Clinical Relevance: Interventional strategies that aim at promoting self-care behaviors among adolescent girls with dysmenorrhea should strengthen girls’ self-care agency and should target those with a younger age, higher pain intensity, mother with a higher educational level, father with a lower educational level, and those who do not take self-medication for dysmenorrhea.
Dysmenorrhea is a common menstrual problem among adolescent girls (Banikarim, Chacko, & Kelder, 2000; Bettendorf, Shay, & Tu, 2008). Prevalence rates have been reported ranging from 20% to 90% (Campbell & McGrath, 1999; Davis, Westhoff, O’Connell, & Gallagher, 2006). Dysmenorrhea is a distressing condition affecting
role of self-care in relieving dysmenorrhea has also been reported (Cheng & Lin, 2010; Wong & Ip, 2012; Wong, Lai, & Tse, 2010). However, little is known about how adolescent girls exercise self-care and the factors associated with it. Understanding adolescents’ self-care behaviors and their associated factors could help healthcare professionals to identify potentially harmful or ineffective behaviors, and therefore formulate appropriate management and education plans (Hillen, Grbacac, Johnston, Straton, Keogh, 1999). This study was guided by Orem’s self-care deficit nursing theory. According to Orem (2001), a person initiates and performs self-care for maintaining life, healthful functioning, and well-being. He or she must acquire selfcare agency for self-care, and self-care agency is influenced by basic conditioning factors (BCFs). BCFs include age, gender, developmental state, environmental factors, family system factors, sociocultural factors, health state, pattern of living, healthcare system factors, and availability of resources (Orem, 2001). These BCFs may influence an individual’s ability to participate in self-care activities or modify the kind or amount of self-care required. On the basis of Orem’s theory and literature review, potential variables of BCFs postulated as influencing self-care behaviors or self-care agency of adolescent girls suffering from dysmenorrhea were identified. The relationship among age, self-care agency, and selfcare behaviors of adolescent girls suffering from dysmenorrhea was initially examined. Previous studies proposed that self-agency and self-care behaviors likely increase as girls increase in age (Moore, 1993; Zhimin, 2003). However, other studies (Cull, 1996; Dashiff, McCaleb, & Cull, 2006; McCaleb & Cull, 2000) documented a negative correlation between age and disease-related self-care. Family system factors are commonly defined as mother’s and father’s occupation and education, living situation, marital status, birth order, and social and emotional support (Moore & Pichler, 2000). Adolescent girls usually sought advice regarding dysmenorrhea self-care from their mothers (Chiou & Wang, 2008); educated mothers may also provide detailed information regarding dysmenorrhea (Finlay, Jones, & Kreitman, 2000); thus, a mother’s educational level possibly influenced the selfcare of adolescent girls suffering from dysmenorrhea. A father’s educational level also possibly influenced selfcare (Cull, 1996; McCaleb & Cull, 2000). For sociocultural factors, Orem (2001) did not provide adefinitionforitbutincludedculture,education,occupation, and experiences as sociocultural factors without further elaboration. In Chinese culture, illness occurs when there is an imbalance between yin–yang, hot–cold, dry– wet, as well as “qi” and holism (Ma, 1999). Menstrual symptoms, such as dysmenorrhea, can be interpreted as
dysmenorrhea in Hong Kong (Wong, Ip, Choi, & Shiu, 2013). Thus, further research is required to test the relationship between self-medication and self-care behavior in a local context. Likewise, self-care agency influences self-care, as explained in Orem’s theory and previous studies (Slusher, 1999; Callaghan, 2006). In summary, previous studies support the proposition and provide inconclusive evidence with regard to the relationship between BCFs, self-care agency, and self-care. However, no study to date was found to examine the role that BCFs and self-care agency play in the dysmenorrhea self-care behaviors. Even though existing theories provide insight into the factors necessary for self-care behavior, this should be tested before conclusions are made. Accordingly, a total of 13 variables were assessed. Eleven of these variables were BCFs, which included age, two family system factors (mother’s educational level and father’s educational level), one sociocultural factor (family income), three health state factors (regularity of menstrual cycle, duration of menstruation, and pain intensity), one pattern of living factor (limitations in daily activities due to dysmenorrhea), one healthcare system
not only the academic and social aspects of adolescent girls, but it is also the leading cause of their short-term school absenteeism (Banikarim et al., 2000). Adolescent girls prefer performing self-care to relieve their discomfort instead of seeking medical advice (Chiou & Wang, 2008; Lau, Yu, Cheung, & Leung, 2000). The important
weakness in the general health of women and is caused by “blood” and “qi” stagnation that results in an imbalance of yin and yang in the body. Given that culture determines the ways in which symptoms, such as menstrual pain, were handled (McMaster, Cormie, & Pitts, 1997), culturally specific self-care behavior on dysmenorrhea, such as the use of herbal remedies and acupressure, were reported in previous studies (Cheng, Lu, Su, Chiang, & Wang, 2008; Wong et al., 2010). However, the influence of culture on self-care agency and behavior of dysmenorrhea are difficult to assess using a quantitative approach; a qualitative approach is required to develop insights into the influence of culture on both aspects (Orem, 2001). For instance, adolescent girls with a high family income may be more resourceful than those with low family income; thus, the former may exhibit a higher level of self-care agency and self-care behavior than the latter (Baker & Denyes, 2008). However, using a multiple regression model to predict self-care behaviors, Chang and Chuang (2012) found that the socioeconomic condition of the family was not significantly associated with dysmenorrhea self-care behaviors among adolescent Taiwanese girls. Measurement of the health state has been either general, such as the presence or absence of health problems (Callaghan, 2006), or specific to the disease condition, such as duration of illness (Ailinger & Dear, 1993) or pain intensity (Zadinsky & Boyle, 1996). The regularity of the menstrual cycle, duration of menstruation, and pain intensity were possibly related to self-care behaviors toward dysmenorrhea (Chang & Chuang, 2012; Chia et al., 2013). Patterns of living encompass all the actions people perform daily (Orem, 2001). Limitation in daily activities affects self-care, and the relationship of these activities with self-care was also noted in previous studies (Chia et al., 2013; Ortiz, 2010). The healthcare system is characterized by disciplines, such as nursing and medicine (Orem, 2001). Study has suggested that medical consultation regarding dysmenorrhea influences self-care (Chiu, Wang, Hsu, & Liu, 2013). Availability of resources influences the means to meet self-care measures (Orem, 2001). Prior experience of receiving menstrual education may influence the adoption of self-care behaviors for dysmenorrhea (Chiu et al., 2013); however, Chang and Chuang (2012) found that knowledge about dysmenorrhea was not significantly correlated with the adoption of self-care behavior among adolescent girls. Few studies reported that adolescent girls from Western countries prefer self-medication for dysmenorrhea (Agarwal & Venkat, 2009; O’Connell, Davis & Westhoff, 2006). However, self-medication is not under the construct of self-care among adolescent girls with
factor (medical consultation for dysmenorrhea), and two related to the availability of resources (received menstrual education and self-medication used when experiencing dysmenorrhea). The remaining variables were self-care agency and self-care behaviors for dysmenorrhea. A hypothesized model of self-care behaviors and their associated factors among adolescent girls with dysmenorrhea was proposed (Figure 1).