Health Information Seeking in Context: How Women Make Decisions Regarding Hormone Replacement Therapy

Abstract

This multimethod study explored women's information seeking behaviour and decision making regarding menopause, hormone replacement therapy (HRT), and use of complementary and alternative medicines (CAM) during menopause. This research was underway during the mass media release of the Women's Health Initiative (WHI) estrogen–progestin trial results, allowing an examination of the impact of this news on women's decisions. There were two studies: first, 20 women who currently were or previously had used HRT were interviewed about their experiences with menopause and HRT-related information seeking and decision making. Following this, 285 demographically representative Canadian women aged 45–65 who were current or former HRT users completed a questionnaire. Results indicate that women's information behaviour differed according to which decision they were making (starting versus stopping HRT, considering CAM), as did the sources they consulted. In general, there has been a paucity of good information to help women who are deciding to stop HRT. The types and sources of CAM information often are found to be less than credible and helpful. When information is lacking, women rely on informal sources, and on their own judgement, to make decisions. The results are discussed in the context of information behaviour and help-seeking theory.

Acknowledgments

Wyeth Canada Inc. provided financial support for this project.

Notes

¹HRT combines estrogens and progestins, created synthetically or from such sources as mare's urine, and dispensed in pill, patch, cream, or implant forms. The aim is to reinstate a certain level of estrogen to women who are ceasing to produce it. While there are several indications for estrogen replacement, including early hysterectomy or oopherectomy (removal of uterus or ovaries), the main indication has been menopausal hormone changes.

²One woman in the interview sample was 43, but met all other eligibility criteria. Women over age 65 were excluded based on results of the pilot phase—these women generally have a higher likelihood of coexisting health concerns and potentially less recollection of their decisions regarding HRT and CAM.

*Two each responded “Latin American-Canadian” or “Native Canadian”; 1 each “African Canadian,” “South Asian Canadian,” and “Southeast Asian-Canadian”; 26 self-identified as “Other,” with a number of write-ins indicating “Canadian.”

³Of the 700 questionnaires distributed to recruitment sites, 302 (43%) were returned, and 285 (41%) were eligible for inclusion. Of the 17 ineligible returned questionnaires, 11 were excluded due to no age provided or above age range, and 6 were excluded due to never having used HRT.

⁴The finding that more highly educated women were less likely to have had a hysterectomy is consistent with Canadian and Ontario-specific data (Basinski, 2002) and national U.S. surveys (Saraiya et al., 2001).

*Percent of valid responses (out of 279, 6 nonresponses).

**Percent of those who responded includes multiple secondary responses.

¹Indicates that respondent wrote the answer in the “Other” category.

^a These categories are not mutually exclusive; therefore, cumulative percentages exceed 100%.

^b Risks/benefits of stopping on health, esp. osteoporosis (50% or 25/51); how to stop (16%); impact on health/well-being (15%); alternatives for symptom control (8%); info. on WHI results (6%); other (6%).

*Percent of valid responses (out of 182; 11 nonresponses).

**Percent of those who responded, includes multiple secondary and overlapping responses.

^a Library (28% or 5 of 18); books (28%); self (11%); other (33%).

^b Books/journals (46% or 11/24); library (17%); other (37%).

*Percent of valid responses (out of 125; 37 nonresponses).

**Percent of those who responded includes multiple secondary and overlapping responses.

^a Books & library (63% or 10 of 16); other (37%).

^b Books/library/journals (74% or 17/24); other (26%).