Study group

The study group was differentiated by several sociodemographic factors, most importantly age of the participants, as it ranged from 45 to 65years. Obviously, it was due to the inclusion criteria adopted in this study, which referred not to the chronological age, but to the time which lapsed since the last menstrual period, and also due to quite large time span (between 2 and 10years of the menopause) accepted for the study. Participants of this study went through menopause between the age of 40 and 60. This is consistent with population studies concerning Poland [26] and other highly developed countries [27, 28].

The diversity concerning the place of living provides, according to some authors, the possibility of identifying beneficial as well as adverse aspects of living in urban and rural areas [29, 30]. It is worth emphasizing that the differences between these areas are becoming less and less noticeable. In this study the number rural residents was significant (40.4%). The vast majority of the respondents (75.5%) declared to have completed secondary education. Study groups in similar studies conducted by other authors also comprised women with similar educational background [31], however some other authors noted a higher percentage of participants with basic vocational education [32]. According to broad population studies, middle aged women are characterized by a lower level of education than the study group in the presented material [33].

Hormone replacement therapy was used by 10.6% of respondents at the time of the study. In the light of reports from literature, this percentage should be considered as relatively low, because, as some authors claim, climacteric syndrome symptoms appear in 75% of perimenopausal women, and 25% of them require treatment [34]. Hormone replacement therapy is effective in relieving menopausal symptoms, i.e. hot flushes, night sweats, dyspareunia, sexual dysfunction and insomnia, as well as in the prevention of osteoporosis [34, 35]. However, there are some contraindications to the use of this therapy [36].

In the presented material, an attempt was made to define the concept of being healthy as understood by the postmenopausal women. The obtained results proved that the respondents perceived health primarily as a feature (to have all parts of the body functioning well and not to feel any physical discomfort) and/or condition (to experience happiness most of the time). These results are similar to the results obtained in other studies which were carried out on groups of elderly people [37, 38]. There are also studies showing that health is perceived as a feature also by younger people, i.e. over 40years of age [39], and by chronic patients [40].

The analysis of the presented results showed that the definition of health was related to the self-assessment of health. The study proved that women with low self-assessment of their health more frequently understood health instrumentally. Interestingly, these participants selected the statements which defined health as a feature of a body (to take medications only occasionally, not be sick or only suffer from flu, cold or indigestion, not need to make appointments with a doctor and/or hardly ever go to the doctor). On the other hand, those who assessed their own health better were more likely to choose claims that corresponded to the definition values of the result (to eat properly) or purpose (to accept oneself, to know your capabilities and deficiencies). In his study, Juczyski noted that low self-assessment of health was associated with attaching greater importance to the physical criteria of health [25]. Moreover, there are differences in the way health is understood in the case of loss of health or the occurrence of chronic illness [3]. Thus, health self-assessment is gaining popularity in the field of epidemiological research where is employed to assess the health condition of entire populations [41]. Additionally, some authors notice a correlation between health self-assessment and the results of laboratory tests and the prevalence of various civilization diseases [42]. In this study self-assessment of health proved to be surprisingly high. It was rated as good by more than half of the respondents, even though they were undergoingcontinuous treatment for various chronic diseases. The literature review shows that hypertension, coronary heart disease and atherosclerosis are the main medical problems in the postmenopausal period [43, 44].

The overall rate of health behaviours of the women in the studied group was average (M=86.18, SD=13.08). The results proved to be comparable with the normalized results of Juczyski (M=85.98, SD=12.70) who observed that the postmenopausal women exhibit more behaviours that have a positive effect on health than younger women. Juczyski claims that the only exception to this observation are the younger women who are affected by some chronic diseases [25]. Recent years indicate a fairly constant tendency among older women to improve their health behaviours. According to some authors, seniors may even show above-average results [45]. However, the study by Kurowska and Kierzenkowska [32] shows the opposite trend women over 60 have worse results in the area of pro-health behaviours. The results of the present study indicate that prevailing pro-health activities encompass prophylactic behaviours. Postmenopausal women should be under a regular care of a gynaecological clinic, just like younger women, and the frequency and type of appointments should be agreed individually, depending on the needs [46]. Nevertheless, gynaecological check-ups should take place at least once a year [14].

