Improving menopausal symptoms through promoting physical activity: a pilot Web-based intervention study among Asian Americans

Telehealth Utilization to Address Health Care Disparities Among Asian Americans, Native Hawaiians, and Pacific Islanders: A Scoping Review

Research has reported health care disparities, including low rates of health care utilization, among racial and ethnic minority groups compared to Whites. Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPIs) have experienced these disparities, attributed to various barriers such as limited access to linguistically and culturally concordant health care services. Telehealth may offer a viable mode of health service delivery for AANHPIs. The coronavirus disease of 2019 (COVID-19) pandemic sparked the adoption of technology for receiving health services. However, the literature on telehealth utilization before and during the COVID-19 pandemic among AANHPIs is limited. To address this gap, we conducted a scoping review of telehealth intervention empirical studies serving AANHPIs published between January 2010 and February 2024, using five databases. Twenty-four articles met our inclusion criteria, which required the use of a telehealth intervention program, provision of disaggregated AANHPIs, and targeting of physical and/or mental health outcomes. Our review revealed positive findings of telehealth interventions in helping AANHPIs access health care, with a primary focus on education and consultation for self-management. The review highlighted a range of technological platforms used in AANHPIs telehealth interventions, including web-based, mobile, and blended approaches. Additionally, the review emphasized the need for improved access to technology and reduction in digital exclusion. The findings affirm the usefulness and potential of telehealth interventions, providing implications for how health professionals can serve AANHPIs. Telehealth technology offers the ability for greater accessibility and individualization to address health care disparities in AANHPIs.

The effect of mobile app-based self-care training on the quality of marital relations and the severity of menopausal symptoms in postmenopausal women: a clinical trial study in Iran

BACKGROUND

Educational interventions for self-care are a necessary solution to help postmenopausal women properly deal with menopausal problems. The present study aimed to investigate the effect of self-care training using an application on the quality of marital relations and the severity of menopausal symptoms in postmenopausal women in Iran.

METHODS

In this study, 60 postmenopausal women selected using the convenience sampling method were divided into two groups, intervention and control, using simple random allocation (lottery). The intervention group used the menopause self-care application for eight weeks in addition to routine care, but the control group only received the routine care. The Menopause Rating Scale (MRS) and the Perceived Relationship Quality Components (PRQC) questionnaire were completed in two stages, before and immediately after eight weeks, in both groups. Data were analyzed using SPSS software (version 16), descriptive (mean and standard deviation), and inferential (ANCOVA and Bonferroni post hoc) statistics.

RESULTS

The ANCOVA results showed that the use of the menopause self-care application decreased the severity of the participants' menopause symptoms (P = 0.001) and improved the quality of their marital relations (P = 0.001).

CONCLUSION

Implementation of a self-care training program through the application helped improve the quality of marital relations and reduce the severity of postmenopausal women's symptoms, so it can be used as an effective method to prevent the unpleasant consequences of menopause.

TRIAL REGISTRATION

The present study was registered at https://fa.irct.ir/ on 2021-05-28 (registration number: IRCT20201226049833N1).

Effects of Health Coaching on Cardiometabolic Health in Middle-Aged Adults: A Systematic Review and Meta-analysis

OBJECTIVE

To appraise and synthesize evidence on the effects of health coaching as the primary intervention on cardiometabolic health among middle-aged adults.

DATA SOURCE

Six electronic databases (MEDLINE, Embase, PsycINFO, CINAHL, PubMed, and the Cochrane library) were searched from inception until July 2021.

STUDY INCLUSION AND EXCLUSION CRITERIA

Randomized controlled trials and controlled clinical trials published in English, reporting health coaching aimed to promote behavioral changes for improving cardiometabolic health among middle-aged adults were included. Studies on health coaching as secondary intervention were excluded.

DATA EXTRACTION

Two reviewers selected the articles, appraised the study quality, and extracted data independently. All kinds of outcomes related to cardiometabolic health, including health behaviors, psychological and physiological outcomes, were included.

