FEATURE
Psychometric Evaluation of the Caregiving Competence Scale Among Chinese Family Caregivers Ho Yu Cheng1, PhD, RN/RNP, PgD, Sek Ying Chair1, PhD, RN & Janita Pak-Chun Chau1, PhD, RN 1 The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
Keywords
Abstract
Stroke; family caregiver; caregiving competence; psychometric evaluation. Correspondence Ho Yu Cheng, The Nethersole School of Nursing, 8/F, Esther Lee Building, The Chinese University of Hong Kong, Shatin, NT, Hong Kong. E-mail: [email protected] Accepted November 22, 2014. doi: 10.1002/rnj.207
Purpose: To develop a Chinese version of the Caregiving Competence Scale (CCS-C) and evaluate its psychometric properties. Design: A multicenter, cross-sectional study design. Methods: Brislin’s translation method was used to translate the CCS into Chinese. Its psychometric properties were tested with 118 Chinese family caregivers of stroke survivors. Findings: The CCS-C demonstrated adequate internal consistency (Cronbach’s a = .81) and stability (weighted kappa statistics: .67–.78). Convergent and discriminative validities were supported by a significant correlation between the CCS-C and the General Self-Efficacy Scale scores (r = .46, p < .01) and a significant difference in the CCS-C scores between depressed and nondepressed caregivers (p = .03), respectively. Conclusions: Study results suggested that the CCS-C could be a valid and reliable self-reported instrument for family caregivers of Chinese stroke survivors. Clinical Relevance: This scale can be used to evaluate the caregiving competence of stroke caregivers in nursing research and in clinical settings.
Introduction Stroke is a cause of long-term disability and a great burden to many people worldwide (Mathers & Loncar, 2006). As the population ages, the increase in the incidence of stroke and the level of disability that arises can pose challenges to the global healthcare system. Community-based rehabilitation is an effective means of alleviating the burden on the healthcare systems associated with the disabilities of stroke; however, its success largely depends on the family caregivers (Levine, Halper, Peist, & Gould, 2010). Family caregivers often devote considerable time and effort in attempting to preserve a sense of independence among the stroke survivors under their care (IngersollDayton & Raschick, 2004); however, the heavy demands and stresses of caregiving create a high risk of psychological morbidity, especially depression, for the caregivers. Visser-Meily, Post, van de Port, van Heugten, and van © 2015 Association of Rehabilitation Nurses Rehabilitation Nursing 2015, 0, 1–9
den Bos (2008) found that 68% of spousal caregivers presented symptoms of depression at the onset of stroke, while 50% still presented these symptoms 3 years after the incident. On the other hand, the challenges faced by the caregivers, such as the uncertainty of change or adjustments made in the family, could assist their personal development (Burman, 2001; Greenwood, Mackenzie, Wilson, & Cloud, 2009) and improve their caregiving competence (Pearlin, Mullan, Semple, & Skaff, 1990). According to the Caregiving Stress Process model, caregiving competence is a role-specific component of self-concept and the psychological state associated with caregiving-related stressors and role strains (Pearlin et al., 1990; Skaff & Pearlin, 1992). Caregiving competence could also be viewed as a protective factor to shield caregivers from the negative effects of caregiving on their mental health (Fortinsky, Kercher, & Burant, 2002). Given the high prevalence of depressive symptoms experienced by family caregivers of stroke survivors, it is
1
Caregiving Competence Scale (Chinese version)
essential to examine the caregiving competence, which is a protective factor for the caregivers themselves. The Caregiving Competence Scale (CCS) developed by Skaff (Pearlin et al., 1990) was designed to measure the adequacy of a caregiver’s performance as perceived by the caregiver himself or herself. The CCS has been widely used as a separate scale in family caregiver research and has demonstrated adequate internal consistency, with Cronbach’s alpha coefficients ranging from .75 to .81 (Hartke & King, 2003; Steng ard, 2002). Additionally, the unidimensionality of the CCS has been demonstrated by confirmatory factor analysis (Henriksson, Andershed, Benzein, & Arestedt, 2012). To date, few instruments have been developed to measure caregiving competence (van Durme, Macq, Jeanmart, & Gobert, 2012), and none has been specifically designed to measure the caregiving competence of family caregivers of stroke survivors. Pointing out the inadequacy of a caregiver’s performance could result in shame or “losing face” among the Chinese people (Braun & Browne, 1998); thus, the self-reported CCS would be more acceptable when applied to these individuals. Furthermore, measuring the caregiving competence from the point of view of the caregiver, rather than basing it on professionally defined standards, could dispel any implied power inequalities among the caregivers, the recipients and the researchers (Cromwell et al., 1996). The present study, therefore, aims to (1) translate the CCS into Chinese, (2) examine its linguistic and cultural relevance, and (3) evaluate its psychometric properties.
