Advisor
Princess Nguyen & Nurit Fischer-Shemer
Course
Practice-Informed Research in Health Systems
Document Type
Capstone
Publication Date
Fall 12-1-2024
Purpose
Menopause can contribute to serious health effects including heart disease and osteoporosis (Monteleone et al., 2018). In the Victorian era, menopause was misunderstood and treated with contempt, even resulting in psychiatric institutionalization of women (Baber & Wright, 2017). Medical providers continue to lack formal didactic education and clinical training on the menopause transition resulting in poor clinical and diagnostic abilities (Allen et al., 2023; Christianson et al., 2013). A 2021 study concluded that patients and providers alike lack basic menopause knowledge leading to delays in care (Aninye et al., 2021). Harlow et al, found that disparities exist for African American women seeking menopause care and structural racism is likely a cause, however assessment confirming this suspicion has been needed (2022). This study investigates disparities between black and white women regarding various aspects of menopause care including structural racism, patient-provider communication, opportunity for shared decision making, and individual knowledge about menopause.
Methods
This study investigated and compared a snowball sample of Black (n=7) and White (n=9) women’s experiences with structural racism using an online questionnaire which integrated the Discrimination in Medical Settings (DMS) scale, questions assessing patient-provider communication, opportunity for shared decision making, and baseline knowledge about menopause. Quantitative data was analyzed manually using basic statistics. Qualitative data was analyzed using a Constructivist Grounded Theory approach (Poulin et al., 2002).
Findings & Conclusions
Very notable differences in mean scores in the DMS scale for African American women (M=2.69) and Caucasian women (M=1.83) were found. The menopause knowledge assessment revealed African American women had superior knowledge with an average score of 60.25% correct answers given compared to Caucasian women who had an average score of 50.7% correct answers given despite Caucasian women having greater confidence in their menopause knowledge. Participants shared that they would like improved awareness about menopause, improved provider expertise, improved patient education, improved opportunity for shared decision making, and greater empathy from medical staff. Findings also reveal that African American women have less favorable assessment, treatment, and education from medical providers regarding menopause compared with Caucasian women.
Recommendations
Menopause poses health risks compounded by structural racism in healthcare settings and poor medical provider knowledge putting African American women at great risk for adverse effects of menopause. African American women have found alternative means of knowledge acquisition resulting in a superior understanding regarding the menopause transition compared to Caucasian women. Although not considered a medical condition by mainstream medicine, African American women are also more likely to consider menopause a medical condition. This perspective seems organic in nature, uninfluenced by historically misogynistic views on menopause, and may represent a much-needed change in perspective on how menopause is viewed. The effects of structural racism are also felt by African American women regarding patient-provider communication and opportunity for shared decision making with medical providers. Efforts to minimize and mitigate structural racism on a mezzo level within healthcare systems are needed. This paper offers helpful insights into structural racism in healthcare settings and offers insights into goals menopause patients have regarding their experiences with medical providers. It offers a new perspective on how menopause may be viewed by the medical community as well as a new look at how social workers can help bridge gaps in menopause care. Research focusing solely on systemic racism in medical settings using the DMS Scale paired with a means of measuring implicit bias and provider mistrust may be a good method to validate study results regarding institutional racism. The Implicit Association Test (IAT) may also be used to measure implicit bias of individual participants and medical providers. Research is needed regarding how to manage and mitigate structural racism in healthcare settings. Research is also needed regarding viewing menopause as a medical condition. Pilot programs may also be done to evaluate the social work role in medical settings with menopause patients. The small number of participants limits the ability to generalize study data. Control and study groups were not even in number and certain sociodemographic characteristics including education and age which may have affected study results. The Discrimination in Medical Settings Scale does not factor in participant mistrust for providers and patient-provider racial discordance which may falsely inflate results (Peek et al., 2011).
Recommended Citation
Veil, Katherine, "Healthcare Disparities in Menopause Care Between African American and Caucasian Women" (2024). MSW Capstone Conference. 25.
https://scholarlycommons.pacific.edu/msw-conference/25