DATA SYNTHESIS

Meta-analysis was performed if three or more studies reported the same outcomes. Narrative synthesis was performed if pooling of data for meta-analysis was not feasible.

RESULTS

Eight studies were reviewed. Most studies involved substantial risk of bias. The majority of the participants were women (99.1%). Meta-analysis showed a small but significant effect of health coaching on increasing physical activity (SMD = .34, 95% CI = .08-.60, p = .01, I² = 0%); however, its effect on perceived barriers to physical activity and depressive symptoms was nonsignificant. Narrative synthesis yielded inconsistent results on diet, smoking, anxiety, goal achievement and self-efficacy for behavioral change, physiological outcomes, and metabolic syndrome severity, and nonsignificant effects on alcohol consumption, sleep quality, perceived benefits of physical activities, and cardiovascular symptoms.

CONCLUSIONS

Health coaching has significant effects on increasing physical activity among middle-aged adults; however, its effects on health behaviors and risk factors related to cardiometabolic health are inconclusive. Further efforts are warranted to examine how health coaching can improve cardiometabolic health among middle-aged adults.

Behavior Change Techniques in Digital Health Interventions for Midlife Women: Systematic Review

BACKGROUND

Digital health interventions are efficacious in health-promoting behaviors (eg, healthy eating and regular physical activity) that mitigate health risks and menopausal symptoms in midlife. However, integrated evidence-based knowledge about the mechanisms of change in these interventions is unclear.

OBJECTIVE

This systematic review aimed to evaluate studies on behavior change techniques (BCTs) and mechanisms of change in digital health interventions aimed at promoting health-enhancing behaviors in midlife women (aged 40-65 years).

METHODS

A systematic literature search of the electronic databases PubMed, Web of Science, PsycINFO, and Cochrane Central Register of Controlled Trials in the Cochrane Library was conducted. In total, 2 independent reviewers selected the studies for inclusion, extracted data, and completed BCT mapping of eligible studies. The mechanism of action and intervention functions of eligible studies were evaluated using the behavior change wheel framework. Reporting of psychological theory use within these interventions was explored using the Theory Coding Scheme. Mode of delivery, psychological theory, and BCTs were presented as descriptive statistics.

RESULTS

In total, 13 interventions (including 1315 women) reviewed used 13 (SD 4.30, range 6-21) BCTs per intervention on average. The "Shaping knowledge" and "Repetition and substitution" behavior change categories were used most frequently, with 92% (12/13) of the interventions implementing at least one of the BCTs from these 2 categories. Only 13.98% (169/1209) of the 93 available BCTs were used, with "Instructions on behaviour" most frequently used (12/13, 92%). The behavior change wheel mapping suggests that half of the intervention content aimed to increase "Capability" (49/98, 50% of the intervention strategies), "Motivation" (41/98, 42%), and "Opportunity" (8/98, 8%). "Behavioural Regulation" was the most frequently used mechanism of action (15/98, 15%), followed by increasing "Knowledge" (13/98, 13%) and "Cognitive and Interpersonal skills" (10/98, 10%). A total of 78% (7/9) of the intervention functions were used in the studies to change behavior, primarily through "Enablement" (60/169, 35.5%), whereas no study used "Restriction" or "Modelling" functions. Although 69% (9/13) of the interventions mentioned a psychological theory or model, most (10/13, 77%) stated or suggested rather than demonstrated the use of a theoretical base, and none reported explicit links between all BCTs within the intervention and the targeted theoretical constructs. Technological components were primarily based on web-based (9/13, 69%) modes of delivery, followed by phone or SMS text message (8/13, 62%) and wearables (7/13, 54%).

CONCLUSIONS

The findings of this review indicate an overall weak use of theory, low levels of treatment fidelity, insignificant outcomes, and insufficient description of several interventions to support the assessment of how specific BCTs were activated. Thus, the identified limitations in the current literature provide an opportunity to improve the design of lifestyle health-enhancing interventions for women in midlife.

TRIAL REGISTRATION

PROSPERO CRD42021259246; https://tinyurl.com/4ph74a9u.

