Korean J Women Health Nurs.  2022 Jun;28(2):123-133. 10.4069/kjwhn.2022.05.24.

Trajectories of subjective health status among married postmenopausal women based on the ecological system theory: a longitudinal analysis using a latent growth model

• Kim EJ
• Nho JH

• KMID: 2535429
• DOI: http://doi.org/10.4069/kjwhn.2022.05.24

Abstract

Purpose
This study investigated the trajectory of subjective health status in married postmenopausal women and aimed to identify predictive factors affecting subjective health status.
Methods
Data were obtained from women who participated in wave 4 (2012) of the Korean Longitudinal Survey of Women & Families Longitudinal Study and continued to the latest phase (wave 7, 2018). A latent growth model (LGM) was used to analyze data from 1,719 married postmenopausal women in the framework of the ecological system theory.
Results
The mean age of the participants at wave 4 was 56.39±4.71 years, and the average subjective health status was around the midpoint (3.19±0.84). LGM analysis confirmed that subjective health status decreased over time (initial B=3.21, slope B=–0.03). The factors affecting initial subjective health were age, body mass index, frequency of vigorous physical activity (microsystem level), marital satisfaction (mesosystem level), and medical service utilization (macrosystem level). Medical service utilization and the frequency of vigorous physical activity were identified as predictive factors affecting the slope in subjective health status. The model fit was satisfactory (TLI=.92, CFI=.95, and RMSEA=.04).
Conclusion
This analysis of the trajectory of subjective health status of married postmenopausal women over time confirmed that subjective health is influenced by overall ecological system factors, including the microsystem, mesosystem, exosystem, macrosystem, and chronosystem. Therefore, it is necessary to assess physical activity and support policies promoting access to medical services in order to improve the subjective health status of married postmenopausal women.

Keyword

Longitudinal studies; Postmenopause; Health status; Women; 종단연구; 건강상태; 폐경; 여성

Figure

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  Figure 1. Flowchart of the study sample. KLoWF: Korean Longitudinal Survey of Women & Families Longitudinal Study.

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  Figure 2. Growth models of this study. (A) Unconditional growth model. (B) Final conditional growth model. BMI: Body mass index; CS: community service; MS: marital satisfaction; MSU: medical service utilization; PA: physical activity.

Reference

1. Karmakar N, Majumdar S, Dasgupta A, Das S. Quality of life among menopausal women: a community-based study in a rural area of West Bengal. J Midlife Health. 2017; 8(1):21–27. https://doi.org/10.4103/jmh.JMH_78_16.

2. Mathew DJ, Kumar S, Jain PK, Srivastava DK, Singh V, Krishnappa K. Morbidity patterns among menopausal women in rural Uttar Pradesh, India: A Cross-Sectional Study. J Menopausal Med. 2021; 27(1):24–31. https://doi.org/10.6118/jmm.19022.

3. Idiana HI, Nik Hazlina NH, Zaharah S, Azidah AK, Mohd Zarawi MN. Developing and validating the Menopausal Spousal Support Questionnaire (MSSQ) for menopausal women. Maturitas. 2022; 158:1–9. https://doi.org/10.1016/j.maturitas.2021.10.005.

4. Jeong YR, Jeong SH, Han SS. The relationship between husband support and depression in Korean married women: the mediating effects of connubial bliss. J Korea Content Assoc. 2018; 18(12):263–271. https://doi.org/10.5392/JKCA.2018.18.12.263.

5. Yazdkhasti M, Simbar M, Abdi F. Empowerment and coping strategies in menopause women: a review. Iran Red Crescent Med J. 2015; 17(3):e18944. https://doi.org/10.5812/ircmj.18944.

6. Kim E, Kim H, Yoon JY. Trajectories of self-rated health among one-person households: a latent class growth analysis. J Korean Acad Community Health Nurs. 2019; 30(4):449–459. https://doi.org/10.12799/jkachn.2019.30.4.449.

7. Freidoony L, Chhabi R, Kim CS, Park MB, Kim CB. The components of self-perceived health in the Kailali district of Nepal: a cross-sectional survey. Int J Environ Res Public Health. 2015; 12(3):3215–3231. https://doi.org/10.3390/ijerph120303215.

8. Silva VH, Rocha JS, Caldeira AP. Factors associated with negative self-rated health in menopausal women. Cien Saude Colet. 2018; 23(5):1611–1620. https://doi.org/10.1590/1413-81232018235.17112016.

