Midlife Women's Symptom Cluster Heuristics: Evaluation of An iPad Application
Methods: Women aged 40-60 years experiencing symptoms they associated with menopause were recruited through flyers posted on campus and in clinics. Women completed the C-SCAT M app using an iPad by identifying and drawing the symptom clusters they experienced during the last 24 hours, indicating relationships among symptoms, prioritizing the clusters and symptoms within them, and describing their causal attributions, and exacerbating and ameliorating factors. While completing the app, women were asked to “think aloud” about their experience using the app. Data from the C-SCAT M application were downloaded from Amazon Web Services account and saved as screen images in order to preserve the graphical images and text elicited from the application. Qualitative data were saved in verbatim phrases. Conventional content analysis was used to analyze qualitative data.
Results: Thirty women completed the application. Most women (77%) stated that the final diagrams were very/extremely accurate as they showed their symptoms and their connections. Women reported between 1 and 22 symptoms (median 11). Hot flashes, waking up during the night, night sweats, and early morning awakening were the most commonly reported symptoms. Women rated the hot flash as their most bothersome symptom, followed by waking up during the night and fatigue. They reported over 300 different bivariate relationships among their symptoms and over 150 unique causal paths. They believed that hot flashes caused several symptoms, especially sleep disruption, and most could describe the time order of their symptoms. Women reported clusters consisting of 2 to 18 symptoms. Women also named each cluster based on their response to their symptoms (“really annoying”), the time of occurrence (“night problem”), and symptoms in the cluster (“hot flash”). They attributed their clusters to menopause, life demands, and other symptoms, among other causes. Management strategies that women used included: use of over the counter preparations, sleep, rest, and other lifestyle changes. Some women requested a copy of their final symptom cluster diagram to discuss with their health care providers.
Conclusion: Using the C-SCAT M afforded women an opportunity to depict their symptoms and clusters and relationships among them, as well as to provide narrative data about their heuristics. Women’s unsolicited comments about using the cluster diagram to facilitate conversation about their symptoms with their health care providers suggest the potential value of modifying the C-SCAT M and evaluating its use in a health care setting.