Every woman experienced menopause as the transition period in their different way. Menopause marked as the end of women’s fertility. Management of symptoms of menopause is greatly influenced by socioeconomic status along with genetic background and medical history of individual women (Carpenter et al., 2016). Research has been conducted over the decade which indicated that aboriginal women of Torres Strait Islanders appear to experience menopause and complications created to the menopause more often as compared to the women who lived in the non-indigenous part of Australia (Hill et al., 2017). Because of their different cultural heritage and holistic view of health and wellbeing, the symptoms of menopause differs significantly for aboriginal women of Torres Strait Islanders as compared to the women who lived in the non-indigenous part of Australia (Harrison, 2015). Therefore, this paper will discuss the historical, social and clinical factors for their vulnerability, ethical guideline, and principles specific to this vulnerable population in the following paragraphs.
Menopause is process in the climacteric period which is characterized by loss of ovarian activity in women. Majority of the women experience the menopause in their 40s, but the age range may vary depending on the individuals (Chadha et al., 2016). Studies show that many factors contribu8tes to the occurrence of menopause in women such as age, menarche, gestational age, menstrual cycle, serum, and other social and economic factors. In the period of menopause, physical, psychological, social and sexual changes in the body affect the quality of life in women (Jurgenson et al., 2014). The factors that contributed to the negative experiences of menopause as follows:
All women around the globe live long enough to experience menopause in their lifetime as the declining activity of ovary. For Australian women, the age at which majority of the women experience menopause is 52.9 years. However, due to the cultural heritage, social factors and busy lifestyle, the experience of menopause varies in different women. Indigenous women of Australia make up only approximately 2.5 % of the total population of Australia (Gartoulla et al., 2014). However, the burden of chronic illness in aboriginal women is twice as compared to the non-indigenous women. The social context in which women lives is essential factor to take into account in understanding the experience of menopause transitions (Halseth, Loppi, & Robinson, 2018). The language differences, culturally shaped expectation about menopause and the gender role influenced by culture and social factors contributed to the negative experience of aboriginal women. The language used to communicate with indigenous women contributed to the perception of menopause that how society see the menopause. Indigenous women do not understand the word “menopause” which indicates the relative unimportance of symptoms of menopause in indigenous women (Dune et al., 2018). While mothers are the principal sources to understand the menopause for their daughter, daughters believe that their mother would deny the symptoms which contribute to the experiences. The majority of women become ignorant about the signs of the menopause since they lack proper knowledge of menopause and related symptoms. Denial of symptoms is due to wanting to avoid the specific labels which hinder the passage of knowledge (Gartoulla et al., 2014). Moreover, due to lack of knowledge and accessed technology, a majority of the older women unable to understand the symptoms of the menopause in their life as compared to younger women who have a superficial idea of menopause (Gartoulla et al., 2015). Besides, it is also evident that the relationship between men and women contributed to the experience of menopause. Due to minimum understanding relevant to the menopause in men of indigenous area, it resulted in a huge gap relationship between men and women. The study reported that men and women both did not wish for information about menopause. Consequently, women do not seek clinical help for the symptoms of menopause and associated other health conditions. Moreover, healthcare workers also lack an adequate source of providing information to the aboriginal women. Consequently, a significant number of indigenous women experience the symptoms of menopause and health complication related to the menopause (Tsai, Lin, & Koo, 2017).
While different pieces of evidence of literature talk about the cultural factors that contributed to the experiences of menopause, the significant number of clinical factors needs to consider for an experience of menopause. Studies suggested that aboriginal women have much higher risk of health issues such as stressful event, too much smoking poor nutrition and apparently no physical activity which contributed to the gap in life expectancy as compared to non-indigenous. No physical activity and smoking strongly related to the occurrence of menopausal symptoms. On the other hand, a diet containing phytoestrogen, breastfeeding for more extended period and contraceptives consumption leads to the decrease of symptoms. Moreover, poor health conditions and coping mechanism leads to the symptoms such as hot flush, vaginal dryness, pain in intercourse, frequent urination and insomnia. The statistics reflect that approximately 64% of aboriginal reported the health conditions such as diabetes mellitus, hypertension, asthma, arthritis, polycystic ovarian symptoms and an unspecified heart condition (Raman et al., 2017). Psychological symptoms for many women contributed to the symptoms of menopause. Many women were suffering from depression, mental and emotional distress that resulted in complication related to the menopause (Costanian et al., 2018). Besides, change of mood, anger issues, insomnia and lack of understanding of family members, the stressful behaviour of women give rise to the complication. The heart conditions, consumption of alcohol, other chronic diseases prevents them from seeking help from the clinical expertise. Hormone replacement therapy proved to be effective in coping up with the symptoms. However, approximately, 20% of participants were reluctant to take hormone replacement therapy due to fear of health complications (Mo et al.,2015). Therefore, the prevalence of early symptoms of menopause in aboriginal women increases rapidly. Lack of discussion of menopause influences the decision making of them and they do not seek the professional help. However, personal exercise, use of music, use of alcohol and visiting family members seems to reduce the prevalence of symptoms and complications associated with it. The sense of humor proved to reduce the stress related to the menopause of the women.