Our study revealed that slightly more than a half of the respondents regularly had a prophylactic gynaecological examination, and only 32.0% of them did so in line with the above-mentioned recommendations. In addition, the study confirmed that some women (11.7%) had never had a prophylactic gynaecological examination performed. It is probable they would never see a doctor without a serious reason, which could be considered a risky behaviour once they reached the postmenopausal period. According to literature, the frequency of women reporting for gynaecological examinations decreases with age, and women between 41 and 60 report to the gynaecologist less frequently than every 20months [47]. This situation should be considered as both worrying and requiring improvement. This study shows that in many cases (37.3%) the only reason for making an appointment with a gynaecologist was the appearance of disturbing symptoms. Such appointments do not have a prophylactic character. Some authors claim that such appointments are perceived by many women as a compulsion or an indispensable duty. They feel exempt from this duty if there are no disturbing symptoms [14]. Sometimes even when symptoms do show up (including the climacteric syndrome), it does not increase the regularity of gynaecological check-ups [48]. Breast self-examination is the first step in the secondary prophylactics of breast cancer. It is a simple, inexpensive, fast and non-invasive examination and all women should be encouraged to be more actively responsible for their own health [49]. It is the self-examination of breast that increases the number of early detections of breast cancers and therefore women should be encouraged to perform this self-check on a regular basis [14]. Our study indicated that 72.4% of women perform breast self-examination, although only a few (13.8%) did it regularly on a monthly basis. Similar trend was observed by other researchers [50]. One of the possible manifestations of womens concerns for their own health is taking advantage of free prophylactic examinations. According to the National Health Fund (NFZ), in 2015 only one in five women took part in the Population-Based Breast Cancer Early Detection Program, and in 2018 nearly two times more women participated. The Population-Based Cervical Cancer Screening Program attracted even fewer women-9.34 and 17.89%, respectively [51]. Our study indicated that 72.4% of the respondents declared undergoing regular mammography examinations and 69.4% confirmed they undergo regular smear tests of the cervix. However, it is not known to what extent this was a participation in a population-based screening programme. Perhaps some of them decided to undergo these examinations on their own initiative, i.e. without an invitation. What is more, some women sign up for test in private clinics. Anyway, the attendance rate is still unsatisfactory [52]. The reasons for such low attendance rate may be numerous and include a lack of faith in their effectiveness, ignoring the problem of cancer, the fear of pain and nudity associated with the examination, as well as fear of detecting the disease [53].

As regards health behaviours concerning positive mental attitude (PMA), the following categories were taken into account: avoidance of upsetting and depressing situations, avoidance of excessive emotions and tensions, and social life. The analysed material showed quite high psychometric properties of this factor (M=3.60; SD=0.70), which can be considered beneficial for the mental health of postmenopausal women. This is good news, as in this age group the incidence of various mental disorders, especially depression and anxiety, is generally on the increase [9]. These women, when compared to younger women, feel more negative emotions, such as anxiety, sadness and exhaustion [49].

Proper eating habits (PEH) are the third important health criterion and a number of factors were taken into account including the frequency of consumption of fruit, vegetables and wholegrain bread, and decrease in the consumption of animal fats, sugar, salt and heavily salted foods. The literature emphasizes the importance of following the principles of healthy nutrition and proper diet in the prophylaxis of diseases typical for the postmenopausal period (metabolic syndrome, ischemic heart disease, diabetes, malignant tumors, osteoporosis and depressive disorders) [14, 54].

It is worth noting that Juczyski [25] presented an identical distribution of results for all categories of health behaviours in his study. It is undeniable, however, that the results obtained by the authors of this study as well as the results obtained by other authors show that women are not sufficiently concerned about their own health. The average results which were obtained in reference to health-related behaviours cannot be considered satisfactory, due to the fact that women in this period are more susceptible to various psychophysical disorders [9, 14, 55, 56].

Choosing pro-health behaviours is usually characteristic of people who are satisfied with their health [57]. In the presented material higher self-assessment of health was significantly associated with a higher general indicator of health-related behaviours. In addition, in both age groups women who regularly performed prophylactic gynaecological examinations obtained higher score of the general indicator of health-related behaviours, proper eating habits (PEH), prophylactic behaviours (PBs) and health activities (HA). Moreover, women over 55years of age, who achieved higher scores in prophylactic behaviours (PBs) had mammography screening and preformed self-examination of breasts more regularly.

The obtained results concerning the concept of health, health self-assessment and the type of health behaviours undertaken by postmenopausal women may be further used in broadly defined health promotion programs, including new prophylactic programs. Most of these programs are aimed at convincing women that the proposed health-related behaviours will not only improve their lives but also they will be beneficial for their families and society. However, the programs need to be constantly improved and adapted to changing needs.

This study has several important limitations that may affect the obtained results. First and foremost, the selection of the study sample using convenience sampling methodology. Next, the broad age range of women included in the study. Therefore, for the purpose of statistical analysis, the study group was divided into two age groups. This way it was possible to show in more detail any possible differences in health behaviours and in the undertaken prophylactic activities. Another limitation is connected with the inclusion of women who had reported that they were undergoing continuous treatment for chronic diseases at the time of the study, which could have modified their health behaviours. However, due to the age of the participants, it is difficult, if at all possible, to include only women without any ongoing health problems. Therefore, to minimize this limitation, a statistical analysis was performed to check any potential differences in health behaviours presented by women in these two groups (with and without chronic diseases). The analysis showed that there is no statistically significant difference between these women in terms of health behaviours. It has to be noted that the claim of an undergoing treatment for a chronic disease was made subjectively by the participants. Their health history was not examined to objectify the results, neither were their former health behaviours investigated. Therefore, it was impossible to compare and analyse any changes, which could have occurred in this regard. It would be advisable to carry out such analyses in the future using a mix-method methodology, supplementing the collected material with qualitative research, which would allow for a more in-depth analysis of the issue.

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Perception of health, health behaviours and the use of prophylactic examinations in postmenopausal women - BMC Blogs Network