Objective: This study explores how menopausal women perceived supports provided by their

husbands.

Methodology: Total of 13 menopausal women recruited using a combination of purposive and

snowball techniques from two sources, tertiary hospital and local communities in the state of

Kelantan, Malaysia. The in-depth semi-structured interview guided was used to explore how they

perceived supports provided by their husbands. The data were then analysed using a thematic

analysis.

Results: Five (5) themes have emerged which comprises of emotional, instrumental, appraisal,

guidance, and sexual supports. One of which was a new theme (sexual intimacy support) that

had not been existed previously in other literature reviews.

Conclusion: Majority of menopausal women perceived the supports provided by their husband

were negative, rather than positive supports that they had hoped. These findings suggest that

an education program tool for husbands as a support person is much needed to ensure women

walk through the menopause phase in a more meaningful life

Hassan, Intan Idiana

Hussain, Nik Hazlina Nik

Kadir, Azidah Abdul

Nor, Mohd Zarawi Mat

Sulaiman, Zaharah

English

Repository@USM

EMsIAabcdRQh1nferm Clin. 2020;30(S2):190--193www.elsevier.es/enfermeriaclinicaenopausal  women’s  experiences  of  husband’support: A  negative  viewntan Idiana Hassana,b, Nik Hazlina Nik Hussainb,∗, Zaharah Sulaimanb,zidah  Abdul Kadirc, Mohd Zarawi Mat NordDepartment  of  Nursing,  School  of  Health  Sciences,  Health  Campus,  Universiti  Sains  Malaysia,  MalaysiaWomen’s  Health  Development  Unit,  School  of  Medical  Sciences,  Health  Campus,  Universiti  Sains  Malaysia,  MalaysiaDepartment  of  Family  Medicine,  School  of  Medical  Sciences,  Health  Campus,  Universiti  Sains  Malaysia,  MalaysiaDepartment  of  Medical  Education,  School  of  Medical  Sciences,  Health  Campus,  Universiti  Sains  Malaysia,  Malaysiaeceived 29  May  2019;  accepted  15  July  2019KEYWORDSSpousal  support;Menopausal  phases;Husband  support;MenopausalsymptomsAbstractObjective:  This  study  explores  how  menopausal  women  perceived  supports  provided  by  theirhusbands.Methodology:  Total  of  13  menopausal  women  recruited  using  a  combination  of  purposive  andsnowball techniques  from  two  sources,  tertiary  hospital  and  local  communities  in  the  state  ofKelantan, Malaysia.  The  in-depth  semi-structured  interview  guided  was  used  to  explore  how  theyperceived supports  provided  by  their  husbands.  The  data  were  then  analysed  using  a  thematicanalysis.Results:  Five  (5)  themes  have  emerged  which  comprises  of  emotional,  instrumental,  appraisal,guidance, and  sexual  supports.  One  of  which  was  a  new  theme  (sexual  intimacy  support)  thathad not  been  existed  previously  in  other  literature  reviews.Conclusion:  Majority  of  menopausal  women  perceived  the  supports  provided  by  their  husbandwere negative,  rather  than  positive  supports  that  they  had  hoped.  These  findings  suggest  thatan education  program  tool  for  husbands  as  a  support  person  is  much  needed  to  ensure  womenwalk through  the  menopause  phase  in  a  more  meaningful  life.© 2019  Published  by  Elsevier  Espan˜a,  S.L.U. Peer-review under responsibility of the scientific committee of theuality of Life (WOSQUAL-2019). Full-text and the content of it is under∗ Corresponding author.E-mail address: hazlinakck@usm.my (N.H. Nik Hussain).ttps://doi.org/10.1016/j.enfcli.2019.07.075130-8621/© 2019 Published by Elsevier Espan˜a, S.L.U. International Conference on Women and Societal Perspective on responsibility of authors of the article.egatiDPde(atapip9arttmasRDT6taMFewgdTTiwtrcTIdMenopausal  women’s  experiences  of  husband’s  support:  A  nIntroductionMenopause,  also  known  as  the  change  of  life,  is  the  timewhen  menstruation  permanently  ceases  due  to  the  natu-ral  depletion  of  hormone  production  by  the  ovaries.  