Menopause is a universal and individual experience that influenced by psychological, biological, social and cultural factors. Researchers suggested that despite a number of sources available in internet aboriginal women lack the understanding of the symptoms of menopause (Donahoo& Ross, 2015). Therefore in order to prevent the negative experience and symptoms of menopause in aboriginal women, proper education and ethical guidelines are needed. Since it is a taboo for most of the aboriginal women, women were approached or contacted with the support of health worker affiliated with Geraldton regional aboriginal medical service or researchers who were working at combined university’s centre for rural health. Most of the researchers have followed the principle of national aboriginal health association to reduce the negative experiences of women. Since the factors of vulnerability are lack of discussion about menopause, health conditions, ignorance towards knowledge, to protect them from vulnerability few initials had been taken by researches. The first approach to reduce the vulnerability introduces the terminology of menopause and communicating with the women about the vulnerability (Bainbridge et al., 2015). Asking women about their menarche experiences significantly reduces the prevalence of the symptoms of menopause. Communication is an effective procedure adopted by many researchers and healthcare provider to reduce the incidence of symptoms (Donahoo& Ross, 2015). Since culture and economic factors influence the prevalence of symptoms, respecting the culture and personal views should be taken in to account during communicating with aboriginal women. The health care professional can provide the information by giving books and written notes to the women for acquiring sound knowledge about the menopause and symptoms related to it. Consequently, it will give them an opportunity to talk about their personal experiences and gain knowledge about the menopause. Educating individuals about treatment procedure such as hormonal replacement therapy is effective in reducing vulnerability. Significant numbers of women are afraid of any treatment that affects their decision making and psychology. Therefore, acquiring knowledge will help them in seeking professional help. Exercises, music, sense of humour significantly reduce the vulnerability of aboriginal women. Men play the massive role in reducing the negative experiences, educating men about the menopause will help men to support their wife in leading quality life (Whiteside et al., 2016).
Conclusion:
Thus it can be concluded that because of cultural heritage and socioeconomic factors, the burden of menopause is significantly higher in the case of aboriginal women as compared to the non-indigenous women. Studies show that many factors contribu8tes to the occurrence of menopause in women such as age, menarche, gestational age, menstrual cycle, serum , and other social and economic factors. The heart conditions, consumption of alcohol, other chronic diseases prevents them from seeking help from the clinical expertise Communication is an effective procedure adopted by many researchers and healthcare provider in order to reduce the prevalence of symptoms. Educating individuals about treatment procedure such as hormonal replacement therapy is effective in reducing vulnerability. Involving men in proving care men significantly reduce the symptoms and it will help men to support their wife in leading quality life.
The primary purpose of this study is to analyse the difference in experience in menopause of Australian aboriginal women of different age group. The strength of the paper relies on the fact that research was conducted by considering the social and economic factors that influence the experience of menopause. To obtain the accurate factual and emotional data, the semi-structured interview has chosen by researchers. Face to face interview helped researchers to gather right emotional state. Researchers for the study followed ethical norms.
The limitation of the study is there was no biological and physiological testing has been undertaken that confirms the status of the current international menopause definition. The survey conducted on a specific geographic area which limited the minor difference in culture in the broader range of aboriginal. Moreover, interviewers were non- indigenous young women which were a barrier for aboriginal women to talk about their problem. No systemic members were there to check the individual transcript.
This appraisal tool consists of 10 questions that will help to analyze the study critically.
Question 1.
Yes.
The research focuses on analysing the difference in experience in menopause of Australian aboriginal women of different age group. This study was conducted for Australian Aboriginal women’s understanding and knowledge of menopause and the impact of menopause in their life. Many factors were revealed related to aboriginal women.
The rationale of the study lies in the fact that research was conducted by considering the social and economic factors that influence the experience of menopause. Moreover, language barrier, lack of appropriate access to the knowledge and social stigma worsen the experience of menopause in aboriginal women. While this study, select the population of indigenous women of Australia, it reveals the health condition of Australian women, the importance of acknowledging the difference of experience of menopause. Hence, Jurgenson et al. (2014) the author of this paper are of the opinion that facilitating education amongst the aboriginal women and communicating with them about their experiences will provide them an opportunity to reduce the negative experiences.
Question 2.
Yes.
