Validity and Reliability of Caregiver Contribution to Self-Care of Chronic Obstructive Pulmonary Disease Inventory and Caregiver Self-Efficacy in Contributing to Self-Care Scale

Generic and disease-specific caregiver contribution to self-care in a population with multiple chronic conditions: A comparative study

AIM

Describe and compare generic and disease-specific caregiver contribution (CC) to self-care behaviours in the dimensions of self-care maintenance, self-care monitoring and self-care management in multiple chronic conditions (MCCs).

DESIGN

Multicentre cross-sectional study.

METHODS

We enrolled caregivers of patients with MCC, from April 2017 to November 2022, if they were (a) 18 years of age or older and (b) identified by the patient as the principal unpaid informal caregiver. The Caregiver Contribution to Self-Care of Chronic Illness Inventory, Caregiver Contribution to Self-Care of Heart Failure Index, Caregiver Contribution to Self-Care of COPD Inventory and Caregiver Contribution to Self-care of Diabetes Inventory were used to measure generic and disease-specific contribution to patient self-care. Descriptive statistics, Student's t-tests and Pearson's correlation coefficients were used.

RESULTS

We found adequate generic CC for self-care monitoring but inadequate CC in self-care maintenance and management. All CC to disease-specific self-care maintenance, monitoring and management scales' scores were inadequate, except for caregivers of diabetic patients in which we observed an adequate score in the CC to self-care maintenance and self-care management scales in those practice insulin therapy.

CONCLUSION

Caregivers experience difficulties in performing behaviours of contribution to their patients affected by chronic conditions. Caregivers of patients with MCCs contribute more to self-care in aspects related to provider prescriptions and less to lifestyle changes.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Healthcare professionals have to know in which behaviours caregivers show gaps and reflect on the reasons for poor CC to self-care to develop interventions to enhance these behaviours.

IMPACT

This study underlines the importance of choosing the most appropriate instrument for measuring CC to self-care, considering the caregiver's characteristics.

REPORTING METHOD

We adhered to STROBE guidelines.

PATIENT OR PUBLIC CONTRIBUTION

Caregivers of patients affected by MCCs were enrolled.

Psychometric properties of the caregiver contribution to self-care of oral anticancer agents index: Longitudinal study

BACKGROUND

The use of oral anticancer agents (OAAs) has increased in recent decades. Despite the advantages of OAAs, people with cancer face challenges such as adherence, prevention, recognition, and management of OAA side effects. Informal caregivers can help their patients who take OAAs by facing the above challenges with the implementation of behaviours to maintain stability (Caregiver contribution to self-care maintenance), monitoring (Caregiver contribution to self-care monitoring) and managing (Caregiver contribution to self-care management) the conditions of their patients.

OBJECTIVE

To develop and test the psychometric properties of the Caregiver Contribution to self-care in the Oral Anticancer Agents Index (CC-SCOAAI).

METHODS

A longitudinal study was conducted. Factorial validity was tested using Confirmatory Factor Analysis (CFA). Furthermore, we also tested the internal consistency and validity of the CC-SCOAAI construct. The Mann-Whitney U test was used to demonstrate associations between CC-SCOAAI scores and patient's re-hospitalizations, emergency-room attendances, and mortality.

RESULTS

We enrolled 318 caregivers, mostly female (63.52 %), with an age of <44 (39.94 %) and spouse of the patient (54.66 %). The CFA demonstrated the factorial validity of the CC-SCOAAI. Caregivers of patients with more re-hospitalizations had a lower contribution to self-care maintenance (U = 2933.500; p = .04), while caregivers of patients with more emergency room admissions (U = 1392.500; p < .001) and re-hospitalizations (U = 2385.500; p < .001) had a lower contribution to self-care management. Caregivers of patients with emergency-room admissions (U = 1392.500; p = .005), re-hospitalisations (U = 2322.500; p < .001) and mortality (U = 515.500; p = .001) had lower contribution to self-care monitoring.

CONCLUSIONS

CC-SCOAAI is a valid and reliable tool. Given that caregivers are crucial in supporting these patients, the CC-SCOAAI may help clinicians improve caregiver efficacy and researchers using CC-SCOAAI to determine better self-care outcomes in patients with OAA.

Measuring Self-Care: A Description of the Family of Disease-Specific and Generic Instruments Based on the Theory of Self-Care of Chronic Illness

BACKGROUND

In recent years, there has been an exponential increase in attention paid to the patient-reported outcome of self-care. Many investigators have used one of the families of self-care instruments freely available on the website www.self-care-measures.com . These self-care measures have been translated into many languages, which are also available on the website. The measures include both disease-specific and generic instruments, which are based on a common theoretical framework, the Middle Range Theory of Self-Care of Chronic Illness.

