title: Menopause Rating Scale as a screening tool in rural Turkey.
abstract: BACKGROUND
  Women living in rural areas of Turkey experience difficulties in accessing healthcare services, and this is attributed to distance from urban healthcare centers, financial barriers and poverty, a low education level, and gender discrimination. The purpose of this study was to test the applicability of the menopause rating scale (MRS) as a screening tool by primary healthcare professionals for identifying women with severe menopausal symptoms. The objectives of the study were to test the validity and reliability of the MRS in rural areas of Turkey, to determine estimation values for referral to the secondary level of healthcare, and to assess the prevalence of severe menopausal symptoms among rural Turkish women.
  
  
  METHODS
  The sample size was 600 women. The Turkish version of the MRS and the Kupperman index were used to evaluate the severity of symptoms. The internal consistency coefficient (Cronbach's alpha) of the MRS was computed using the test-retest method. The influence of the MRS with regard to the decision to seek medical advice due to menopausal symptoms was considered the validity criterion, and the sensitivity and specificity of the test were established according to this criterion. Estimation values of the test were determined by ROC analysis. Independent variables for the severity of menopausal symptoms were determined using a logistic regression model.
  
  
  RESULTS
  A positive correlation between the MRS and the Kupperman index was revealed (r=0.86, p=0.000). The estimation value or the MRS score that would predict whether a woman had visited a gynecologist at least once due to the severity of menopause symptoms was found to be 16, its sensitivity and specificity were both 60%. The MRS score was higher among participants who evaluated their general health as 'unfit' or who had advanced age, chronic disease, a history of dysmenorrhea, or who had had two or more miscarriages.
  
  
  CONCLUSIONS
  This evaluation of the MRS indicates that the instrument is a comprehensible, useable, reliable screening test for the identification of women with severe menopausal symptoms. By screening using the MRS it is possible for primary healthcare workers in rural areas to identify women in need of referral to an upper-level healthcare institution.
authors.affiliation: Eskisehir Osmangazi University Medical Faculty, Public Health Department, Turkey. selmamet@ogu.edu.tr
authors.forename: Selma
authors.initials: S
authors.lastname: Metintas
authors.forename: Inci
authors.initials: I
authors.lastname: Arýkan
authors.forename: Cemalettin
authors.initials: C
authors.lastname: Kalyoncu
authors.forename: Sinan
authors.initials: S
authors.lastname: Ozalp
mesh_terms: D000328:Adult; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008403:Mass Screening / Q000379:methods; D008507:Medically Underserved Area; D008593:Menopause / Q000502:physiology* / Q000523:psychology*; D008875:Middle Aged; D011594:Psychometrics / Q000295:instrumentation; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D014421:Turkey