1. Faculty of Nursing Herdís Sveinsdóttir1 Women’s Decision Making and Attitudes Towards Hormone Therapy in the Aftermath of the WHI Study Herdís Sveinsdóttir, RN, PhD Associate Professor, Faculty of Nursing University of Iceland Ragnar Ólafsson, PhD cand, Institute of Nursing Research, University of Iceland

2. Faculty of Nursing Herdís Sveinsdóttir2 Bakground of study  Shift in the discourse on menopause in the medical literature from discourse on treatment towards discourse on prevention

3. Faculty of Nursing Herdís Sveinsdóttir3 Bakground of study  Discontinuation of the WHI- study in 2002

4. Faculty of Nursing Herdís Sveinsdóttir4 Study Setting  Icelandic Health Care System  Access to Health Care

5. Faculty of Nursing Herdís Sveinsdóttir5 Prevalence of Hormone Therapy (HT) in Iceland  1986 – 1995 5.7 fold increase in use of HT  1996 – 2001 57% of 52-57 year old women used HT  Long-time use has increased steadily: 1990 – 1995 27% of users had used HT> 5 years 1996 – 1998 49% of users had used HT> 5 years 1999 – 2001 67% of users had used HT> 5 years

6. Faculty of Nursing Herdís Sveinsdóttir6 Markmið 1  Lýsa hvað hefur áhrif á ákvörðun kvenna um að nota tíðahvarfahormóna, líðan þeirra við tíðahvörf, heilsu og lífsstíl, viðhorfum til tíðahvarfa og til notkunar tíðahvarfahormóna, mati þeirra á fræðslu sem þær hafa fengið um tíðahvörf og afstöðu þeirra til ýmissa atriða sem tengjast þekkingu á fyrrnefndri rannsókn.

7. Faculty of Nursing Herdís Sveinsdóttir7 Objective 2 This study sought to illuminate how women make decisions about HT by describing the attitudes towards HT (ATHT) and determining the effect of demographic characteristics, attitudes towards menopause, menopausal education, symptom experience, health and lifestyle and knowledge about the findings of the Women’s Health Initiative study on attitudes towards HT.

8. Faculty of Nursing Herdís Sveinsdóttir8 Method  Design: Cross-sectional descriptive survey  Population: Women aged 47 – 53, residing in Reykjavík and neighbouring towns  Sample: 1000 women, meeting the criteria, randomly selected from the national registry of Iceland  Data collection method: Posted questionnaire  Response rate: 56.1%

9. Faculty of Nursing Herdís Sveinsdóttir9 Instrument Self-administered questionnaire that assessed:  socio-demographics (age, education, marital status)  attitudes towards menopause (Hvas et al., 2003)  ATHT (Hvas et al., 2003)  menopausal status, incl. surgical operations  use of HT  menopausal education (source, perceived adequacy)  awareness of the findings from the WHI study presented in 2002  symptom experience  use of alternative remedies

10. Faculty of Nursing Herdís Sveinsdóttir10 Úrvinnsla  Við lýsandi úrvinnslu gagna voru niðurstöður skoðaðar út frá eftirtöldum breytum: aldri, því hvort viðkomandi væri komin á tíðahvörf, væri ekki komin á tíðahvörf eða vissi ekki af því og út frá notkun tíðahvarfahormóna. Notkun tíðahvarfahormóna var skipt upp í aldrei notað, notað en er hætt og nota núna. Frekari greininga gagna byggði á lýsandi tölfræði og var marktækni mæld með kí-kvaðrat prófi, Fisher exact prófi og dreifigreiningu

11. Faculty of Nursing Herdís Sveinsdóttir11 Analysis  Regression models were used to explain ATHT.  ATHT were compared on the study variables using ANOVAs, t-tests or correlations.  Variables showing significant differences or significant relationships with the ATHT scale were entered into a multiple regression model.