PURPOSE

The purpose of this article is to illustrate similarities among the instruments and to standardize their scoring, analysis, and use. We describe the Self-Care of Heart Failure Index, the Self-Care of Coronary Heart Disease Inventory, the Self-Care of Hypertension Inventory, the Self-Care of Diabetes Inventory, the Self-Care of Chronic Obstructive Pulmonary Disease Inventory, the Self-Care of Chronic Illness Inventory, and the Self-Care Inventory. Detailed guidance on scoring, translation, and analysis is provided. Complementary measures of self-care self-efficacy and those used to measure caregiver contributions to patient self-care are briefly described.

CONCLUSIONS

Many of the common questions of instrument users are answered in this article. Following this guidance will facilitate consistent use of the instruments, which will enable users to compare their results to those of others worldwide and facilitate future reviews and meta-analyses.Clinical ImplicationsThis review, emphasizing standard scoring and interpretation, is useful for clinicians and researchers across various populations and settings.

Translation and psychometric properties of the Persian version of the mental health quality of life (MHQoL) questionnaire

BACKGROUND

Patients with psychiatric disorders often experience a reduced quality of life. To accurately assess their well-being, reliable and culturally appropriate tools are essential. The Mental Health Quality of Life (MHQoL) questionnaire, which has seven questions, is designed for this purpose. This study aimed to translate and evaluate the psychometric properties of the MHQoL tool among patients with psychiatric disorders at the psychiatric department of Baqiyatallah Hospital.

METHODS

This study employed a methodological approach with a descriptive cross-sectional design. After obtaining written permission from the original developer and following the World Health Organization protocol, the Persian version of the questionnaire was administered to 300 psychiatric patients hospitalized in a psychiatric ward in Tehran from October 2022 to March 2023. Of the participants, 39% were female and 61% were male. The questionnaire's face validity, content validity, and construct validity were subsequently evaluated. To determine reliability, Cronbach's alpha coefficient and test-retest methods were used.

RESULTS

Through exploratory factor analysis (N = 150) and confirmatory factor analysis (N = 150), one factor was extracted that explained 59.45% of the total observed variance. The model exhibited a good fit, with a GFI of 0.90, CFI of 0.97, IFI of 0.97, NFI of 0.95, PNFI of 0.64, RMSEA of 0.14, CMIN/DF of 3.5, and RMR of 0.049. The Persian version of the MHQoL tool demonstrated high reliability, with a Cronbach's alpha of 0.876 and an intraclass correlation coefficient of 0.979.

CONCLUSIONS

The current study's findings suggest that the Persian version of the MHQoL is valid and reliable for assessing the quality of life in Persian patients with psychiatric disorders.

Psychometric Testing of the Cross-Culturally Adapted Thai Version of the Caregiver Self-Efficacy in Contributing to Patient Self-Care Scale in Caregivers of Patients With Chronic Illnesses

AIM

To evaluate the psychometric properties of the Caregiver Self-Efficacy in Contributing to Patient Self-Care Scale (CSE-CSC).

BACKGROUND

The CSE-CSC scale was developed congruently with the Caregiver Contribution to Self-Care of Patient with Chronic Illness Inventory (CC-SC-CII) to assess caregiver self-efficacy (CSE), the motivation factor of caregiving. Its applicability in Asian populations, including Thailand, was limited.

METHODS

Psychometric tests were guided by COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) principles. This included translating the English version into Thai, following the principles of good practice for the translation and cultural adaptation process for patient-reported outcome (PRO) measures. Nine nursing experts evaluated the content validity. The analysis included caregivers of patients with chronic conditions from 16 primary care centres in Thailand. We tested the structural validity using exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and concurrent validity for CC-SC-CII-v2. We tested the scale's reliability with methods for multidimensional and unidimensional constructs, the intraclass correlation coefficients (ICCs) and measurement error variance.

RESULTS

Kappa coefficient (k = 1.00) indicated the scale's excellent content validity. The final analysis included a total of 407 samples. The EFA with the first split-half subsample (n = 194) extracted a two-dimensional structure. One reflected CSE in Maintenance and Monitoring behaviour and another captured CSE in Management behaviour. CFA with the second split-half subsample (n = 213) and the overall sample (n = 407) supported the scale's bidimensional model with high factor loadings. Each dimension and the overall CSE-CSC scale positively correlated with each scale and the overall CC-SC-CII-v2. McDonald's ω and Cronbach's α (both ranged from 0.91-0.94) indicated excellent internal reliability. Test-retest reliability showed ICCs between 0.95 and 0.96. Measurement error yielded satisfactory results.

