Validation of the Hungarian version of the CarerQol instrument in informal caregivers: results from a cross-sectional survey among the general population in Hungary

Psychometric validation and cultural adaptation of the Chinese version of the CarerQol-7D instrument

OBJECTIVE

This study aims to translate and validate the CarerQol in a sample of informal caregivers in China.

METHOD

The CarerQol was translated following a standard process. Validation data was collected from multiple sources, including hospitals, patient associations, and community health centers between September 2023 and December 2024 in China. Caregivers of individuals with disability or long-term care needs were recruited. The psychometric properties of the CarerQol-7D were evaluated through ceiling and floor effects, factorial structure, convergent and divergent validity, known-groups validity, and test-retest reliability.

RESULTS

A total of 324 participants completed the survey and provided validated responses. The mean CarerQol level sum score was 12.8 (SD = 2.9). The CarerQol-7D showed no ceiling or floor effects at either dimension or scale levels. Test-retest reliability of the CarerQol-7D was satisfactory, as supported by ICC and Gwet's AC1 measures. Correlation analysis confirmed all hypothesized pairs of dimensions and level sum scores/utility scores between CarerQol-7D, SF-6Dv2, and ICECAP-A. The CarerQol-7D successfully distinguished between risk groups through ANOVA testing. Confirmatory factor analysis revealed that a one-factor model of the CarerQol-7D fit the data.

CONCLUSION

This study provides the Chinese version of the CarerQol and confirms its sound psychometric properties for informal caregivers in China. These findings demonstrate the CarerQol's value in cost-effectiveness analyses of caregiving interventions and strategies.

The CarerQol Instrument: A Systematic Review, Validity Analysis, and Generalization Reliability Study

Background/Objectives: The CarerQol instrument is used to measure the quality of life of informal caregivers and to assess the impact that caring for a dependent person has on them. The scale consists of two parts, CarerQol-7D, which measures the effects of informal care using two positive and five negative domains, and CarerQol-VAS, which measures happiness on a visual analog scale. Methods: In the present work, we conducted a systematic review of the instrument since its development in 2006, followed by a (convergent, clinical, and discriminative) validity analysis and a meta-analysis of the reliability of generalizing CarerQol. A total of 54 articles that used CarerQol were identified. Results: The instrument was found to have good convergent, clinical, and discriminant validity, although the average reliability coefficient was 0.67 (95% CI [0.56, 0.75]) for Cronbach's alpha coefficients and 0.62 (95% CI [0.04, 0.89]) for test-retest reliability coefficients, with a high degree of heterogeneity between the coefficients. Conclusions: According to the psychometric theory, CarerQol is a reliable instrument and can be used for exploratory purposes in the field of research, although it should be used with caution when making decisions in clinical practice.

Assessing the psychometric performance of the EQ-5D-5L among informal caregivers of people with dementia

PURPOSE

This study aimed to examine the psychometric performance of the EQ-5D-5L in informal caregivers of people with dementia.

METHODS

Data were obtained from an online survey administered to informal caregivers of people with dementia in Australia. Known-group comparisons were examined by formulating 15 a priori hypotheses, where a difference was made between weak and strong hypotheses. Group comparisons were tested using the non-parametric Wilcoxon-rank and the Kruskal-Wallis test, as well as regression analysis. Floor and ceiling effects were considered to be present if more than 15% of respondents achieved the lowest or highest possible score, respectively.

RESULTS

In total, 212 informal caregivers of people with dementia were included in the analysis. On average, participants were 47 years old (SD: 17) and 61% of them were female. The mean EQ-5D-5L utility score was 0.88 (SD: 0.16) and the mean EQ-VAS was 72.47 (SD: 17.86). While there was no floor effect, 26% reported full health. Nine strong and three weak hypotheses were confirmed, supporting the ability of the EQ-5D-5L to discriminate between groups with respect to: self-reported health status, happiness levels, presence of mental or physical health conditions, ability to engage in enjoyable activities, and availability of support.

CONCLUSION

Findings provide supporting evidence for the EQ-5D-5L in terms of its discriminant validity in informal caregivers of patients with dementia. However, the present ceiling effect suggests that the sensitivity of the EQ-5D-5L to detect improvements may be limited. Further studies are warranted examining other psychometric criteria, including reliability and responsiveness to change.

