Health service use and self-care by older Australian women with sleeping problems

Research output: ThesisDoctoral Thesis


Objectives: There is very limited research describing the levels or types of
health service use or self-care for women sleeping problems and no study to
date has provided an overview of the use of all treatment options for sleeping
problems among women. The aim of this doctoral study by compilation is, then,
to illuminate the prevalence and type of health service use —including
complementary and alternative medicine (CAM)—and self-care by older
women with sleeping problems. It also aims to investigate the relationship
between demographic profile, and characteristics such as age, income, body
mass index (BMI) and sleeping problems in older Australian women, and
explore the interrelationship between chronic illness and sleeping problems in
This thesis includes two stages of research. The first stage (stage 1, outlined
in chapters 4 and 6), utilises data from the Australian Longitudinal Study on
Women’s Health (ALSWH).
By reporting on the analyses of the most recent survey conducted in 2013, for
the mid-age cohort when the women were aged 62−67 years, chapter 4 aims
to provide some answers to the four research objectives of this thesis. These
objectives are firstly to determine prevalence of health service use—including
practitioner-based CAM—by older Australian women with sleeping problems
and also to determine the prevalence of self-care practiced by older Australian
women with sleeping problems. The chapter also investigates the
xvii characteristics of older women with sleeping problems and the chronic
conditions associated with sleeping problems (objectives 3 and 4 of this thesis
to be outlined in chapter 1) by comparing the profile of women with sleeping
problems to those without. 9,110 participants (99.6%) responded to questions
about sleeping problems, health service utilization and self-care (e.g., herbal
medicines and vitamins), demographics, and chronic illnesses. All health
service and CAM self-care variables were entered into a logistic regression
model. Then a backward stepwise elimination process—using all health
service and CAM self-care variables—was undertaken to ascertain the
likelihood of women with sleeping problems using various health services and
self-care products and practices compared to women without sleeping
problems. Chapter 6 was also part of stage 1 of this research which used data from the ALSWH and similarly contributes to the four research objectives. In chapter 6, characteristics of women with sleeping problems are compared with women without sleeping problems longitudinally by again, as with chapter 4, looking at the cohort of women born in 1946−1951. However, this chapter utilises data from four surveys when the women were aged 56−61 years in 2007, Survey 5 (mean age 58.49 years; SD = 1.46); 59−64 years in 2010, Survey 6 (mean age 61.53 years; SD = 1.46); 62−67 years in 2013, Survey 7 (mean age 64.78 years; SD = 1.47); and 65−70 years in 2016, Survey 8 (mean age 67.74
years; SD = 1.46) meaning there is a greater breadth of ages and age groups
available for analysis. This chapter is a longitudinal analysis of the utilisation
of health services and self-care activities by Australian women with sleeping
problems through GEE regression analysis.
xviii Stage 2 of this research (described in chapter 5), analyses data from a substudy of the 45 and Up Study, the largest ongoing study of healthy ageing in
the southern hemisphere. It investigates risk factors for sleeping problems in a
cohort of older women aged 50-100. Chapter 5 particularly focuses on
answering the research objectives 3 and 4 (as described in the introduction of
this thesis). These research objectives focus on the characteristics of women
with sleeping problems and chronic conditions for older Australian women. To
help reach the research objectives, all variables identified as having a
bivariate association (p < 0.30) with sleeping problems were entered in to a
logistic regression model and a stepwise backward elimination process was
then used to find the most significant predictors of sleeping problems.
Results: Around one in every two older women have sleeping problems.
Health service use and self-care is increased in women with sleeping
problems compared to women without sleeping problems. Specifically, the
odds of consulting a general practitioner (GP) once or twice for women with
sleeping problems increases by a factor of 1.16, 95% confidence interval (CI)
[1.10, 1.24], 1.34, 95% CI [1.26, 1.42] for three−six visits, and 1.58, 95% CI
[1.41, 1.78] for more than seven visits compared with women without sleeping
problems. Women with sleeping problems were also more likely to use herbal
medicines the odds ratio (OR) = 1.13; 95% CI [1.07, 1.30] than women
without sleeping problems.
Longitudinal analysis found that sleeping problems were less likely to arise in
women aged 62−67 years than when women were aged 56−61 years, (OR =
0.85; 95% CI [0.81, 0.90]). Longitudinal analysis of ALSWH showed women
xix with sleeping problems were more likely to be sedentary and less likely to
engage in low levels of exercise (OR = 0.87; 95% CI [0.81, 0.93]), moderate
exercise (OR = 0.85; 95% CI [0.79, 0.91]) or high levels of exercise (OR =
0.82; 95% CI [0.76, 0.88]) than women without sleeping problems (p < 0.001).
Sleeping problems are also significantly associated with chronic conditions.
Analysis of a sub-study of the 45 and Up Study showed that 43% of women
with comorbid chronic conditions reported sleeping problems. Women were
more likely to have a sleeping problem if they reported some difficulties with
available income (OR = 1.61; 95% CI [1.27, 2.04]; p < 0.005), or were
struggling with available income (OR = 2.84; 95% CI [2.04, 3.96]; p < 0.005).
Women were less likely to have sleeping problems if they were highly
physically active (OR = 0.63; 95% CI [0.51, 0.79]; p < 0.005).
Conclusion: Health service use and self-care is elevated amongst women
with sleeping problems in the form of increased GP consultations and herb
use. Medical professionals need to enquire about sleeping problems in older
women and their self-care—particularly herb use, to safeguard patient-safety
and reduce the risk of adverse drug reactions and herb-drug interactions.
Original languageEnglish
QualificationDoctor of Public Health
Awarding Institution
  • University of Technology Sydney
  • Adams, Distinguished Professor Jon , Principal Supervisor, External person
  • Frawley, Associate Professor Jane, Co-Supervisor, External person
  • Sibbritt, Professor David, Co-Supervisor, External person
Award date21 Apr 2021
Place of PublicationSydney, Australia
Publication statusPublished - 21 Apr 2021
Externally publishedYes

Grant Number

  • ARC DP140100238


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