CONCLUSION

Testing of the Thai CSE-CSC scale supported validity and reliability, indicating that the scale can apply to Thai caregivers. This scale can be used in clinical practice and research to evaluate CSE in contribution to patient self-care.

Assessment instruments of caregiver contributions to self-care of chronic illness: A systematic review

OBJECTIVE

This study aimed to identify and assess the psychometric properties of assessment instruments of caregiver contributions to self-care of chronic illness.

METHODS

Ten databases and relevant websites were used to retrieve relevant literature. Methodological quality was assessed using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) Risk of Bias Checklist. Each instrument's psychometric properties were assessed using COSMIN criteria. The recommendation level was assessed using a modified Grading, Recommendations, Assessment, Development, and Evaluation system.

RESULTS

Twenty-three studies reported 11 different instrument versions. None of the instruments exhibited an A-level recommendation. The Caregiver Contribution to Heart Failure Self-care (CACHS) scale can be temporarily recommended. Significant issues exist with the standardization of result reporting, instrument development, content validity, and criterion validity.

CONCLUSION

According to this study's findings, the CACHS scale can be provisionally recommended. Further research on reporting standards, instrument development, content validity, and criterion validity is required.

Psychometric testing of the Care Dependency Scale in patients with heart failure and their caregivers

AIMS

This study aims to (i) test the validity and reliability of the Care Dependency Scale (CDS) for patients with heart failure (HF) and (ii) test the validity and reliability of the proxy version of the CDS assessing informal caregivers' perception of the dependency level of individuals with HF.

METHODS AND RESULTS

Secondary data analysis was conducted of transnational multicentre cross-sectional design study. A convenience sample comprised of HF patients-informal caregivers' dyads in three European countries. The CDS was administered to patients and the proxy version to informal caregivers. Factorial validity was tested for each scale using confirmatory factor analysis. Reliability was evaluated with the composite coefficient and Cronbach's alpha. Construct validity was tested via known group differences. Measurement error was tested to assess responsiveness to changes. A total of 229 patients and 208 caregivers were recruited. Confirmatory factor analysis supported the two-factor structure (Physical Care Dependency and Psychosocial Care Dependency) of the CDS in both HF patients and their caregiver. Reliability estimates were adequate for all reliability coefficients. Construct validity was supported. The measurement error was adequate.

CONCLUSION

The scale shows acceptable validity and reliability and can be useful for care dependency assessment of patients with HF and their informal caregivers. Further research is needed for assessing the validity and reliability in other cross-cultural settings. The use of the CDS has the potential to effectively enable the development of pertinent care plans, taking dependency into consideration including the perspective of both members of the dyad as a whole.

Sex based differences in depression, anxiety, and quality of life and predictors of quality of life among South Asian individuals with chronic obstructive pulmonary disease: A Bayesian analysis

BACKGROUND

COPD can affect both men and women leading to deteriorating impact on general well-being, personal, and family life and decreased quality of life. Anxiety, depression, and self-care behaviours can affect the quality of life of individuals with COPD. There is a dearth of sex-based comparative analyses of anxiety, depression, quality of life, and predictors of quality of life among South Asian individuals with COPD.

PURPOSE

To identify the sex-based differences in depression, anxiety, and quality of life and the predictors of quality of life among South Asian individuals with COPD.

METHODS

A cross-sectional survey of 294 men and 114 women with COPD was conducted in Khyber Pakhtunkhwa, Pakistan. Hospital Anxiety and Depression scale, World Health Organization Quality of Life-brief version, Self-Care of Chronic Obstructive Pulmonary Disease Inventory, the Self-Care Self-Efficacy in COPD Scale were used for data collection. Bayesian independent sample t-test was used to compare mean differences in depression, anxiety, and quality of life among men and women. Two regression models were examined to determine if age, years of living with COPD, anxiety, depression, self-care self-efficacy, self-care monitoring, management, and maintenance were predictors of quality of life among men and women.

