Study design
This cross-sectional, descriptive and community-conducted study was designed to investigate the most serious and common health problems faced by women of different age groups (10-19 years, 20-39 years, 40-49 years and 50-70 years) and their health needs.
Participants
A total of 10,089 women aged 10-70 years old were recruited. We selected 2790 women aged 50-70 years who were surveyed about the demographic data, diseases-related information, self-reported health, and health behaviors and psychological health. Then we excluded 205 subjects aged less than 50 years or more than 70 years. Totally 2585 women aged 50-70 years were included in the analysis.
Procedures
We used a multi-stage stratified random sampling method. Firstly, one prefecture-level city was randomly selected from the eastern, western, southern, northern and central regions of Hunan Province, respectively and as the primary sampling units (PSU). Secondly, a district (urban area) and a county (rural area) in each PSU were randomly selected. Thirdly, 20 communities were randomly selected from 5 sampled districts and 5counties. The random methods mentioned above were the random number table method. Finally, all eligible women were recruited from each sampled communities until the required sample size was reached (No less than 250 women of per age group within each PSU were needed according to the project implementation document). The following eligibility criteria were applied at recruitment: a) Women aged 10-70 years old; b) Current residents in Hunan Province; c) Being able to complete the questionnaires independently or with the help of the investigators.
Approval from the Institutional Review Board of the local organization where the researchers were affiliated was obtained. We used the data with permission which did not need a separate ethical approval.
Data collection was implemented by well-trained community health workers, who were local familiarity. The training contents included the purpose and procedures of the current study and the methods to collect questionnaires. Women were recruited through direct door to door visits. Inform consent was obtained.
Measures
Sociodemographic variables
A sociodemographic questionnaire was self-designed and used to describe the demographic characteristics of the participants. It included: age, height, weight, education level, occupation, average monthly household income, self-reported weight and self-reported physical health. Body mass index (BMI) was calculated as body weight in kilograms divided by the square of height in meters. The BMI was divided into 4 grades according to the China’s Ministry of Health Disease Control Department criteria, as follows: BMI<18.5 (underweight), 18.5≤BMI<24(normal), 24≤BMI<28 (overweight) and BMI≥28 (obese) [19].
Diseases-related information
Women who responded 'yes ' to the question: Has the doctor or other health care professionals ever told you that you had any of the following diseases (hypertension, coronary heart disease/stroke, diabetes, thyroid disorders, rarefaction of bone, gastrosis) were classified as having chronic diseases, (colpitis, cervicitis, pelvic infection, hysteromyoma/adenomyosis, oophoritic cyst, endometriosis, gynecologic tumor, pelvic floor dysfunction) were classified as having gynecopathy and (breast hyperplasia, benign breast cyst, breast fibroids, breast cancer) were classified as having mastopathy.
Health behaviors
We used 8 indicators to describe health behaviors as following: drinking, smoking, exposure to secondhand smoke, cervical cancer screening, breast cancer screening, regular health examination, sleep and moderate exercise. Sleep were classified as insufficient (sleep duration <7 hours per day), sufficient (7 hours per day ≤ sleep duration <9 hours per day) and excessive (sleep duration ≥9hours per day (excessive) [20].
The Patient Health Questionnaire and the Generalized Anxiety Scale
The Patient Health Questionnaire (PHQ-9) was a self-report questionnaire to assess depressive symptoms over the past 2 weeks[21]. PHQ-9 has been translated by scholars in China and the Chinese version of PHQ-9 has showed good sensitivity, specificity and reliability with a Cronbach’s α value of 0.857[22, 23]. It uses a 4-point rating scale generating a total score ranging from 0 to 27. The participants in the present study were categorized into two groups: non-depressive symptoms (the total scores were <10) and depressive symptoms (the total scores were≥10).
The Generalized Anxiety Scale (GAD-7) was a self-report questionnaire to assess anxiety symptoms over the past 2 weeks[21]. Chinese version of GAD-7 has been widely used and a Cronbach’s α value of 0.898 was found in the previous study which suggested good reliability[24]. The GAD-7 uses a 4-point rating scale generating a total score ranging from 0 to 21. The participants in the present study were categorized into two groups: non-depressive symptoms (the total scores were <10) and depressive symptoms (the total scores were≥10).
Statistics analyses
All data were independently double-entered and validated using EpiData 3.0. Data were analyzed with SPSS 19.0. Descriptive statistics were used to examine the sociodemographic factors, the diseases-related information, health behaviors and psychological health status of the participants, including means and standard deviations (mean ± SD) for continuous variables, and counts (percentages) for categorical variables. The chi-square test was used for the measurement of the categorical variables, in order to assess the statistical significances among the groups. Significant variables were used in a multivariate binary logistic regression model to examine the correlating factors of diseases-related information, health behaviors, and psychological health status. The inclusion P-value was 0.05, and the removal value was 0.10. A two-tailed p-value < 0.05 (p-value < 0.10 in logistic regression) was considered significant. Missing values of all items were less than 10%.