Psychometric validation of the Persian version of the CarerQol-7D instrument on caregivers of patients with multiple sclerosis

Background: Providing informal care can deeply influence, both physically and emotionally, the quality of life (QoL) of caregivers, especially when the disease becomes chronic. CarerQol-7D is one of the most common instruments for measuring informal care. We aimed to develop a Persian version of the CarerQol-7D in the context of Iranian caregivers of patients with multiple sclerosis (MS). To this end, we investigated the validity and reliability of the mentioned instrument. Methods: In this cross-sectional study using consecutive sampling method, the backward-forward translation method was used to achieve the Persian version of CarerQol-7D. Structural equation modeling (SEM) was used to perform confirmatory factor analysis (CFA). Cronbach's alpha was also reported for this instrument for the evaluation of internal consistency. Results: This tool was evaluated based on a sample of 452 caregivers of patients with MS from Sina Hospital, Tehran, Iran. Most of the participants were men (62.6%) and spouses of patients (56.6%). Based on the correlation of caregivers' characteristics, the clinical validity of this tool was observed to be relatively moderate. The Cronbach's alpha for this tool was estimated to be 65%. The normed fit index (NFI) (0.906), relative fit index (RFI) (0.812), incremental fit index (IFI) (0.948), Tucker-Lewis index (TLI) (0.892), comparative fit index (CFI) (0.946), and root mean square error of approximation (RMSEA) (0.049) were the model fit indices for the CarerQol-7D instrument. Conclusion: The findings showed good internal consistency and strong validity of the CarerQol-7D. Thus, we suggest researchers use this instrument to measure the QoL of caregivers for use in economic evaluations.

Impact of neurofibromatosis type 1 with plexiform neurofibromas on the health-related quality of life and work productivity of adult patients and caregivers in the UK: a cross-sectional survey

BACKGROUND

Plexiform neurofibromas (PN) are complex, benign nerve-sheath tumours that occur in 30-50% of patients with neurofibromatosis type 1 (NF1), a rare, genetic disorder. PN are associated with substantial, heterogeneous morbidities that impact health-related quality of life (HRQoL), including affecting motor function and causing pain, though HRQoL and work productivity data are scarce. This UK cross-sectional study explored HRQoL and work productivity in adult patients with NF1 PN and caregivers of paediatric patients.

METHODS

Adult patients and caregivers of paediatric patients self-enrolled in an online survey (March-April 2021). Outcomes included EQ-5D-5L, PROMIS® GH and INF1-QOL (adult patients only), and EQ-5D-5L, CarerQol and WPAI (caregivers only). Utilities were estimated from EQ-5D-5L responses using the UK crosswalk value set. Linear regression models explored univariable associations between adult patient characteristics and HRQoL.

RESULTS

Mean (± standard deviation) EQ-5D utility in adult patients with NF1 PN was 0.65 (± 0.29; n = 35; age-/sex-matched norm: 0.89 [± 0.04]). Moderate-extreme pain/discomfort and anxiety/depression were reported by 14/35 (40.0%) and 18/35 (51.4%) patients, respectively. Mean PROMIS® GH physical and mental health scores were 43.6 (± 9.19) and 41.7 (± 11.5; n = 35; matched norm: 50.0 [± 10.0]). Mean INF1-QOL score was 11.03 (± 6.02; n = 33). Chronic itching, at least one symptom, at least one comorbidity, PN location at extremities (arms/legs) and pain were associated with worse HRQoL scores. Mean caregiver EQ-5D utility was 0.72 (± 0.24; n = 8; age-/sex-matched norm: 0.88 [± 0.03]). Moderate pain/discomfort and moderate-severe anxiety/depression were reported by 4/8 (50.0%) and 2/8 (25.0%) caregivers, respectively. Mean CarerQol score was 69.3 (± 13.9; n = 8). Mean WPAI regular activity productivity loss was 36.3% (± 31.6%; n = 8).

CONCLUSIONS

NF1 PN worsens adult patient and caregiver HRQoL compared to the general population, notably affecting pain and discomfort, anxiety and depression and caregiver productivity.

Correlation Between the Frailty of Elderly Patients on Regular Haemodialysis and the Quality of Life of Their Family Caregivers: A Cross-Sectional Evaluation

Objective

To investigate the correlation between the frailty status of elderly patients on regular haemodialysis and the quality of life of their family caregivers.

Methods

90 elderly patients with regular haemodialysis and 90 family caregivers of the respective patients were selected from January 2020 to April 2021. The influencing factors of the caregivers' quality of life and correlation between patient debility and caregiver quality of life were analyzed by general information questionnaire, Tilburg debility index scale, self-care ability scale, family caregiver-related quality-of-life scale and social support scale.

