Visual-analog scales can be uni- or multidimensional. That is, some VAS ask for
a rating of a single issue on a single line (i.e.,‘how tired do you feel right now?’),
whereas others ask for ratings of multiple items and calculate a total score by
adding together the measured score for each item. TheVerran Snyder-Halpern
Sleep Scale(VSH) is one multidimensional scale that uses VAS to obtain answers
to 16 questions about the respondent’s sleep characteristics. These questions
investigate the domains of sleep disturbance (7 questions), sleep effectiveness (5
questions), and sleep supplementation (i.e., additional periods of sleep) (4 ques-
tions) during the previous night (Snyderhalpern and Verran 1987 ; Rychnovsky and
Hunter 2009 ). The scale was initially tested on a healthy, non-clinical sample of
non-postpartum male and female respondents (Snyderhalpern and Verran 1987 ). It
has since been used to evaluate sleep characteristics of postpartum US women
(Rychnovsky and Hunter 2009 ).
Lee’sFatigue Scalewas initially developed using an 18-item VAS scale with
non-postpartum respondents (Lee et al. 1991 ). A shortened 9-item version using
10-point Likert scales for 18 items, anchored at each end with statements such as
‘not fatigued/extremely fatigued’, has been used to measure fatigue among post-
partum mothers of low-birthweight infants (Lee and Hsu 2012 ).
TheGeneral Sleep Disturbances Scale(GSDS) is a multidimensional 21-item
index, with each item scored on an 8-point scale, through which respondents are
asked to indicate how many days in the past week they have experienced particular
sleep-related issues. The scale was initially designed to investigate sleep distur-
bance among female shift workers (Lee 1992 ) but has been validated and widely
used with pregnant women and with new parents (Gay et al. 2004 ; Goyal et al.
2007 ; Lee and Hsu 2012 ). The self-medication subscale investigating the use of
alcohol and other substances to initiate sleep has been found to be of limited use
with the population of postpartum women.
Swanson and colleagues (Swanson et al. 2011 ) used theInsomnia Severity
Index(ISI) in a study of depression and anxiety among perinatal women. The ISI is
a 7-item self-report measure of the severity of insomnia symptoms, rated on a
5-point scale, with scores ranging from 0 to 28. While this measure was appropriate
for the study population (those with mental health issues that might seriously affect
sleep), its appropriateness for a general population of postpartum parents might be
questionable.
TheFatigue Symptoms Checklist(FSC) wasfirst devised to measure fatigue
experience among Japanese workers, eliciting yes/no answers to 30 symptoms of
fatigue (Yoshitake 1978 ). It has since been used quite widely to investigate fatigue
in the postpartum period, with variations in naming including the Fatigue
Identification Formand theFatigue Continuum Form. Milligan and colleagues
employed a slightly modified (reworded) version of the FSC to measure fatigue
among postpartum women (Milligan et al. 1997 ). The authors argued that despite its
development with (mostly male) shift-workers, the scale is particularly appropriate
for the measurement of postpartum fatigue because it is a multidimensional
instrument, it conceptualizes fatigue as a negative experience, shows good construct
validity, and is short and easy to administer (Milligan et al. 1997 ). They also tested
36 A.E.F. Rudzik and H.L. Ball