Alongwith  these  hormonal  changes,  women  might  also  expe-rience  a  midlife  crisis  that  involves  personal  and  socialchanges.1 Although  the  journey  through  the  menopausalphases  is  a  normal  life  transition,  recent  systematic  studieson  the  menopause  experience  have  discovered  that  biologi-cal  changes  that  occur  simultaneously  with  the  midlife  crisismay  have  a  negative  impact  on  women’s  quality  of  life.2,3Nevertheless,  these  impacts  during  menopausal  phaserevolved  not  only  around  the  women  themselves  but  also  bytheir  husbands.  Research  findings  suggested  that  husband’ssupports  may  ease  the  problem  during  their  menopausalphase4 and  may  also  help  healthcare  providers  to  develophealth  interventions  for  these  menopausal  women.5 How-ever,  several  studies  have  also  discovered  that  the  majorityof  husbands  in  many  countries  exhibit  a  negative  reac-tion  toward  their  menopausal  wives.4--7 Previous  researchalso  claiming  that  existing  studies  of  the  husband’s  rolewere  more  concerned  with  women’s  reproductive  phasesand  other  diseases  compared  with  menopausal  phases.7,8Unfortunately,  husbands’  support  to  menopausal  womenin  Asian  countries,  particularly  in  Malaysia  is  still  not  wellstudied.  Therefore,  this  study  explores  the  experiences  ofmenopausal  women  within  the  Malaysian  culture.MethodResearch  designThe  qualitative  method  was  used  to  explore  the  experiencesof  husband  support  among  menopausal  women.  The  in-depthsemi-structured  interview  method  was  the  most  appropri-ate  method  for  discussing  the  sensitive  issues  revolving  themenopause  that  would  normally  be  considered  private  orstressful  event.9,10Research  setting  and  participantsThe  participants  were  recruited  from  two  sources;  a  ter-tiary  government  hospital  and  local  communities  in  the  stateof  Kelantan,  Malaysia.  Participants  were  restricted  to  peri-menopausal  and  postmenopausal  women  as  defined  by  WorldHealth  Organization  (1996)11 women  who  were  not  under-going  Hormonal  Replacement  Therapy  (HRT),  and  womenwho  were  living  with  their  spouse.  Of  the  18  menopausalwomen  initially  approached  as  participants,  only  13  fulfilledthe  inclusion  criteria  for  the  current  study.  The  repeatedinformation  used  to  generate  the  themes  and  subthemeswere  obtained  from  the  interviews  with  nine  participants.However,  the  researcher  continued  to  the  point  of  saturationby  adding  another  four  participants  to  confirm  data  satura-tion  with  maximum  variances.  Thus,  13  participants  wereincluded  in  this  qualitative  study.isawve  view  191ata  collection  methodarticipants  were  invited  for  interview  sessions  at  the  time,ate  and  location  that  suited  their  convenience  and  pref-rence.  The  semi-structured  in-depth  interview  guidelinesIDG)  was  developed  based  on  the  research  questions  thatddressed  the  types  of  support  provided  by  the  spouse,  andhe  support  needed  by  the  menopausal  women.  To  evalu-te  and  enhance  the  rigour  of  the  interview  sessions,  threeilot  interviews  were  conducted  to  refine  the  IDG.  Eachnterview  session  was  conducted  only  once  for  each  partici-ant,  and  each  session  lasted  between  approximately  45  and0  min.  The  data  from  the  interviews  were  audio-recordednd  transcribed  verbatim.  Three  of  the  participants  wereandomly  selected  to  verify  that  the  information  in  theranscripts  was  compatible  with  their  interpretation  duringhe  interviews.  Finally,  the  verbatim  transcripts  were  the-atically  analysed  using  computer-aided  qualitative  datanalysis  software  (CAQDAS),  namely,  ATLAS.ti  software  ver-ion  11  (Scientific  Software  Development,  GmbH,  Berlin).esultsemographic  characteristics  of  participantshirteen  menopausal  women  between  the  ages  of  49  and0  years  participated  voluntarily  in  this  study.  