Potential effects of virtual interventions for menopause management: a systematic review

IMPORTANCE

Menopausal women are one of the fastest growing demographic groups globally. Virtual interventions have emerged as alternate avenues for menopausal women to manage and cope with their symptoms.

OBJECTIVE

The purpose of this review is to summarize existing research on the potential effects of virtual interventions for menopause management.

EVIDENCE REVIEW

This systematic review was written in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MEDLINE, PsychINFO, CINAHL, AgeLine, ERIC, ProQuest, Nursing and Allied Health Database, PsychARTICLES, and Sociology Database were used for literature search and searched from conception to December 2021. Original studies, including randomized controlled trials and quasi-experimental studies, were included if they evaluated a virtual intervention for menopause management and investigated the effects of these interventions on physical and psychosocial outcomes and/or the feasibility of these interventions among menopausal women. Included studies were published in peer-reviewed journals and assessed for quality using the Critical Appraisal Skills Program Checklists.

FINDINGS

A total of 16 articles were included in this review. Virtual interventions have the potential to improve physical health outcomes including body weight/body mass index/waist circumference, pain, blood pressure, and cholesterol. However, conflicting results were identified for the outcomes of vasomotor and endocrine symptoms, sleep, and sexual functioning. Virtual interventions might also improve psychosocial outcomes, including knowledge and patient-physician communication, although conflicting results were again identified for treatment decision-making ability, quality of life, and anxiety and depression. Virtual interventions were feasible in terms of being usable and cost-effective, and eliciting satisfaction and compliance among menopausal women.

CONCLUSIONS AND RELEVANCE

Virtual interventions might have the potential to improve the physical and psychosocial health outcomes of menopausal women, although some conflicting findings arose. Future studies should focus on including diverse menopausal women and ethnic minorities, conducting research within low- to middle-income countries and communities, further exploring intervention design to incorporate features that are age and culture sensitive, and conducting full randomized controlled trials to evaluate the effects of the interventions.

The effect of exercise training based on the health promotion model on menopausal symptoms

PURPOSE

This study was conducted to determine the effect of exercise training provided based on the health promotion model on menopausal symptoms.

DESIGN AND METHODS

The sample size was identified as 156 women. The women who were given exercise training applied a 30-min daily exercise program for 12 weeks, while those in the control group were not trained and did not exercise.

FINDINGS

The difference between the mean scores of the groups was statistically significant (p = 0.000).

PRACTICE IMPLICATIONS

Exercise training given to women in the experimental group based on a health promotion model reduced menopausal symptoms.

Psychological well-being of midlife women: a structural equation modeling approach

OBJECTIVE

Women experience menopause at approximately 50 to 52 years of age, when reproductive aging causes various somatic, psychological, and urogenital symptoms. Women's changing lifestyles and increasing lifespan make it difficult to pinpoint the factors affecting their well-being during menopause, warranting continuous research in this field. Therefore, this study developed a structural equation model, based on the transactional model of stress and coping, to test the significance of positive and negative factors associated with psychological health during menopause.

METHODS

This study validated a structural equation model based on the empirical data collected using a crosssectional study. We analyzed 300 questionnaire responses completed between May 15 and July 10, 2020, by South Korean middle-aged women (aged 45-60 y) who agreed to participate. The study's structural equation model used self-efficacy as an exogenous variable and perceived stress, menopausal management, self-compassion, menopausal symptoms, and psychological well-being as endogenous variables. Educational and economic levels were set as control variables.

RESULTS

We observed statistical support for 9 out of 10 hypotheses; the predictor variables had an explanatory power of 79.5% for psychological well-being. Self-efficacy was positively associated with the psychological wellbeing of middle-aged menopausal women and appeared to be mediated by perceived stress, menopausal management, menopausal symptoms, and self-compassion.

CONCLUSIONS

To improve the psychological well-being of middle-aged women, it is important to increase their self-efficacy and minimize stress. Moreover, managing menopausal symptoms and increasing self-compassion through effective coping may maximize psychological well-being.

VIDEO SUMMARY

http://links.lww.com/MENO/A933.

