Hormone Therapy After The Women's Health Initiative: A Qualitative Study

Linda M. French; Mindy A. Smith; Jodi S. Holtrop; Margaret Holmes-Rovner

Disclosures

BMC Fam Pract 

In This Article

Methods

Since current recommendations discourage use of HT except for symptomatic relief of menopausal symptoms, care-seeking women were the population of interest rather than a community-based sample. The study was conducted in the waiting room of a faculty family medicine clinic serving a predominantly white non-Hispanic population (about 65%) in a small urban/suburban university community. Women aged 50-70 attending for office visits were invited to participate. A priori judgment was that 100 respondents would ensure a broad sampling of the qualitative data. Enrollment was assessed at the end of each month of data collection until that sample size was reached.

A questionnaire including open-ended questions regarding women's HT decisions was developed for this study (See Additional file 1). Questions included current views about HT and change in views after July 2002. Reading level was approximately eighth grade. Pilot testing consisted of obtaining feedback on understandability and acceptability from three women in the appropriate age group with high school education.

Self-administered questionnaires were located at the reception desk next to the sign-in sheet for office visits. A sign posted above the surveys invited women in the appropriate age range to complete one and return it to the receptionist. A brief explanation of the purpose of the questionnaire was, " to know more about the use of hormone replacement therapy by women in this clinic, and how and why it may be changing". The survey was anonymous and was granted exempt status by the University Committee on Research in Human Subjects of Michigan State University.

Data were analyzed at the conclusion of the data collection period. Numeric codes for descriptive data were assigned and entered into an Access database. Transcribed responses to each free-text question were first analyzed by LMF who generated a list of labels and numeric codes to summarize each concept. A second researcher reviewed the coding scheme for each question for accuracy and completeness. Two independent researchers coded each question using multiple codes when indicated. Disagreements were resolved by discussion. Major themes in the responses were identified by consensus.

A chart review of the electronic medical record for this practice was performed as a measure of comparison between the study sample and the entire clinic population of which the sample is a subset. HT prescribing rates were determined for the whole clinic population of women in the same age range during the study window and during the previous 2 years, based on the presence or not of an estrogen-containing product in the list of active medications.

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