Capítulo 3. “Validación de la Solución Propuesta.”
3.4. Métricas aplicadas a la solución propuesta
A life course approach investigates the extent to which prior health throughout earlier adulthood will affect health outcomes in later life (Kuh, Power, Blane, & Bartley, 1997) and how an individual perceives, interprets and responds to a later health challenge.
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Previous literature has described associations between adult health and both utilisation of professional health care services and individuals’ health self-management.
2.3.2.1 Adult health status and health care utilisation
In a conceptual model of the individual-level factors associated with health care utilisation, Andersen & Newman (2005) identified previous illness (including how it is perceived and evaluated by the individual) as a predisposing predictor of health care utilisation. However, this framework does not specify the direction of the association between previous health and later health management. Whilst it would seem probable that individuals with worse health would be more likely to access health care services, there is evidence to suggest the opposite. In a sub-sample taken from the Manitoba Longitudinal study on Ageing (N=2422), Shapiro & Roos (1985) found that older adults who reported having one or two chronic conditions were less likely to access professional health services than those who reported none and those who reported three or more were even less likely to access services. However, the existing evidence is mixed. Worse reported physical health, measured by the presence of chronic conditions, has also been associated with higher rates of health care utilisation and this association strengthens with the increasing number of comorbid chronic conditions; in a sample of N=18941 patients aged 50+, Glynn et al (2011) found an association between the increasing number of chronic conditions reported and higher levels of primary care consultation and more hospital admissions, after controlling for sex and free medical care eligibility (in an Irish sample, where access to medical care is means tested).
Adult health, particularly self-rated health, is associated with health check attendance. In a cross-sectional study, postal questionnaires were delivered to N=2678 British individuals who had been invited to attend health checks to screen for cardiovascular diseases and cancer (Thorogood et al., 1993). Demographic and socioeconomic data from the questionnaires were then extracted to identify correlates of attendance and non-attendance to the health checks they were invited to. It was reported that participants who rated their health as either excellent or poor (the two extreme ends of an ordinal scale of self-rated health) were less likely to attend health checks than those who rated their health as very good, good or fair. However, having a chronic condition (reporting having a ‘long-standing illness or disability’) was not associated with attendance, suggesting that self-rated health was associated differently with health check attendance compared to a measure of health status defined by illness/disability. One limitation of this study is its self-selecting sample, as it depended on individuals who were motivated to return the questionnaire, thus it may not be representative of individuals not engaged with health care or preventive health care services. Labeit et al (2013) reported that poor
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self-rated health was associated with increased attendance to blood pressure checks, cholesterol checks and eyesight tests, but not with screening for breast or cervical cancer. This study demonstrates the different attitudes towards different types of health checks, suggesting that people may consider different types of health checks (for instance, cardiovascular checks compared to cancer screening) as different approaches to managing one’s health and therefore be more likely to engage with one and less so with another.
2.3.2.2 Adult health status and health self-management
As discussed in Chapter 1, managing comorbid conditions is becoming an increasingly important public health issue as the population ages and the prevalence of comorbidity increases (Brilleman et al., 2013; ONS, 2012). In a study of the predictors of health self-management, Kenning et al (2015) hypothesised that comorbidity was a potential barrier to self-management. However, the results of this prospective study found that, although it was related to self-rated health, comorbidity was not associated with self-management.
This unexpected finding may reflect methodological limitations, as the measurement of self-management was restricted only to eliciting ‘self-monitoring and insight’ and the measure of comorbidity included only combinations of just five chronic conditions.
2.3.2.3 Women’s prior health and management of health symptoms in midlife
There is existing literature to support the idea that women’s experience of previous or additional health challenges is associated with both how they experience and manage the menopause and health symptoms in midlife. It is necessary to address both the association between women’s health and management of symptoms in midlife and the other pathways that might contribute to this association, including symptom experience, and review the relevant literature.
There is little, though consistent, evidence describing the association between women’s health status and the likelihood of health professional consultation, in that worse health is associated with greater help-seeking. One study reported that previous pre-menstrual symptoms and worse self-rated health were associated with consulting a professional for menstrual or menopausal symptoms (Avis & McKinlay, 1990). Furthermore, a cross-sectional study of N=453 Australian women in the menopausal transition reported that moderate to severe premenstrual symptoms assessed retrospectively were associated with the use of hormonal therapy in the menopausal transition (Guthrie, Dennerstein, Hopper, & Burger, 1996). Another cross-sectional study investigating health care
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utilisation in menopausal women, found that women who did not engage in either treatment-related or preventive health care were more likely to be in better health, less likely to have experienced prior premenstrual complaints and have lower stress levels than ‘health care utilisers’ (Morse et al., 1994). There is a further body of literature (discussed below in section 2.3.2.3.1) that describes some of the pathways by which women’s health may be related to the way in which women manage their symptoms in midlife.
2.3.2.3.1 Pathways between women’s health and management of symptoms in midlife
Women’s experience of symptoms during the menopausal transition is a possible mediator between women’s prior health status and their management of symptoms in midlife. Symptomatology is associated with women’s response to the menopause, particularly help-seeking behaviour. The literature consistently supports the idea that women with more bothersome symptoms are more likely to consult a health care professional regarding their symptoms. Avis et al (1997) concluded from analysis of the Massachusetts Women’s Health Study data that greater frequency and severity of symptoms predicted more help-seeking.
Previous literature has also described associations both between health in earlier adulthood and in midlife and women’s experience of symptoms in midlife. The effect of health status from earlier adulthood (both physical and psychological health) influences menopausal symptomatology as physical and emotional health conditions from over ten years prior to the menopause were found to be linked to higher levels of somatic symptoms (Kuh, Wadsworth, & Hardy, 1997). Greater prevalence of vasomotor symptoms is also reported by women who have previously experienced migraines, with the rate of symptomatology increasing with the severity of migraines (Smith & Waters, 1983). Worse self-rated health and having chronic conditions were associated with reported higher levels of a wide range of symptoms throughout the perimenopause and the menopausal transition in a cross-sectional study of N=2000 women between the ages of 45 and 55 (Dennerstein et al., 1993).
Health events specific to women that occur throughout reproductive life (from menarche to menopause) are associated with the experience of the menopause. Symptomatology has been associated with a number of factors associated with a woman’s reproduction, such as the age at which she had her first child and experiences of miscarriage, still-birth and termination (Smith & Waters, 1983). Moreover, there is evidence demonstrating the link between women’s history of menstrual problems and symptomatology and wellbeing throughout the menopausal transition. Experiencing more pre-menstrual complaints prior
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to the menopause is associated with more menopausal symptoms (Dennerstein et al., 1993), particularly vasomotor symptoms (Guthrie et al., 1996; Hunter, 1992; Smith &
Waters, 1983) and lower wellbeing throughout the menopause transition (Dennerstein, Smith, & Morse, 1994).