Majority  ofhese  Muslim  couples  had  been  married  more  than  30  yearsnd  had  secondary  education.enopausal  women’s  experiencesive  themes  were  identified  to  explain  the  women’s  experi-nce  of  support  from  their  husband  during  menopausal  phasehich  comprises  of  emotional,  instrumental,  appraisal,uidance,  and  sexual  supports.  The  following  present  theetails  of  some  of  the  themes  and  quotations.heme  1:  Emotional  supporthe  findings  indicated  that  this  type  of  support  related  tondirect  support  to  show  care.  However,  there  were  womenho  did  not  like  to  express  their  problems  to  their  respec-ive  spouses  because  they  were  used  to  not  getting  anyesponses  from  their  respective  spouses.  One  of  the  womenommented:‘‘I  told  him  [husband]  that  I  often  felt  tired  nowadays,but  he  just  kept  quiet.  He  listened  but  he  kept  quiet,and  it  has  always  been  like  that.’’  (ID  03)heme  2:  Instrumental  supportnstrumental  support  relates  to  behaviours  that  provideirect  assistance  such  as  helping  with  housework,  provid-ng  company  and  managing  personal  needs.  Some  of  thepouses  assisted  the  women  in  managing  the  household  suchs  doing  the  laundry,  folding  the  clothes  and  preparing  mealsithout  being  asked.  However,  there  were  also  cases  when1teTTddcsoTTscgwnqTTtrisnassmwcmaDToitittmmrirNwmnemmnhkmwdttasoprrBtamscal92  he  spouse  never  helped  at  all,  even  when  requested.  Forxample,  a  woman  mentioned:If  he  stayed  at  home,  there  was  a  lot  of  work  that  hecould  have  helped  me  with.  But  he  left  me  to  do  allthese  house  chores,  clean  the  yard  and  plant  trees.  Ialready  asked  him  to  do  them,  to  clear  the  drains,  buteven  today,  it  has  not  been  taken  care  of.  He  rarely  isaround  because  he  likes  to  be  at  the  coffee  shop  and  havea  long  chat  with  his  friends.  (ID  08)heme  3:  Esteem  supporthis  type  of  support  relates  to  validation  and  showing  confi-ence  in  the  women’s  abilities  such  as  helping  to  easeiscomfort,  giving  compliments,  showing  agreement,  beingonsoling  and  expressing  love.  As  expected,  none  of  thepouses  verbally  expressed  their  love  for  these  women.  Onef  them  expressed:‘‘He  does  not  say  that  he  loves  me.  But  I  know  that  heloves  me  through  his  own  ways,  such  as  by  gently  caress-ing  me  when  we  are  in  [the  privacy  of]  our  room  andspeaking  to  me  gently  and  affectionately.’’  (ID  12)heme  4:  Guidance  supporthe  findings  of  the  current  study  identified  that  this  type  ofupport  related  to  providing  knowledge  and  advice  to  showare.  Only  a  small  number  of  women  said  that  their  spousesave  them  advice  when  they  were  facing  problems.  Mean-hile,  nearly  half  of  the  women  said  that  their  partners  didot  give  them  any  kind  of  advice,  but  rather  chose  to  stayuiet.  For  example,  a  woman  mentioned:‘‘He  was  not  giving  any  advice  but  rather  he  was  justbragging  about  how  he  had  managed  to  avoid  facing  sim-ilar  issues  that  I  was  facing.  He  said  to  me  that  I  hadgained  weight  because  I  did  not  watch  my  diet. .  .  thatI  was  drinking  my  drinks  during  my  meals.  [He  told  methat]  I should  drink  my  drinks  2  to  3  minutes  after  a  meal.[He  also  told  me  that]  I  should  not  drink  cold  drinks  withice.  . .  so  that  [my]  body  would  stay  in  shape  and  wouldnot  age  quickly.  [He  also  said  that]  Women  [usually]  agefaster  than  men.’’  (ID  13)heme  5:  Sexual  intimacy  supporthis  was  the  first  issue  women  raised  that  was  the  effecthat  the  menopause  had  on  their  sexual  relationship.  