9. Yang HM, Choo J. Socioeconomic inequalities in self-rated health: role of work-to-family conflict in married Korean working women. Women Health. 2019; 59(8):921–936. https://doi.org/10.1080/03630242.2019.1567648.

10. Kim YT, Cha C, Lee MR. Factors related to age at menopause among Korean women: the Korean longitudinal survey of women and families. Menopause. 2019; 26(5):492–498. https://doi.org/10.1097/GME.0000000000001268.

11. Bronfenbrenner U. Contexts of child rearing: problems and prospects. Am Psychol. 1979; 34(10):844–850. https://doi.org/10.1037/0003-066X.34.10.844.

12. Lee GR, Choi HK. Factors influencing happiness among pregnant women in the ecological systems theory. J Korean Acad Community Health Nurs. 2019; 30(1):11–24. https://doi.org/10.12799/jkachn.2019.30.1.11.

13. Bronfenbrenner U, Morris PA. Handbook of child psychology. The bioecological model of human development. 6th ed. RM Lerner W Damon . Hoboken, NJ: John Wiley & Sons;2006. p. 793–828.

14. Bae GI. An ecosystematic approach to childbirth of married women: comparison between the first childbirth and the second childbirth. Korean J Soc Welf Stud. 2020; 51(1):275–301.

15. Pfefferbaum RL, Jacobs AK, Noffsinger MA, Pfefferbaum B, Sherrieb K, Norris FH. The burden of disaster: part II. applying interventions across the child’s social ecology. Int J Emerg Ment Health. 2012; 14(3):175–187.

16. Lee Y, Kang J. Related factors of turnover intention among Korean hospital nurses: a systematic review and meta-analysis. Korean J Adult Nurs. 2018; 30(1):1–17. https://doi.org/10.7475/kjan.2018.30.1.1.

17. Glanz K, Rimer BK, Viswanath K. Health behavior: theory, research, and practice. 5nd ed. San Francisco: Wiley;2015.

18. Korean Women’s Development Institute. Korean Longitudinal Survey of Women & Families [Internet]. Seoul: Author;2021. [cited 2022 Feb 1]. Available from: http://klowf.kwdi.re.kr/portal/mainPage.do.

19. Gold EB, Crawford SL, Avis NE, Crandall CJ, Matthews KA, Waetjen LE, et al. Factors related to age at natural menopause: longitudinal analyses from SWAN. Am J Epidemiol. 2013; 178(1):70–83. https://doi.org/10.1093/aje/kws421.

20. Choi HG, Kim HJ. Comparison of health-related habits and metabolic syndrome risk factors according to obesity type in Korean postmenopausal women. Menopause. 2020; 27(9):1022–1029. https://doi.org/10.1097/GME.0000000000001569.

21. Yang HM. How work environment, work-family conflict, and job satisfaction are relevant to the self-rated health of married working women. Women Stud. 2020; 105(2):105–131. https://doi.org/tws.2020.105.2.004.

22. Chae D, Kang KH. Factors associated with the self-rated health of married immigrant women in South Korea. J Korean Public Health Nurs. 2021; 35(2):224–238. https://doi.org/10.5932/JKPHN.2021.35.2.224.

23. Fu Y, Lin W, Yang Y, Du R, Gao D. Analysis of diverse factors influencing the health status as well as medical and health service utilization in the floating elderly of China. BMC Health Serv Res. 2021; 21(1):438. https://doi.org/10.1186/s12913-021-06410-7.

24. Park SY, Park SY. A longitudinal study on ecological determinants associated with middle-aged and elderly women’s life satisfaction and depressive symptoms. Health Soc Welf Rev. 2018; 38(4):129–163. https://doi.org/10.15709/hswr.2018.38.4.129.

25. Korean Society for the Study of Obesity. Obesity treatment guidelines [Internet]. Seoul: Author;2020. [cited 2022 Jan 5]. Available from: http://general.kosso.or.kr/html/?pmode=BBBS0001300003&page=1&smode=view&seq=1358&searchValue=&searchTitle=strTitle.

26. Kim J. Influential factors of social relation on the change in the depression level of elderly: longitudinal analysis using a latent growth model. J Korea Contents Assoc. 2019; 19(7):138–148. https://doi.org/10.5392/JKCA.2019.19.07.138.

27. Choi YJ, Kim HY. Analyzing changes and determinants of self-rated health during adolescence: a latent growth analysis. Child Health Nurs Res. 2018; 24(4):496–505. https://doi.org/10.4094/chnr.2018.24.4.496.