H.Y. Cheng et al.
rate measurement in this study, modifications to the instruction for two questions (Q3 and Q4) were necessary to provide a clearer context for the caregivers. The instruction for these two questions was modified from “Think now of all the things we’ve been talking about. . .” to “Think now of all the things related to caregiving. . .” Such modification would thereby support the concept of caregiving when administered separately. Brislin’s (1986) model of translation was used to translate the CCS from the original English into Chinese. The author first translated the CCS, and a native Chinese language teacher reviewed the first draft to identify grammatical and syntactical errors, if any. The revised Chinese version was translated back into English by an independent bilingual nurse, who was not given any information regarding the original. The original and the back-translated versions were compared by the author for linguistic and cultural equivalence. This translation process was repeated using independent “blinded” bilingual nurses and the professional translator until the original and the back-translated versions of CCS achieved optimum equivalence. Next, the semantic and cultural equivalence of the translated version of the CCS was rated by a group of bilingual nurses and physicians (n = 20). Each item was rated on a four-point Likert scale, in an ascending trend of “equivalence.” The details of the translated version of the CCS were considered equivalent because no item was rated as
Psychometric Evaluation of the Caregiving Competence Scale Among Chinese Family Caregivers Ho Yu Cheng1, PhD, RN/RNP, PgD, Sek Ying Chair1, PhD, RN & Janita Pak-Chun Chau1, PhD, RN 1 The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
Keywords
Abstract
Stroke; family caregiver; caregiving competence; psychometric evaluation. Correspondence Ho Yu Cheng, The Nethersole School of Nursing, 8/F, Esther Lee Building, The Chinese University of Hong Kong, Shatin, NT, Hong Kong. E-mail: [email protected] Accepted November 22, 2014. doi: 10.1002/rnj.207
Purpose: To develop a Chinese version of the Caregiving Competence Scale (CCS-C) and evaluate its psychometric properties. Design: A multicenter, cross-sectional study design. Methods: Brislin’s translation method was used to translate the CCS into Chinese. Its psychometric properties were tested with 118 Chinese family caregivers of stroke survivors. Findings: The CCS-C demonstrated adequate internal consistency (Cronbach’s a = .81) and stability (weighted kappa statistics: .67–.78). Convergent and discriminative validities were supported by a significant correlation between the CCS-C and the General Self-Efficacy Scale scores (r = .46, p < .01) and a significant difference in the CCS-C scores between depressed and nondepressed caregivers (p = .03), respectively. Conclusions: Study results suggested that the CCS-C could be a valid and reliable self-reported instrument for family caregivers of Chinese stroke survivors. Clinical Relevance: This scale can be used to evaluate the caregiving competence of stroke caregivers in nursing research and in clinical settings.