12. Faculty of Nursing Herdís Sveinsdóttir12 Attitudes towards menopause Attitudes towards menopause Responses: Agree, disagree, Neutral Chronbacs alpha 0.72 Mean score on the attitudes towards menopause scale was 1.9 (SD=0.53) – higher score indicative of more positive attitude

13. Faculty of Nursing Herdís Sveinsdóttir13 ATHT-Scale ATHT-Scale Responses: Agree, disagree, Neutral Chronbacs alpha 0.82 Mean score on the attitudes towards menopause scale was 2.2 (SD=0.60) – higher score indicative of more positive attitude

14. Faculty of Nursing Herdís Sveinsdóttir14 )

15. Faculty of Nursing Herdís Sveinsdóttir15

16. Faculty of Nursing Herdís Sveinsdóttir16

17. Faculty of Nursing Herdís Sveinsdóttir17

18. Faculty of Nursing Herdís Sveinsdóttir18

19. Faculty of Nursing Herdís Sveinsdóttir19

20. Faculty of Nursing Herdís Sveinsdóttir20

21. Faculty of Nursing Herdís Sveinsdóttir21 Information about menopause (N=561) Yes Have you received enough information about menopause?51% Do you think that the health authorities should provide more information about menopause?84% Have you heard about the (WHI study)?65%

22. Faculty of Nursing Herdís Sveinsdóttir22

23. Faculty of Nursing Herdís Sveinsdóttir23 Source of information about menopause (N=561)

24. Faculty of Nursing Herdís Sveinsdóttir24 Source of information the WHI study (N=561)

25. Faculty of Nursing Herdís Sveinsdóttir25 Receiving information about menopause from a physician was associated with more postitive ATHT (t(514)=3.828;p<0.001) Receiving the information from spouse (t(514=1.971; p<0.05) and other friends than female friends (t(514=2.540; p<0.05) is associated with more negative ATHT

26. Faculty of Nursing Herdís Sveinsdóttir26 Receiving information about the WHI-study from a physician was associated with more postitive ATHT (t(346)=2.815;p<0.001)

27. Faculty of Nursing Herdís Sveinsdóttir27 Use of hormones

28. Faculty of Nursing Herdís Sveinsdóttir28

29. Faculty of Nursing Herdís Sveinsdóttir29 ATHT were more favourable among hormone users and previous users than amongst non- users (F(4.539)=27,927; p<0.001).

30. Faculty of Nursing Herdís Sveinsdóttir30

31. Faculty of Nursing Herdís Sveinsdóttir31 With whom have you discussed the outcome of the WHI-study (N=561)?  Other friends6%  Mother3%  Nurse3%  Children2%

32. Faculty of Nursing Herdís Sveinsdóttir32 Having discussed the outcome of the WHI-study with a physician was associated with more postitive ATHT (t(346)=4.174;p<0.001)

33. Faculty of Nursing Herdís Sveinsdóttir33

34. Faculty of Nursing Herdís Sveinsdóttir34 Use of other methods to relieve symptoms (N=561)

35. Faculty of Nursing Herdís Sveinsdóttir35  Users of relaxation (t(494)=-2.346;p<0.05), natural medicine (t(439)=-2.466;p<0.05), and meditation (t(439)=-1.973;p<0.05), showed more negative ATHT than non-users  A user-index of alternative medicines was computed, representing the total number of different alternative remedies used. This scale had a correlation of rho= - 0.10 (p=0.022), indicating that use of alternative remedies is negatively related to ATHT therapy.

36. Faculty of Nursing Herdís Sveinsdóttir36 Attitudes The Pearson correlation between attitudes to menopause and attitudes to HT was r= -.034 (n.s.).

37. Faculty of Nursing Herdís Sveinsdóttir37 Socio demographics  76% married/cohabitation  76% participating in the workforce  32% finished university education with 33% having high school diploma as a final degree  Mean age was 49.8 (+ 2.2) years The correlation of attitudes to HT with age was r=-0.12; (p=0.006)

38. Faculty of Nursing Herdís Sveinsdóttir38

39. Faculty of Nursing Herdís Sveinsdóttir39 Discussion and conclusion  Physicians have great influence on womens decision regarding use of HT  Physicians consultations regarding HT  Peri-menopausal women do not find menstrual education sufficient to meet their needs  Educate women

40. Faculty of Nursing Herdís Sveinsdóttir40 Thank you