28. Bae BR. Structural equation modeling with Amos 23: Principles and practice. Seoul: Chungram;2018.

29. Campbell KE, Dennerstein L, Finch S, Szoeke CE. Impact of menopausal status on negative mood and depressive symptoms in a longitudinal sample spanning 20 years. Menopause. 2017; 24(5):490–496. https://doi.org/10.1097/GME.0000000000000805.

30. Del Sueldo M, Martell-Claros N, Abad-Cardiel M, Zilberman JM, Marchegiani R, Fernández-Pérez C. Health perception in menopausal women. Int J Womens Health. 2018; 10:655–661. https://doi.org/10.2147/IJWH.S173891.

31. Gomina M, Ele RN, Imorou RS, Alassani A, Djidonou G, Sina H, et al. Prevalence and factors associated with dyslipidemia among menopausal women in the city of Parakou (Benin). Int Res J Biochem Bioinform. 2017; 7(1):12–18. https://doi.org/10.14303/irjbb.2017.011.

32. Hellgren MI, Kitsche E, Groot-Zevert M, Lindblad U, Daka B. Association between body mass index and self-rated health: a Swedish population-based longitudinal study. Scand J Public Health. 2021; 49(4):369–376. https://doi.org/10.1177/1403494819875012.

33. Lee HM, Chung HJ, Jung IK. Relationships among metabolically healthy status, physical activity, and sedentary behavior according to obesity in low-income menopause women. Asian J Phys Educ Sports Sci. 2020; 8(2):75–89. https://doi.org/10.24007/ajpess.2020.8.2.007.

34. Du Bois SN, Yoder W, Ramos SD, Grotkowski K, Sher TG. Unexpected gender moderation of marital satisfaction–health associations in long-distance relationships. Fam J. 2019; 27(2):133–141. https://doi.org/10.1177/1066480719826300.

35. Cooper J. Examining factors that influence a woman's search for information about menopause using the socio-ecological model of health promotion. Maturitas. 2018; 116:73–78. https://doi.org/10.1016/j.maturitas.2018.07.013.

36. Lee Y. Childbirth and change in marital satisfaction of wives: the mediating effects of changes in leisure with husbands and in their housework. Korean J Fam Welf. 2019; 24(4):519–538. https://doi.org/10.13049/kfwa.2019.24.4.4.

37. Jeong J, Kim M. Awareness and related factors of dyslipidemia in menopausal women in Korea. Healthcare (Basel). 2022; 10(1):112. https://doi.org/10.3390/healthcare10010112.

38. Yang H, Deng Q, Geng Q, Tang Y, Ma J, Ye W, et al. Association of self-rated health with chronic disease, mental health symptom and social relationship in older people. Sci Rep. 2021; 11(1):14653. https://doi.org/10.1038/s41598-021-94318-x.

39. Kim KA, Hwang SY. Effects of a daily life-based physical activity enhancement program for middle-aged women at risk for cardiovascular disease. J Korean Acad Nurs. 2019; 49(2):113–125. https://doi.org/10.4040/jkan.2019.49.2.113.

40. Cho OH, Hwang KH. Comparison of quality of life and related factors according to premature menopause using the Korea National Health and Nutrition Examination Survey (2014–2017). Korean J Women Health Nurs. 2020; 26(2):131–140. https://doi.org/10.4069/kjwhn.2020.03.27.

41. Chen GC, Arthur R, Iyengar NM, Kamensky V, Xue X, Wassertheil-Smoller S, et al. Association between regional body fat and cardiovascular disease risk among postmenopausal women with normal body mass index. Eur Heart J. 2019; 40(34):2849–2855. https://doi.org/10.1093/eurheartj/ehz391.

42. Chae H. Relationships between obesity and physical activities and prevalence of osteoarthritis in menopause women. J Digit Converg. 2020; 18(3):217–225. https://doi.org/10.14400/JDC.2020.18.3.217.

43. JafariNasabian P, Inglis JE, Reilly W, Kelly OJ, Ilich JZ. Aging human body: changes in bone, muscle and body fat with consequent changes in nutrient intake. J Endocrinol. 2017; 234(1):R37–R51. https://doi.org/10.1530/JOE-16-0603.

44. Naworska B, Brzęk A, Bąk-Sosnowska M. The relationship between health status and social activity of perimenopausal and postmenopausal women (health status and social relationships in menopause). Int J Environ Res Public Health. 2020; 17(22):8388. https://doi.org/10.3390/ijerph17228388.