A Test of a Model of Care Seeking in Military Women
Name: Petra Goodman
Rank: MAJ, USA
Organization: University of South Carolina Research Foundation
Performance Site: University of South Carolina at Columbia, SC; Moncrief Army Community Hospital, Troop Medical Clinic, Fort Jackson, SC
Year Published: 2002
Abstract Status: Final
Purpose: Many people, including military women, do not seek professional care in an appropriate and timely manner. One health problem for which military women may not seek appropriate professional care in a timely manner is vaginitis. Vaginitis is a significant health problem due to its prevalence and potential for severe consequences. To facilitate appropriate and timely careseeking and to reduce poor health outcomes, care seeking behaviors by military women must be examined. How a person decides to seek care is defined by these behaviors, beginning with cognitive appraisal of a health problem, to management of the problem. The primary aim of this study was to test, based on Lazarus and Folkman's theory of stress and coping, a model of care seeking in military women with vaginitis. Explication of the decision-making process of care seeking was ascertained by understanding how the health outcomes of military women with vaginitis is dependent on the processes of cognitive appraisal and coping, which, in turn, are influenced by antecedent environmental factors (signs and symptoms and material resources). Design: A descriptive design was used to test the model.Sample: A non-random sample of 300 military women, who presented with symptoms of vaginitis were recruited from a health clinic. Instrumentation: The following questionnaires were administered: (a) the Symptom Perception Index, (b) a questionnaire measuring environmental factors specific to the military, (c) the Cognitive Appraisal of Need for Care Seeking Scale, (d) the Ways of Coping Checklist, and (e) the Profile of Mood States. Methods: Data collection included a physical exam and diagnostic testing for measurement of physiological outcomes and completion of questionnaires for measurement of all other variables.Analysis: The model was tested using structural equation modeling.Findings: The data indicated that (a) the antecedent environmental variables directly affected cognitive appraisal (threat), (b) cognitive appraisal (threat) directly affected coping and psychological outcomes, and (c) problem-focused coping directly affected physiological outcomes and emotion-focused coping directly affected psychological outcomes. Seven percent of the variance in physiological outcomes and 45% of the variance in psychological outcomes were accounted for by the structural model equations and the variables age, education level of the participants' fathers/guardians, number of days of physical training, type of military unit, embarrassment about symptoms, and vaginal discharge. The demographic, social, health, and model variables accounted for 15% of the variance in cognitive appraisal (threat), 10% of the variance in problem-focused coping, and 18% of the variance in emotion-focused coping. Nursing Implications: Based on the findings, nurses need to (a) dialogue with women about their appraisal of symptoms of vaginitis; (b) acknowledge the role that factors such as fear and discomfort of clinical procedures and embarrassment related to symptoms play in seeking care; (c) assess the degree of threat posed by symptoms, the type and efficacy of coping strategies, and how the degree of threat contributed to the coping strategy; and (d) assist women with managing the psychological outcomes. The military needs to incorporate educational programs that address the decision-making processes associated with vaginitis and needs to acknowledge constraints on seeking appropriate and timely care.
Final report is available on NTRL: https://ntrl.ntis.gov/NTRL/dashboard/searchResults/titleDetail/PB2014101...