Introduction Stroke is a cause of long-term disability and a great burden to many people worldwide (Mathers & Loncar, 2006). As the population ages, the increase in the incidence of stroke and the level of disability that arises can pose challenges to the global healthcare system. Community-based rehabilitation is an effective means of alleviating the burden on the healthcare systems associated with the disabilities of stroke; however, its success largely depends on the family caregivers (Levine, Halper, Peist, & Gould, 2010). Family caregivers often devote considerable time and effort in attempting to preserve a sense of independence among the stroke survivors under their care (IngersollDayton & Raschick, 2004); however, the heavy demands and stresses of caregiving create a high risk of psychological morbidity, especially depression, for the caregivers. Visser-Meily, Post, van de Port, van Heugten, and van © 2015 Association of Rehabilitation Nurses Rehabilitation Nursing 2015, 0, 1–9
den Bos (2008) found that 68% of spousal caregivers presented symptoms of depression at the onset of stroke, while 50% still presented these symptoms 3 years after the incident. On the other hand, the challenges faced by the caregivers, such as the uncertainty of change or adjustments made in the family, could assist their personal development (Burman, 2001; Greenwood, Mackenzie, Wilson, & Cloud, 2009) and improve their caregiving competence (Pearlin, Mullan, Semple, & Skaff, 1990). According to the Caregiving Stress Process model, caregiving competence is a role-specific component of self-concept and the psychological state associated with caregiving-related stressors and role strains (Pearlin et al., 1990; Skaff & Pearlin, 1992). Caregiving competence could also be viewed as a protective factor to shield caregivers from the negative effects of caregiving on their mental health (Fortinsky, Kercher, & Burant, 2002). Given the high prevalence of depressive symptoms experienced by family caregivers of stroke survivors, it is
1
Caregiving Competence Scale (Chinese version)
essential to examine the caregiving competence, which is a protective factor for the caregivers themselves. The Caregiving Competence Scale (CCS) developed by Skaff (Pearlin et al., 1990) was designed to measure the adequacy of a caregiver’s performance as perceived by the caregiver himself or herself. The CCS has been widely used as a separate scale in family caregiver research and has demonstrated adequate internal consistency, with Cronbach’s alpha coefficients ranging from .75 to .81 (Hartke & King, 2003; Steng ard, 2002). Additionally, the unidimensionality of the CCS has been demonstrated by confirmatory factor analysis (Henriksson, Andershed, Benzein, & Arestedt, 2012). To date, few instruments have been developed to measure caregiving competence (van Durme, Macq, Jeanmart, & Gobert, 2012), and none has been specifically designed to measure the caregiving competence of family caregivers of stroke survivors. Pointing out the inadequacy of a caregiver’s performance could result in shame or “losing face” among the Chinese people (Braun & Browne, 1998); thus, the self-reported CCS would be more acceptable when applied to these individuals. Furthermore, measuring the caregiving competence from the point of view of the caregiver, rather than basing it on professionally defined standards, could dispel any implied power inequalities among the caregivers, the recipients and the researchers (Cromwell et al., 1996). The present study, therefore, aims to (1) translate the CCS into Chinese, (2) examine its linguistic and cultural relevance, and (3) evaluate its psychometric properties.
H.Y. Cheng et al.
rate measurement in this study, modifications to the instruction for two questions (Q3 and Q4) were necessary to provide a clearer context for the caregivers. The instruction for these two questions was modified from “Think now of all the things we’ve been talking about. . .” to “Think now of all the things related to caregiving. . .” Such modification would thereby support the concept of caregiving when administered separately. Brislin’s (1986) model of translation was used to translate the CCS from the original English into Chinese. The author first translated the CCS, and a native Chinese language teacher reviewed the first draft to identify grammatical and syntactical errors, if any. The revised Chinese version was translated back into English by an independent bilingual nurse, who was not given any information regarding the original. The original and the back-translated versions were compared by the author for linguistic and cultural equivalence. This translation process was repeated using independent “blinded” bilingual nurses and the professional translator until the original and the back-translated versions of CCS achieved optimum equivalence. Next, the semantic and cultural equivalence of the translated version of the CCS was rated by a group of bilingual nurses and physicians (n = 20). Each item was rated on a four-point Likert scale, in an ascending trend of “equivalence.” The details of the translated version of the CCS were considered equivalent because no item was rated as
