripts yielded four main themes: perceived outcomes of hysterectomy, perceived views of men/partners, opinions about healthcare providers, decision-making process. Across groups, the women expressed similar expectations from hysterectomy, differing only in the degree to which dimensions were emphasized. The women thought men perceived women with hysterectomy as less desirable for reasons unrelated to childbearing. Attitudes toward physicians were negative except among Hispanic women. All women expressed a strong desire to be involved in elective treatment decisions and would discuss their choice with important others. Implications for intervention development include enhancing womens skills and confidence to evaluate treatment options and to interact with physicians around treatment choices and creation of portable educational components for important others.

Readiness to change physical activity and dietary practices and willingness to consult healthcare providers

BackgroundComplementary or discrepant stages of change for multiple risk behaviors can guide the development of effective risk reduction interventions for multiple risk factors. The objectives of this study were to assess readiness to change physical activity and dietary practices and the relationships among readiness scores for physical activity and dietary practices. In an underserved population, the readiness scores were analyzed in relationship to the patients interest in communicating with healthcare providers about health behavior change. Healthcare providers are important contributors in promoting behavior change in community health centers.MethodsPatients completed questionnaires about communicating with healthcare providers and readiness to change physical activity, intake of fruits and vegetables, dietary fat, calories and weight management. Frequency distributions, correlations, and analysis of variance were computed.ResultsReadiness to change physical activity was not related to readiness to change dietary practices. Readiness to change fruit and vegetable intake and readiness to change dietary fat intake were significantly related. Readiness to change and interest in communicating with healthcare providers were significantly related for physical activity but not for dietary practices.ConclusionsReadiness to change behavior and interest in talking to healthcare providers were distinct dimensions; for physical activity, the dimensions were congruent and for dietary practices, the dimensions were unrelated. Readiness to change physical activity and dietary practices were not related (discrepant stages of readiness). Therefore, among underserved populations, sequential rather than simultaneous interventions may be appropriate when intervening on multiple risk behaviors, particularly physical activity and dietary practices.

Perceptions of hormone replacement therapy among African American women.

Hormone replacement therapy (HRT) is commonly prescribed for women to relieve symptoms associated with menopause. The medical community does not uniformly recommend HRT, and ethnic and cultural differences may influence a womans decision to request and adhere to it. Thirty-eight African American women were enrolled in a qualitative study to investigate beliefs, attitudes, and knowledge about HRT. Data collected from six focus groups were part of Ethnicity, Needs, and Decisions of Women (ENDOW), a multisite project investigating decision making and hysterectomy. Participants, age 30 to 65 years, were recruited from community agencies and public health clinics. The women were aware of fa medical indications for HRT and its risks and benefits. Although a majority of participants were past or current users, they expressed reservations about the use of HRT and wanted a better dialogue with health care providers, including information about alternative treatments.