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The Hot Flush Behavior Scale: a measure of behavioral reactions to menopausal hot flushes and night sweats

Hunter, Myra S. PhD; Ayers, Beverley DHPsych; Smith, Melanie DClinPsych

doi: 10.1097/gme.0b013e318219d791
Original Articles

Objective: There is increasing interest in the development of nonmedical treatments for menopausal hot flushes (HF) and night sweats (NS) and some evidence that cognitive behavioral interventions reduce their impact. However, the behavioral component of HF/NS is underresearched. This article describes the development of the Hot Flush Behavior Scale (HFBehS), a measure of the behavioral strategies that women use in response to HF/NS, and reports on the reliability, validity, and factor structure of the scale.

Methods: Behavioral items were generated from the empirical literature and qualitative studies based on in-depth interviews, with the aim of reflecting common behaviors related to HF/NS. A total of 140 women who had HF/NS completed the initial measure. Principal components analyses were applied to the data, with orthogonal rotation, to determine the most coherent and interpretable solution.

Results: Exploratory factor analysis culminated in an 11-item measure comprising three dimensions: behavioral avoidance, practical cooling behaviors, and positive behavioral strategies. The Hot Flush Beliefs Scale subscales had reasonable internal consistency, with α values ranging from 0.59 to 0.76. Validity was supported through correlations with measures of HF/NS problem rating and frequency and cognitive measures (HF/NS beliefs).

Conclusions: Preliminary analysis of the HFBehS reveals it to be a psychometrically sound instrument. The HFBehS is grounded in women's experiences and can be used as a measure of behavioral reactions to HF/NS as well as enabling more rigorous evaluation of psychological interventions.

This study describes the development of the Hot Flush Behavior Scale (including dimensions of avoidance, cooling behaviors, and positive coping strategies), which can be used in evaluations of psychological interventions for menopausal symptoms.

From the Department of Psychology, Institute of Psychiatry, King's College London, London, UK.

Received January 20, 2011; revised and accepted March 10, 2011.

Funding/support: This work was supported by the National Institute of Health Research Biomedical Research Centre for Mental Health, South London, and Maudsley National Health Service Foundation Trust and Institute of Psychiatry, King's College London.

Financial disclosure/conflicts of interest: None reported.

Address correspondence to: Myra S. Hunter, PhD, Clinical Health Psychology, Institute of Psychiatry, King's College London, Department of Psychology, 5th Floor Bermondsey Wing, Guy's Campus, London Bridge, London SE1 9RT, England. E-mail:

©2011The North American Menopause Society