particularly in multiethnic or cross-cultural contexts (Byrne and Campbell 1999 ;
Gonzalez-Calvo et al. 1997 ). In sum, symptom scales are well suited to large
studies which demand low burden and minimal cost, but lack sufficient precision
for more in-depth study of hotflashes.
Daily Diaries
. Daily diaries come in paper and electronic format and are ubiquitous in medical
and clinical research. In fact, they are used to collect data in 25% of all phase II–IV
pharmaceutical trials (Shiffman et al. 2001 ). Typically these diaries are completed at
the end of the day or upon waking. One widely used diary in hotflash research is
the Hot Flash Daily Diary, which asks women to report the frequency and severity
of their hotflashes (mild, moderate, severe, very severe) over the prior 24 h (Sloan
et al. 2001 ). Other diaries ask participants to report their hotflashes before bed and
upon waking. For example, the MsFlash study asked women to record the number
and severity of hotflashes or night sweats in daily diaries in the evening and upon
waking throughout their study (Freeman et al.2011a). Although hotflash diaries
are commonly kept for a week, research has shown that a 3-day diary completed at
the time of the hotflash yields comparable hotflash estimates as a similar diary
used for a week (Grady et al. 2009 ).
An advantage to diaries is that they reduce some of the recall and reconstruction
required by questionnaire measures. However, diaries completed at the end of the
day or upon waking still involve a certain degree of reconstruction. For example, a
study comparing end-of-the-day diaries to prospectively completed diaries revealed
that women underestimated the number of daytime hotflashes recorded at the end
of the day compared to hotflashes that were prospectively reported or physiolog-
ically monitored (Fu et al. 2014 ). Moreover, hotflashes that occur during sleep may
not be accurately reported on waking and may be influenced by the quality of sleep
during the prior night (Regestein 2006 ; Thurston et al. 2006 ). Further, the mood
and/or physical state of the participants at the time of data entry can impact the
memory of symptom reports over the prior day. For example, when compared to
prospective symptom reports, individuals’recall of pain symptoms at the end of the
day was increased if they were fatigued or in a negative mood (Eich et al. 1985 ;
Stone and Shiffman 2002 ).
The recall advantage of diaries may be further undermined if participants fail to
complete them when instructed (Stone et al. 2003 ). In fact, data indicate that
backfilling of paper diary entries is common (Besch 1995 ). In one study of pain,
only 11% of the diaries werefilled out at the prompts, despite 90% of the paper
entries indicating the appropriate time, suggesting a high level of faked compliance
(Stone et al. 2003 ). Compliance with electronic diaries is typically much higher
(e.g., 94%; Stone et al. 2003 ). Thus, if daily diaries are to be employed, electronic
diaries with compliance-enhancing features are recommended. Diaries completed
once or twice a day can provide a rich source of data, particularly for longer
11 Hot Flashes: Phenomenology and Measurement 237