needed in the houses for the study were not available when the survey team made its visit, or that the house was empty when visited; arrangements were made to make repeated visits up to three times until subjects were at home.
6. The same procedure (multistage sampling technique) was adopted in the selection of the subjects in the control group. i.e. selection of six wards and three streets in each wards by simple random sampling techniques. Houses in each street were selected using systematic random sampling technique and all the subject that meets the inclusion criteria were interviewed.
3.6 INCLUSION CRITERIA
Women aged 40 years and above who had stopped menstruating for twelve consecutive months.
3.7 EXCLUSION CRITERIA Women aged less than 40 years.
Women of age 40 years and above who were frail, or bedridden.
Women of age greater than 40 years but still menstruating.
3.8 RESEARCH INSTRUMENTS
Focus Group Discussion guide
Interviewer administered semi-structured questionnaire was used.
3.8.1 FOCUS GROUP DISCUSSIONS
This was carried out at pre intervention stage of the study to obtain qualitative data. Eight to ten volunteers’ subjects of homogenous socio-economic background formed a focus group in the six sessions conducted. The researcher moderated each of the (FGD) while the research assistants were in charge of the manual and audio recording.
(FGD guide is attached as appendix I).
3.8.2 QUESTIONNAIRE
A semi–structured questionnaire was used to collect information from the subjects using interview method. The questionnaire was translated to Yoruba language and used for respondents who do not understand English language. The questionnaire contained relevant information on the respondents’ socio-demographic characteristics, knowledge, attitudes and adjustment practices towards menopause.
3.8.3 PRE- TESTING OF INSTRUMENT
The research instrument was pre-tested among menopausal women at Offa, a town located about 50 kilometers south of Ilorin. This was to ensure validity and reliability of the instrument. It also gave an idea of the level of difficulty and complexity, which could hinder the administration of the instrument. The pre-tested instrument was then analyzed and necessary modification effected.
3.8.4 VALIDITY OF THE QUESTIONNAIRE
Content validity was used as one of the methods to validate the contents of the instrument. Chief Nursing Officer and Lecturers in the department of Epidemiology and Community Health, and Department of Obstetrics and Gynaecology, College of Medicine, University of Ilorin were consulted for a careful vetting of the initial items in the questionnaire. These experts made useful corrections and suggestions that led to the modification of some items of the instrument. Some items were deleted while some were retained. The suggestions of the experts were incorporated in the final copy of the questionnaire. The final corrected format (6 items of sociodemographic, 10 items of
knowledge, 10 items in attitudinal and 16 items of adjustment practices) formed the questionnaire that was administered to the respondents.
3.8.5 RELIABILITY OF THE QESTIONNAIRE:
Reliability refers to the constancy with which scores are obtained when the same person or group of persons is examined on different occasions with the same instrument.
The reliability of Attitudes Towards Menopause Scale (ATOMS) and Adjustment Practices Towards Menopause Scale (APTMS) was established through a test-retest method of reliability88. The instrument was administered twice on 20 randomly selected menopausal women in Ilorin with a time interval of two weeks. The two administrations were correlated using the Pearson’s Product Moment Correlation Coefficient. A reliable co-efficient of 0.89 was obtained. This coefficient value was considered high enough to affirm the instrument’s reliability. This guaranteed the use of the instrument among the subjects.
3.9 METHOD OF DATA COLLECTION
Research Assistants made up of community health workers and medical students were recruited and trained for two days on data collection survey method. Proficiency of the interviewers was verified through role-play and pre testing. The researcher carried out visitation and checks in order to validate the collected data. Qualitative data was collected using FGD guide.
3.10 SCORING PROCEDURE
In scoring the items in the questionnaire, recognition was given to the four-Likert type rating scale. The highest score for any item was 4 and the lowest was 1. Attitudes Towards Menopause Scale (ATOMS). There are (10) items on the instrument. Hence, the highest possible scores obtainable was 40 (i.e. 4 X 10) while the lowest possible score obtainable was10 (i.e. 1 X 10). The attitude of respondents was therefore categorized into two levels: positive and negative attitudes. The range being 30, (i.e. 40 - 10 = 30) the mid-point was 15. The cut-off point was thus 40 –15 or 10 +15, which in either case gave 25.00. Thus, respondents who obtained scores ranging from 25.00 to 40.00 were considered as having positive attitude towards menopause while those with scores less than 25 down to 10 were regarded as having negative attitude towards menopause.
