This research draws on qualitative and anthropological methods to: a.) examine the variety of ways a diverse group of women understand their lived experiences of menopause over time, b.) observe how these varied understandings are represented in clinical encounters, and c.) explore the ways in which physicians effectively transmit information while eliciting and respecting personal understandings of menopause and non-medical knowledge. Although the cessation of menses in midlife is considered a constant among women, the ways in which it is experienced and the meanings ascribed to it vary greatly among cultures, ethnicities and political-economic backgrounds. Women want to know more about menopause, but often are dissatisfied with menopausal counseling and sometimes feel their own ways of understanding menopause are dismissed by clinicians. In addition, women's apprehension may be increased by the confusion following the abrupt changes in hormone therapy recommendations. Addressing lack of knowledge and apprehension is vital as women with negative expectations for menopause are indeed more likely to have harsher menopausal symptoms. Thus high quality clinical communication about menopause is essential. Nevertheless, almost no research has examined how actual providers counsel menopausal women and address disparate understandings in their clinics. Using a multi-method approach, data will be collected through interviews on understandings of menopause over 18-24 months with 112 Latina, African-American, Japanese American, and Caucasian women. Ethnographic observation will be performed during 84 clinical encounters to collect data on how clinicians elicit personal understandings and effectively transmit medical information without disrespecting women's models. Dr. Hill-Sakurai is uniquely suited to this project through clinical training and practice with the patient centered care approach in family medicine and her research fellowship's intensive focus on anthropological research methods. During this grant, she will continue training in appropriate social science theory and advanced qualitative data analysis. She will undertake a full review of current research on patient-clinician communication. This proposal will allow her to develop future work with intervention trials in communication, allowing her to become a leader in communication in women's health.