As  aesult,  the  following  subthemes  emerged:  discusses  sexualssues,  show  intimacy  openly,  shows  affection,  satisfactoryex  and  respectful  of  my  feelings.  Most  of  the  spouses  couldot  compromise  on  issues  involving  sexual  intercourse.  Only few  women  stated  that  their  partners  did  not  discuss  theirexual  relationship  issues  at  all,  which  then  led  to  misunder-tandings.  One  of  them  expressed:‘‘I  felt  some  kind  of  burning  pain  when  we  were  engagingin  intimate  [sexual]  acts  but  I  did  not  tell  him  aboutit.  So,  [for  us  women]  if  we  feel  pain. .  .  we  would  loseinterest  [in  sex].  So,  if  I  did  not  respond  to  his  sexualCTcH.  Intan  Idiana  et  al.advances...  [and]  gave  excuses  that  I  was  tired. .  . or  thatI  was  having  hot  flushes,  he  would  not  say  anything  butappeared  to  sulk  and  turned  his  back  toward  me  in  bed.’’(ID  03)Towards  the  end  of  the  interview,  however,  allenopausal  women  agreed  affirmatively  when  askedhether  they  thought  that  their  spouse  should  help  themope  with  the  menopause  phase.  Nonetheless,  all  of  theseenopausal  women  hoped  that  their  spouses  would  eventu-lly  express  their  love  verbally  to  them.iscussionhis  research  was  undertaken  with  menopausal  women  inrder  to  explore  their  experience  of  husband’s  support  dur-ng  this  phase.  Four  of  the  themes  were  found  parallel  withhe  findings  from  literature  reviews  while  the  fifth  themes  a  new  theme  emerge  (sexual  intimacy  support)  fromhis  study.  Notably,  when  asked  about  their  experiences  ofhe  perceived  support  from  their  spouses,  the  sexual  inti-acy  support  theme  was  the  first  issue  expressed  by  theenopausal  women  in  this  study.  This  result  was  compa-able  with  the  previous  study  among  menopausal  womenn  Kelantan,  nearly  two-thirds  of  menopausal  women  expe-ienced  reduced  sexual  desire  following  the  menopause.9apes  (2013),  who  conducted  a  study  among  menopausalomen  in  Malaysia,  also  noted  that  low  sexual  desire  was  aajor  complaint  among  these  women.10 Interestingly,  thisew  emerged  domain  had  not  been  included  in  any  of  thexisting  support  model,  measurements  or  any  of  the  inti-ate  studies  reviewed.12,13The  findings  also  revealed  that  quite  a number  ofenopausal  women  perceived  the  support  provided  wereegative  rather  than  positive  types  of  support  that  they  hadoped.  Many  previous  studies  have  stated  that  a  lack  ofnowledge  among  husbands  is  the  major  factor  that  deter-ines  their  negative  reactions  towards  their  menopausalives.6,7,14--16 As  described  in  a  recent  qualitative  study  con-ucted  with  men  in  Brazil  revealed  that  the  men  believedhat  menopausal  symptoms  are  a  myth  or  excuses  told  byheir  wives.6 This  poor  knowledge  consequently  leads  ton  underestimation  or  misunderstanding  of  the  developingymptoms  among  their  menopausal  partners4 and  these  menften  feel  powerless  to  offer  support.7 Similarly,  a  recentreliminary  study  among  Malaysians  found  that  male  spouseseported  that  their  lack  of  knowledge  was  the  main  bar-ier  to  providing  menopausal  support  to  their  partners.16esides,  a  recent  review  on  men’s  perceptions  revealedhat  negative  reactions  towards  the  menopause  are  medi-ted  mainly  by  the  sociocultural  factors  of  a  country.6 Inany  Western  communities,  menopause  is  related  to  socialtigmatisation  and  labelled  as  a  taboo  that  cannot  be  dis-ussed  openly,17 a private  thing  that  is  associated  with  sexualspects18,19 or  an  awkwardness  that  is  inappropriate  for  pub-ic  discussion.7,17,20onclusionhe  negative  support  that  the  menopausal  women  per-eived  from  their  husbands  highlight  the  need  to  developegati1111111111Menopausal  women’s  experiences  of  husband’s  support:  A  nan  educational  intervention  as  early  as  possible  dur-ing  the  menopausal  phases.  