FINDINGS

Bayesian analysis showed anecdotal evidence that women had higher levels of depression, but lower levels of anxiety compared to men. Anecdotal evidence indicated that the physical quality of life of men was better than women, but strong evidence that their social relationship and environmental quality of life was better than women. Years of living with COPD, anxiety, depression, self-care self-efficacy, self-care management, self-care monitoring, and self-care maintenance were stronger predictors of women's quality of life. Anxiety and depression only predicted men's psychological quality of life, but predicted women's psychological, social relationships, and environmental quality of life.

CONCLUSIONS

The findings contribute to literature highlighting sex-based differences in anxiety, depression, and quality of life among South Asian men and women with COPD. Men generally reported higher levels of quality of life than women across all domains. Women's social relationships and environmental quality of life were greatly impacted by anxiety and depression. Quality of life interventions for women should be targeted at improving their social relationships and environmental satisfaction and addressing anxiety and depression.

Contributing to self-care of a person with chronic obstructive pulmonary disease: A qualitative study of the experiences of family caregivers

AIM

To explore family caregivers' experiences of contributing to self-care of patients with chronic obstructive pulmonary disease (COPD).

DESIGN

A qualitative description study.

METHODS

Individual semi-structured interviews were conducted face-to face, by telephone or video calls in a purposive sample of 17 family caregivers of patients with COPD recruited in Italy, and analysed through content analysis. The consolidated criteria for reporting qualitative studies (COREQ) checklist was used for study reporting.

RESULTS

Ten subcategories were derived from 106 codes grouped into three main categories: family caregiver contributions to maintaining disease stable and ensuring a normal life for patients; family caregiver contributions to disease monitoring; and family caregiver contributions to coping with disease exacerbations. Family caregivers provided practical and emotional support, and their contribution was essential to improve treatment adherence, to enable the patient to continue living a normal life, and to have access to the healthcare services. Family caregivers were constantly vigilant and monitored patients daily to detect worsening conditions, and they managed exacerbations especially when patients were unable to do it due to their critical conditions.

CONCLUSION

This study broadens knowledge of family caregivers' contributions to patients' self-care in COPD, describing the different ways family members provide daily care to patients and the many responsibilities they take on.

IMPACT

Family caregivers perform a variety of behaviours when supporting patients with COPD in self-care, especially when patients are more dependent and the disease more severe. Nurses should acknowledge the various contributions provided by family caregivers and develop educational interventions aiming to support them in patient care and improve patient outcomes.

PATIENT OR PUBLIC CONTRIBUTION

Researchers shared the draft study report with participants for validation and feedback. This helped to strengthen the study design and results.

A psychometrics evaluation of the Thai version of Caregiver Contribution to Self-Care of Chronic Illness Inventory Version 2 in stroke caregivers

Objectives

To evaluate the psychometric characteristics of the Thai version of Caregiver Contribution to Self-Care (CC-SC) of Chronic Illness Inventory version 2 (CC-SC-CII-v2) in stroke caregivers.

Methods

We conducted a multicenter, cross-sectional study following the COSMIN guidelines, evaluating validity and reliability of three separate scales, CC-SC Maintenance, CC-SC Monitoring, and CC-SC Management, as well as overall CC-SC-CII-v2. From September to December 2022, we enrolled 422 stroke caregivers from primary care centers in southern Thailand. Structural validity was assessed through confirmatory factor analysis (CFA), while concurrent validity was evaluated using Pearson's correlation r coefficients between CC-SC-CII-v2 and the Caregiver Self-Efficacy in Contributing to Patient Self-Care Scale (CSE-CSC). Internal coherence reliability was assessed using Cronbach's α coefficient, the composite reliability index, and the McDonald's ω coefficient. Additionally, test-retest reliability was assessed with intraclass correlation coefficients (ICCs).

Results

The study included mostly middle-aged women who cared for their parent. CFA supported the two-factor structure of the CC-SC Maintenance and Management scales and the one-factor structure of the CC-SC Monitoring scale. A simultaneous CFA on the combined set of items supported the more general model. The concurrent validity of CC-SC-CII-v2 with CSE-CSC was established (r ranging 0.47-0.65, all P < 0.001). Reliability estimates supported adequate Cronbach's α coefficient (ranging 0.83-0.89), composite reliability (ranging 0.84-0.85), McDonald's ω coefficients (ranging 0.83-0.85), and ICCs (ranging 0.86-0.90) across the three scales.

Conclusions

The Thai CC-SC-CII-v2 demonstrated strong psychometric properties among stroke caregivers. It can be a valuable instrument to investigate the role of caregivers in contributing to stroke patients' self-care in diverse cultural contexts like Thailand.