Results

The quality of life of the family caregivers of elderly patients on regular haemodialysis is at the medium level (4.50 ± 2.96). Multiple linear stepwise regression analysis shows that the ability of patients to take care of themselves, the degree of patients' weaknesses, whether they care for non-dialysis patients, the time to care for patients, social support and the type of current residence have significant impacts on the quality of life of the caregivers (p < 0.001). Variance analysis showed that the fitting degree of linear regression equation is relatively high, and the regression equation is significant (F = 9.195, p < 0.001, R = 0.595, R² = 0.315). The quality of life of caregivers is positively correlated with the ability of the patients to take care of themselves, the length of care, social support and type of current residence (p < 0.05). The degree of weakness in patients is negatively correlated with taking care of non-regular dialysis patients (p < 0.05).

Conclusion

The ability of patients to take care of themselves, the degree of weakness of the patients, social support and the type of current residence are the influencing factors of the burden on the family caregivers of maintenance haemodialysis patients.

The Role of Associations in Reducing the Emotional and Financial Impact on Parents Caring for Children with Duchenne Muscular Dystrophy: A Cross-Cultural Study

Caregivers' emotions and finances are affected by the deterioration of functional capacity of patients with Duchenne muscular dystrophy (DMD), both in Mexico and Spain. Patient associations may reduce this impact on caregivers. This study aims to study the role of two models of associations, inspired by two different cultural models, in how the services they provide can help decrease the emotional and financial impact on the caregivers of children with DMD. The sample consisted of 34 caregivers from Mexico and 40 from Spain recruited from Spanish hospitals and rare disease organizations in Spain and Mexico. The instruments used consisted of a sociodemographic and socioeconomic questionnaire, the CarerQol-7D, the PHQ-15, the Zarit Caregiver's Burden Scale and the SWLS. The results showed that caregivers in Mexico are in better physical and psychological health than caregivers in Spain. They also receive more subsidies than those in Spain. Caregivers in Mexico have a greater well-being and are less affected by the economic impact of the disease due to the associations' day-to-day work and the fact that they generate a network of health services that they make available to the patient free of charge. These differences may also be attributable to cultural issues and to the fact that Mexico has a deeply established culture of support.

Patient-centred care in Hungary: Contributions to foster a policy agenda

In Hungary, the National Health Insurance Fund provides health care coverage for nearly all residents, but healthcare spending is below the EU's average (6.4% versus 9.9% of the GDP in 2019, respectively). In 1997, patients' rights were established by laws of the healthcare system. The patients' voice, however, has remained weakly embedded in decision-making processes both on the system and individual patient levels. Policy progress achieved in the past years may foster patient-centeredness in health policy decision-making. However, people-reported data are not yet embedded in the Hungarian health information system and national population or household surveys, thus undermining the monitoring of the performance of the health system regarding patient-centred aspects. From the academic research side, several advances have occurred regarding the availability of validated instruments for the measurement of patient-centred aspects. These recent studies have placed Hungary in a uniquely advanced position compared with other countries in the Central and Eastern European (CEE) region. The use of those instruments in clinical guidelines and practices, to the education curricula of future health workers, is still in an early stage.

Estimating an exchange-rate between care-related and health-related quality of life outcomes for economic evaluation: An application of the wellbeing valuation method

Quality of life outcomes for family carers and patients may be measured in different ways within the same economic evaluation. We used the wellbeing valuation method to calculate "exchange rates" between care-related outcomes (the Carer Experience Scale and CarerQoL-7D) and health-related (the EQ-5D-5L) outcomes. Data on quality of life outcomes were collected through a postal quality of life survey in the UK. A random effects model was used to estimate carers' wellbeing as a function of their EQ-5D-5L, Carer Experience Scale (or CarerQoL-7D) and a set of control variables. When life satisfaction was used as the measure of wellbeing, a one-point gain in the Carer Experience Scale (0-100 scale) was equivalent (in wellbeing terms) to a 0.014 gain in EQ-5D-5L value; and a one point gain in the CarerQoL-7D (0-100 scale) was equivalent to a 0.033 gain in EQ-5D-5L. The exchange rate values were reduced when capability was used as the measure of wellbeing. The exchange rates estimated in this study offer a means to place carer and patient outcomes, measured via different quality of life instruments, on a common scale, although there are important issues to consider in operationalising the technique.