JMIR Publications

ABSTRACT

Background:

The global population of women in menopause is fast increasing. The COVID pandemic has led to a drastic increase in the use of telehealth services, especially technological solutions targeting women’s health. Understanding the factors behind midlife women’s help-seeking amidst the pandemic will assist the development of person-centered, holistic telehealth solutions targeting menopausal and post-reproductive health.

Objective:

This study compared the factors behind help-seeking among midlife women in the United States (U.S.) and China for their menopausal distress.

Methods:

Two online panel surveys were conducted in the U.S. using Amazon Mechanical Turk (MTurk) and China using Credamo between July and October 2022. 1002 American and 860 Chinese women aged between 40 and 65 years were recruited to participate. The survey was designed based on the Health Belief Model with questions related to their menopausal knowledge, perceived severity of menopausal symptoms, perceived susceptibility to menopausal distress, perceived benefits of help-seeking, perceived COVID- and non-COVID-related barriers against help-seeking, self-efficacy, and motivation to seek help. Structural equations models were fitted for the U.S. and China data using full information maximum likelihood to manage the missing data.

Results:

Knowledge was not directly related to help-seeking motivation in both samples. Among the Chinese sample, knowledge was negatively related to perceived severity (B (SE)=-0.50 (0.17)) but positively to COVID-related barriers (B (SE)=0.12 (0.02)); in turn, higher perceived severity (B (SE)=0.01 (0.00)), benefits (B (SE)=0.13 (0.03)), COVID-related barriers (B (SE)=0.07 (0.02)), and self-efficacy (B (SE)=0.43 (0.03)), and lower non-COVID-related barriers (B (SE)=-0.35 (0.05)) were related to more motivation to seek help. In the US sample, knowledge was negatively related to perceived severity (B (SE)=-0.69 (0.09)), susceptibility (B (SE)=-0.09 (0.02)), benefits (B (SE)=-0.05 (0.01)), barriers (COVID: B (SE)=-0.17 (0.02) ; non-COVID: -0.17(0.02)), and self-efficacy (B (SE)=-0.105 (0.01)); in turn, higher self-efficacy (B (SE)=0.40 (0.04)), COVID-related barriers (B (SE)=0.08 (0.04)), and benefits (B (SE)=0.41 (0.06)) were associated with more help-seeking motivation. The factors explained 53.0% and 45.3% of the variance of help-seeking motivation among the American and the Chinese sample, respectively.

Conclusions:

This study revealed disparate pathways between knowledge, health beliefs, and motivation of help-seeking among American and Chinese midlife women with respect to menopausal care. Our findings show that knowledge may not directly influence help-seeking motivation. Instead, perceived benefits and self-efficacy consistently predicted help-seeking motivation. Interestingly, concern over COVID infection was related to higher help-seeking motivation in both samples. Hence, our findings call for telehealth services to (i) develop contents beyond health education and symptom management to enhance the perceived benefits of its solutions to address women’s multidimensional menopausal health needs, (2) facilitate patient-care provider communication to foster self-efficacy of help-seeking, and (3) target women who have greater concern over infectious diseases in the post-pandemic era.