As  numerous  studies  haverecommended,  educational  interventions  that  suited  tocultural  aspects  of  the  population  are  needed  to  increasemenopausal  health  awareness  among  husbands  and  over-coming  social  stigma  in  society.Conflict of interestThe  authors  declare  no  conflict  of  interest.AcknowledgementsThe  researchers  would  like  to  thank  all  menopausal  womenwho  have  been  participated  in  this  study  and  to  Univer-siti  Sains  Malaysia  for  funding  this  study  through  ResearchUniversity  Grant  (1001/PPSP/8012224).References1. Wong LP, Awang H, Jani R. Midlife crisis perceptions, experi-ences, help-seeking, and needs among multi-ethnic Malaysianwomen. Women Health. 2012;52:804--19.2. Mahboubeh T, Somayeh A, Ozgoli G, Ebadi A, Nourossadat K.Strategies to improve menopausal quality of life: a systematicreview. J Educ Health Promot. 2018;7:1--9.3. Yazdkhast M, Simbar M, Abdi F. Empowerment and coping strate-gies in menopause women: a review. Iran Red Crescent Med J.2015;17:1--5.4. Hidiroglu S, Tanriover O, Ay P, Karavus M. A qualitative study onmenopause described from the man’s perspective. J Pak MedAssoc. 2014;64:1031--6.5. Dillaway HE. «Why can’t you control this?» How women’s inter-actions with intimate partners define menopause and family. JWomen Aging. 2008;20:47--65.6. Reale J, Rodolpho C, Quirino BC, Hoga LAK, Rosa PLFS. Men’sperceptions and attitudes toward their wives experiencingmenopause. J Women Aging. 2016;28:322--33.2ve  view  1937. Mansfield PK, Koch PB, Gierach G. Husbands’ support of theirperimenopausal wives. Women Health. 2003;38:97--113.8. Stewart M, Davidson K, Meade D, Hirth A, Weld-Viscount P.Group support for couples coping with a cardiac condition. JAdv Nurs. 2001;33:190--9.9. Dillon H, Singh HJ, Shuib R, Hamid AM, Mohd Zaki Nik MahmoodN. Prevalence of menopausal symptoms in women in Kelantan,Malaysia. Maturitas. 2006;54:213--21.0. Napes MM, Sidi H, Ahmad S, Naim NM, Midin M, KasimMZM, et al. Prevalence and associated factors of sexual dys-function in Malaysian menopausal women. Sains Malaysiana.2013;42:1011--7.1. World Health Organ Tech Rep Ser. World Health Organization.Research on the menopause in the 1990’s. Report of a WHOScientific Group; 1996.2. Dehle C, Larsen D, Landers JE. Social support in marriage. AmJ Fam Ther. 2001;29:307--24.3. Suhr JA, Cutrona CE, Krebs KK, Jensen SL. The social supportbehavior code (SSBC). In: Baucom PKKD, editor. Couple obser-vational coding systems. Mahwah, NJ: Erlbaum; 2004. p. 311--8.4. Solstad K, Garde K. Middle-aged Danish men’s ideas of amale climacteric -- and of the female climacteric. Maturitas.1992;15:7--16.5. Koch PB, Mansfield PK. Facing the unknown: social support dur-ing the menopausal transition. Women Ther. 2004;27:179--94.6. Kadir AA, Hassan II, Hussain NHN, Sulaiman Z, Noor NM, IsmailSB. Spouse’s knowledge, attitude and support on menopause:the hidden facts. Malaysian Fam Physician J. 2015;10:2.7. Yagnik AS. Reframing menstruation in India: metamorphosis ofthe menstrual taboo with the changing media coverage. HealthCare Women Int. 2014;35:617--33.8. Ayers B, Mann E, Hunter MS. A randomised controlled trialof cognitive-behavioural therapy for women with problematicmenopausal hot flushes: MENOS 2 trial protocol. BMJ Open.2011;1:1--8.9. Hinchliff S, Gott M. Seeking medical help for sexual concernsin mid-and later life: a review of the literature. J Sex Res.2011;48:106--17.0. Duffy O, Iversen L, Hannaford PC. The menopause «It’s some-where between a taboo and a joke». A focus group study.Climacteric. 2011;14:497--505.

Menopausal women’s experiences of husband’s

support: a negative view

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Menopausal women’s experiences of husband’s support: a negative view

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