Decision making, beliefs, and attitudes toward hysterectomy: A focus groupstudy with medically underserved women in Texas

Variations in hysterectomy rates have been associated with assorted physici an and patient characteristics, and the disproportionate rate of hysterecto mies in African American women has been attributed to a higher prevalence o f leiomyomas. The role of women's beliefs and attitudes toward hysterectomy and participation in decision making for medical treatment has not been ex plored as a source of variance. The purposes of this qualitative study were to explore these constructs in a triethnic sample of women to understand b eliefs, attitudes, and decision-making preferences among underserved women; to facilitate development of a quantitative survey; and to inform developm ent of interventions to assist women with such medical decisions. Twenty-th ree focus groups were conducted with 148 women from community sites and pub lic health clinics. Thirteen self-identified lesbians participated in three groups. Analysis of audiotaped transcripts yielded four main themes: perce ived outcomes of hysterectomy, perceived views of men/partners, opinions ab out healthcare providers, decisionmaking process. Across groups, the women expressed similar expectations from hysterectomy, differing only in the deg ree to which dimensions were emphasized. The women thought men perceived wo men with hysterectomy as less desirable for reasons unrelated to childbeari ng. Attitudes toward physicians were negative except among Hispanic women. All women expressed a strong desire to be involved in elective treatment de cisions and would discuss their choice with important others. Implications for intervention development include enhancing women's skills and confidenc e to evaluate treatment options and to interact with physicians around trea tment choices and creation of portable educational components for important others.