Secondary Topic: Integrative Health and the Underserved
A Systems Thinking Exploration of Women’s Migraine Experiences and Self-Management Strategies
Deanna Befus, PhD, Wake Forest School of Medicine, Winston Salem, NC, United States; Kristen Hassmiller Lich, PhD; Shawn Kneipp, PhD, MSN; Janet Bettger, ScD; Remy Coeytaux, MD, PhD; Janice Humphreys, PhD, MSN, , Durham, NC, United States
Late Breaker: No
Migraine affects over 20% of women and is the 6th most disabling condition worldwide. In incidence and severity, migraine disproportionately disables women occupying low social locations (LSLs). Self-management (SM) behaviors are inextricably linked to social determinants of health, and have direct correlations to health outcomes. Yet women in LSLs are often ignored in highly medicalized migraine research, making their SM behaviors and outcomes largely unknown.
We developed a systems thinking data collection tool to identify and describe: migraine triggers; pharmacological and non-pharmacological SM approaches used; most important management outcomes. During qualitative content analysis, we divided participants (n=19) into three SL groups based on a composite of education, race, and number of times receiving public assistance.
‘Life stressors’ was the top trigger across groups, though specific stressors varied by SL. LSL women engaged in more isolating and avoidant SM behaviors. High social locations (HSL) women used more proactive and integrative approaches and consistently demonstrated more self-efficacy and internal loci of control. LSL women identified concrete SM needs, such as specific objects or environmental requirements (e.g., darkness, quiet), while women in HSLs identified personal qualities and behaviors (e.g., discipline, memory). LSL women identified reduced pain severity as their most valued outcome, while HSL women valued more opportunities for self-improvement. LSL women had lower expectations for SM, displayed less self-efficacy, used fewer integrative approaches and were more focused on difficulties of the migraine experience than SM.
Traditional migraine treatment metrics (frequency, severity, duration) do not reflect our participants’ most meaningful outcomes. SL proved a useful lens through which to explore women’s experiences, and revealed heterogeneity in SM strategies, priorities, and outcomes. Systems thinking approaches present ways to understand complex health behaviors within the context of multiple overlapping systems influencing choices and experiences.