In scoring the second scale of the instrument i.e. Adjustment practices towards menopause scale (APTMS), the four-point Likert type-rating scale was also used. Since there were 16 items on the instrument, the highest possible score obtainable was 64 (i.e. 4 X 16) while the lowest possible core obtainable was 16 (i.e. 1 X 16). The researcher categorized the adjustment practices of the respondents into two levels: good adjustment practices (less adjustment needs) and poor adjustment practices (more adjustment needs).
The range being 48 (i.e. 64-16=48), the mid-point of the range was 24. The cut-off point was therefore, 64 –24 or 16 + 24 which in either case gave 40 Thus, respondents who obtained scores ranging from 40 to 64 were considered to have better adjustment practices towards menopause (i.e. less adjustment needs). While those who obtained scores of between 16-40 were considered to have poor adjustment practices towards menopause (i.e. more adjustment needs).
The APTMS was used to examine three areas of respondents’ adjustment practices towards menopause: Psychological, Medical/Health and Social adjustment practices, with six, five and five items respectively. For the psychological adjustment practices, since there were 6 items on the instrument the highest possible score obtainable was 24 (i.e. 4 X 6) while the lowest possible score obtainable was 6 (1 X 6). The range was therefore 18 (24-6), and mid-point of the range was 9. The cut-off point was therefore, 24- 9 or 6 + 9, which in either case was 15. Thus, respondents who obtained scores ranging from 15 to 24 were considered to have good adjustment practices (i.e. less psychological adjustment needs) towards menopause while those who obtained scores below 15 were regarded as having poor adjustment practices (more psychologically adjustment needs) towards menopause.
For medical/health adjustment practices, since there were 5 items on the instrument the highest possible score obtainable was 20 (i.e. 4 X 5) while the lowest possible score obtainable was 5 (1 X 5). The range was therefore 15 (20-5), and mid-point of the range was 7.5. The cut-off mid-point was therefore 20- 7.5 or 5 + 7.5, which in either case was 12.5. Thus, respondents who obtained scores ranging from 12.5 to 20 were considered to have better adjustment practices (i.e. less adjustment needs) towards menopause while those who obtained scores below 12.5 were regarded as having poor adjustment practices (more medical adjustment needs) towards menopause.
Lastly, for the social adjustment practices, since there were 5 items on the instrument the highest possible score obtainable was 20 (i.e. 4 X 5) while the lowest possible score obtainable was 5 (1 X 5). The range was therefore 15 (20-5), and mid-point of the range was 7.5. The cut-off mid-point was therefore, 20- 7.5 or 5 + 7.5, which in either case was 12.5. Thus, respondents who obtained scores ranging from 12.5 to 20 were considered to have better adjustment practices towards menopause (i.e. less adjustment needs socially in menopause) while those who obtained scores below 12. 5 were regarded as having poor adjustment practices towards menopause. (More adjustment needs socially in menopause).
3.11 METHOD OF DATA ANALYSIS
All collected data were collated and checked manually for errors and then entered for analysis to determine the knowledge, attitudes and adjustment practices of menopausal women towards menopause using EPI-INFO Version 6.4 computer-software package and SPSS 7.5. Data analysis was done to produce frequency distribution tables, cross tabulation and appropriate statistical tests, (t-test and chi square), were used to test for statistical significance. In addition, a non - parametric rank values and analysis of variance (ANOVA) were used, because the form of the research data led themselves to interval scores obtained from four-point Likert type scale of Strongly Agree (SA), Agree (A), Disagree (D) and Strongly Disagree (SD). Data was presented in form of tables with the use of illustration such as bar chart. Similarly FGDS responses were group coded and analyzed.
3.12 CONSTRAINTS OF THE STUDY
Dearth of relevant local literature on the topic.
Cultural and religious barriers to having access to women were surmounted by advocacy and good community entry. Also female interviewers were used.
There were also problems with accurate determination of respondents’ ages as some respondents were not sure of their age. Historical estimation was employed by interviewers to obtain approximate ages in such instances. E.g the assertion of the throne by the immediate past Emir and his duration of reign. And the use of age of the first born plus twenty years.