This 5-year project (with 3 year no-cost extension to facilitate dissemination) was funded by the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health, Office of Women's Health. It included four centers, at the University of Alabama at Birmingham, University of South Carolina, University of Texas at Houston, and the University of New Mexico. It was designed to study ethnic variation in women's attitudes, experiences and decisions regarding hysterectomy/surgical menopause and questions about menopause and the use of hormone replacement therapy (HRT) that exist in and across racial/cultural groups. The aims were, in Phase 1 to examine with qualitative and quantitative data the factors that influence women’s choices with special emphasis on exploring the potential roles of cultural identity and ethnicity, in Phase 2 to use the information from Phase 1 to develop materials and dissemination strategies to enhance women’s decision-making about hysterectomy, oophorectomy and HRT, and in Phase 3, to evaluate the intervention materials and dissemination strategies in communities. The multicenter study assessed the attitudes of more than 4,000 women from 4 ethnic groups: African-American, Hispanic, Navajo, and non-Hispanic White.

The New Mexico ENDOW Center examined the issues regarding hysterectomy, menopause and hormone replacement among Navajo, Hispanic, and non-Hispanic white women. During the first nine months of the study, over 25 focus group interviews were conducted and the results were combined with previously validated survey instruments and demographic information in developing and pilot testing a survey questionnaire. Then, over a 16-month period, the questionnaire was used in a cross-sectional survey, by personal interview, that was conducted among 1100 pre-menopausal and post-menopausal women in the three ethnic groups. Analysis of the focus group and survey data informed the development of culturally-appropriate health education materials in print and video formats for women and their health care providers.

In addition, to assure that the health education intervention materials were disseminated through a more convenient site to Navajo women, a mid-life women’s resource center, the Women/Change Exchange, was opened in Gallup, New Mexico. This office is a place for women, as they age, to learn about their health prior to making important healthcare decisions. The center trained volunteers to educate women about wellness and also provided a place where women can meet and share information through support groups and workshops.

The findings from this study at the four centers indicated that all groups wanted to be more educated on menopausal issues and expressed interest in discussing these issues with their families and health care providers. Based on their findings from extensive focus groups and surveys, ENDOW investigators developed “Hysterectomy: The Decision is Yours,” a video and a brochure (available in English and Spanish) that provides information on the medical procedure, indicates proper communication techniques with health care providers, and offers effective decision-making skills. The video was the recipient of the prestigious Telly Award in 1999 and the Cindy Award. Additional intervention materials include The Wise Woman's Guide to Making Decisions and The Decision is Yours: Talking to Your Doctor. Materials may be obtained from ENDOW at the cost of reproduction (see http://www.dopm.uab.edu/endow/).

For more information about this project, contact the Women Change/ENDOW Project staff can be contacted in New Mexico at (505) 272-9962 or by e-mail at cherman@salud.unm.edu.