How stress, discrimination, acculturation and the gut microbiome affect depression, anxiety and sleep among Chinese and Korean immigrants in the USA: a cross-sectional pilot study protocol

INTRODUCTION

Although a considerable proportion of Asians in the USA experience depression, anxiety and poor sleep, these health issues have been underestimated due to the model minority myth about Asians, the stigma associated with mental illness, lower rates of treatment seeking and a shortage of culturally tailored mental health services. Indeed, despite emerging evidence of links between psychosocial risk factors, the gut microbiome and depression, anxiety and sleep quality, very few studies have examined how these factors are related in Chinese and Korean immigrants in the USA. The purpose of this pilot study was to address this issue by (a) testing the usability and feasibility of the study's multilingual survey measures and biospecimen collection procedure among Chinese and Korean immigrants in the USA and (b) examining how stress, discrimination, acculturation and the gut microbiome are associated with depression, anxiety and sleep quality in this population.

METHOD AND ANALYSIS

This is a cross-sectional pilot study among first and second generations of adult Chinese and Korean immigrants in the greater Atlanta area (Georgia, USA). We collected (a) gut microbiome samples and (b) data on psychosocial risk factors, depression, anxiety and sleep disturbance using validated, online surveys in English, Chinese and Korean. We aim to recruit 60 participants (30 Chinese, 30 Korean). We will profile participants' gut microbiome using 16S rRNA V3-V4 sequencing data, which will be analysed by QIIME 2. Associations of the gut microbiome and psychosocial factors with depression, anxiety and sleep disturbance will be analysed using descriptive and inferential statistics, including linear regression.

ETHICS AND DISSEMINATION

This study has been approved by the Institutional Review Board at Emory University (IRB ID: STUDY00000935). Results will be made available to Chinese and Korean community members, the funder and other researchers and the broader scientific community.

Factors Influencing Physical Activity Participation among Midlife Immigrant Women: A Systematic Review

Immigrant women are less likely to be physically active and face many barriers to participation in physical activity. This systematic review aims to identify the influencing factors and adaption approaches of physical activity interventions among midlife immigrant women. A systematic literature search was performed using various databases, such as MEDLINE, PsycINFO, and CINAHL, in February 2021. Studies were included if they investigated midlife immigrant women participating in physical activity interventions and were published in an English peer-reviewed journal in or after 2000. Twenty-two papers were included in this review. Guided by the Ecosocial theory, thematic analysis was utilized for data analysis. Among midlife immigrant women, influencing factors associated with physical activity participation included individual factors (a lack of time, current health status, motivation, and a lack of proficiency in various life skills), familial factors (familial support and seasonality), and community factors (social support and neighbourhood environment). The appropriate adaptation of physical activity interventions included adjustments in language, physical activity intensity, physical activity duration, logistical intervention adjustments and other potential technology-based adjustments. The findings can inform community stakeholders, healthcare professionals and researchers to design appropriate physical activity interventions that meet the needs of midlife immigrant women and improve their health outcomes.

Effect of An Online Physical Activity Promotion Program and Cardiovascular Symptoms Among Asian American Women at Midlife

Despite an increasing number of online programs to promote physical activity, they have rarely been evaluated for their effects on cardiovascular symptoms of racial/ethnic minority women at midlife. This study aimed to determine the preliminary efficacy of a newly developed online program for physical activity promotion on cardiovascular symptoms of Asian American midlife women. This study was a pilot repeated-measures randomized controlled trial (pretest/posttest) among 26 Asian American midlife women. The variables were measured using multiple instruments on background features, physical activity, and cardiovascular symptoms at three points of time (baseline, after 1 month, and after 3 months). Linear mixed models were used to analyze the data. The prevalence and severity of cardiovascular symptoms did not show a statistically significant group-time interaction. However, the increase in lifestyle physical activity over time was significant only among the intervention group (Δ = 0.49, P = .016). The results supported the program's preliminary efficacy on lifestyle physical activity for Asian American women at midlife, but not on cardiovascular symptoms.