Characterized by menstrual pain, dysmenorrhea affects 45-95% of women of reproductive age worldwide. It is the leading cause of school and work absences among women. According to an increasing volume of research evidence, dysmenorrhea may increase women’s risk for developing other chronic pain later in life. To develop and test interventions to support dysmenorrhea management, validated symptom measurement tools are fundamental. Symptom interference with daily activities has been widely recognized as a core outcome in symptom research. Available pain interference scales are limited by (1) mainly targeting individuals with chronic non-cyclic pain (i.e., not dysmenorrhea-specific) and (2) only applying to one age group (i.e., either a pediatric or an adult population). To the best of our knowledge, few validated tools are available to specifically quantify how cyclic dysmenorrhea symptoms interfere with women's daily activities. In addition, few tools are applicable to both young adolescent and adult populations--both groups can be affected by dysmenorrhea. Therefore, the purpose of this study was to develop and test the Dysmenorrhea Symptom Interference (DSI) scale among adolescent girls and women with dysmenorrhea.
Methods:
Our study team used qualitative approach for scale development and quantitative approach for scale testing. The goal of the qualitative phase was to develop the items for the DSI scale while the goal for the quantitative phase was to evaluate the psychometric properties of the DSI scale. In the completed qualitative phase, we recruited a sample of 30 individuals with dysmenorrhea through (1) a study information page hosted at our home institution, (2) study flyers posted locally, and (3) Facebook® and Instagram® ads. We selected a heterogeneous sample in terms of age, race/ethnicity, education level, employment status, and symptom severity to capture the views of women from different backgrounds and lifestyles. Before the interview, an initial pool of the items was developed by our team based on previous research on dysmenorrhea and a review of established questionnaires measuring symptom interference. These items were administered to 30 participants, then cognitive interviews were performed using the think-aloud and verbal probing techniques. The interview process ensured that the content of items captured the most important aspects of the concepts of interest and that respondents understood how to complete the items, how to reference the appropriate recall period, the meaning of the items, and how to use the response option scales. During each interview, detailed notes were taken, and after each interview, participants’ responses were analyzed for relevant input to identify potential items for the questionnaire. The research team met regularly to discuss the analysis. This process led to a preliminary questionnaire of 9 items. The quantitative portion of the study is ongoing. The quantitative phase involves a survey of 600 participants with dysmenorrhea. We will evaluate newly developed items in terms of reliability, construct validity, content validity, and criterion validity.
Results:
Through the qualitative interviews, we found dysmenorrhea symptoms affected various aspects of women’s lives (e.g., physical activities, sleep, mood, concentration, leisure, and social activities). In addition, individuals were affected by dysmenorrhea symptoms differently based on their lifestyles and types of daily activities (employment status, whether in school, and hobbies). A 9-item scale was developed based on the findings from the qualitative interviews. These items measure how dysmenorrhea symptoms interfere with an individual’s physical, mental, and social activities. Items were selected to ensure they represent how dysmenorrhea symptoms interfere with various aspects of lives. Items were worded to be relevant to women of different age and lifestyles. In addition, we revised the questionnaire to improve item clarity, comprehension, and ease of response judgment. The cognitive interviews supported preliminary content validity of the questionnaire. The results from the larger scale psychometric testing will be available by May 2019
Conclusion:
The newly developed DSI scale measures how dysmenorrhea symptoms interferes with individuals’ physical, mental, and social activities. It overcomes the limitations of generic symptom interference scale by (1) focusing on dysmenorrhea symptoms that are cyclic/episodic in nature, (2) targeting multiple age groups, and (3) accommodating various life styles. Through further validating the scale in larger samples, the DSI scale can be adopted in research and clinical practice to facilitate dysmenorrhea symptom assessment and management.