The focus group interview has been conducted as the qualitative methodology for the research. A semi-structured interview was conducted which had open-ended questionnaire. Those questionnaires related to the terminology, beliefs, expectation, symptoms, treatment, along with ways of dealing with menopause. According to the research conducted by researchers, for successfully performing the quantitative research interview is the best method (Jamshed, 2014). The semi-structured interview that was conducted for the study is also called in-depth interviews where the participants need to answer the open end questions. Hence it is considered as suitable data collection method for qualitative research in clinical setting. Moreover, selecting the focus groups is essential for an interview since it helps to generate accurate information on a particular area by a selected group of the population. Qualitative interview helps the interviewer to gather not only factual data but also enable to obtain personal experiences of individuals. This is paper Jurgenson et al. (2014), the authors were able to explore the personal experiences and gather information about the menopause of aboriginal women.
Question 3.
Yes.
For this study, Jurgenson et al. (2014), have showed the research design in the portion of methodology and accurate description of the process. Ethical factors also have been undertaken in this research. Here the method of research adopted is a first-person interview of accumulating data since the first-person interview enables to analyse the mental state of participants over specific issues. The study of aboriginal women, Jurgenson et al. (2014), focused on the experience of pre and post menopause of different age group of aboriginal women of Australia. Therefore, researching by face to face interview helped researchers to gather direct mental consequences of the data and the series of event experienced by indigenous women (Merriam &Tisdell, 2015).
Question 4.
Yes.
In this study, Jurgenson et al. (2014), focus group was taken for interview. The participants of focus groups were gathered who have same experience for ensuring that the group should be sufficiently homogenous. The discussions for focus groups are pre, peri or post-menopausal women of indigenous and non-indigenous women, one focus group of five participants. Moreover, researches have clearly discussed how participants have been selected which also suggested the huge social demographic background and setting. However, the only limitation of the study is that it focused on the specific geographical area.
Moreover, family members of participants also take part in the focus group. The accurate focus group characterized is important for quantitative research because it aid in decreasing the biasness. In the study, researchers had given in table format of characteristics of focus group and it made the data crystal clear.
Question 5.
Yes.
In this research, the ways of collecting data were clearly justified. Jurgenson et al. (2014), in this study, mentioned the experiences and reasons behind the knowledge of research and consent of study also have been included in this study. The place of conducting study and environment of the interview also observed in this study. The place for interview conduction is important for the research since comfortable environment enhances the participants to provide accurate answers. However, there was no biological and physiological testing has been undertaken that confirms the status of the current international menopause definition. Moreover, researchers were not able to identify whether the ovaries was eliminated and hence the occurrence of surgical menopause. The selection method of data collection is justified by authors and face to face to interview for obtaining personal data. However, thorough scrutiny of original transcriptions should be taken into account. Researchers also mentioned the time of the interview and saturation of the data.
Question 6.
No.
In the paper, Jurgenson et al. (2014), researchers are able to locate the data theoretically and culturally. However, the study conducted on a specific geographic area which limited the minor difference in culture in the broader range of aboriginal women. Accurate knowledge of the potential bias will help reduce the chances of getting bias results (Munhall, 2012). Due to the exploration of a specific part of the population, findings limited to the particular piece of aboriginal women. Here, recruitment of participants was undertaken from wide socio-demographic characters such as an aboriginal region of Australia. However, researchers failed to consider the individual demographic characteristic which increases the biasness of the study. Reduction of biasness is the essential part of conducting potential research which researchers are was unable to address.
Question7.
Yes.
The ethical issues were considered by researcher while interviewing aboriginal women. No participants were forced to give the face to face the interview and information of the interview provided to the participants agreed to give the interview, names were not disclosed (Silverman, 2016). This ethical consideration goes following the moral norms. However, the interviewers were young women from non-Indigenous part of Australia, and this may have been a barrier to participants disclosing their personal experience.
Question 8.
Yes.
The data analysis was meticulous as the in-depth process has been conducted for researches. The thematic analysis of the study was done along with proper tabular representations according to participants. The researchers have used quotation of the participants for justifying the generation process of used which is appropriate for methodology (Bryman, 2016). Appropriate use of direct quotes is an ideal approach for conducting research. However, re-analysis of the individual interview did not take into account in conducting the investigations.
Question 9
Yes.
In this paper, the authors had been researched in accordance with ethical norms. Ethical approval for conducting the research was provided by the University of Western Australia Human Research Ethics Office along with the Western Australian Aboriginal Health Information and Ethics Committee (WAAHEC). Moreover, no participants were forced to give the interview in the research setting (Munns et al., 2016). The findings are discussed according to the original question which aid in understanding the rationale of the research.
Question 10.
Yes.
The conclusion drawn in the researchers report flow from analysis research flow from analysis or interpretation of data. The study is extremely valuable in the present situation of Australia. This study provided a vision of personal experience of Australian Aboriginal women from the Midwest region of Western Australia. The main focus of the study was the experiences and understanding of aboriginal differs from others, which reflect the cultural beliefs, social life of individual and its interactions with surroundings and relations that construct cultural belief’s and knowledge about health that influences their decision of seeking help.
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