Worry About Caregiving Performance: A Confirmatory Factor Analysis.

Ruijie Li,Wee Shiong Lim,Peng Chew Mark Chan,Noorhazlina Binte Ali,Bee Gek Laura Tay,Mei Sian Chong

doi:10.3389/fmed.2018.00079

Abstract

Recent studies on the Zarit Burden Interview (ZBI) support the existence of a unique factor, worry about caregiving performance (WaP), beyond role and personal strain. Our current study aims to confirm the existence of WaP within the multidimensionality of ZBI and to determine if predictors of WaP differ from the role and personal strain. We performed confirmatory factor analysis (CFA) on 466 caregiver-patient dyads to compare between one-factor (total score), two-factor (role/personal strain), three-factor (role/personal strain and WaP), and four-factor models (role strain split into two factors). We conducted linear regression analyses to explore the relationships between different ZBI factors with socio-demographic and disease characteristics, and investigated the stage-dependent differences between WaP with role and personal strain by dyadic relationship. The four-factor structure that incorporated WaP and split role strain into two factors yielded the best fit. Linear regression analyses reveal that different variables significantly predict WaP (adult child caregiver and Neuropsychiatric Inventory Questionnaire (NPI-Q) severity) from role/personal strain (adult child caregiver, instrumental activities of daily living, and NPI-Q distress). Unlike other factors, WaP was significantly endorsed in early cognitive impairment. Among spouses, WaP remained low across Clinical Dementia Rating (CDR) stages until a sharp rise in CDR 3; adult child and sibling caregivers experience a gradual rise throughout the stages. Our results affirm the existence of WaP as a unique factor. Future research should explore the potential of WaP as a possible intervention target to improve self-efficacy in the milder stages of burden.

Highlights

Dementia is a disease that is frequently associated with significant caregiving burden
We included caregiver-patient dyads who fulfilled the following criteria: [1] patients who were aged 55 years and above with a Clinical Dementia Rating (CDR) [20] global score of >0 and a diagnosis of mild cognitive impairment (MCI) or dementia; [2] community-dwelling patients who were not residing in an assisted living facility or nursing home; [3] primary caregiver of the patient, defined as the family member above 21 years of age who was most involved in the provision of day-to-day care and who was familiar with the patient’s medical and social condition
Our study adds to the growing body of evidence that supports the existence of worry about caregiving performance (WaP) as a distinct dimension of caregiving burden, and corroborates our earlier proposal that the three key dimensions of role strain, personal strain, and WaP underpin the multidimensionality of Zarit Burden Interview (ZBI)-defined burden

Summary

Introduction

Dementia is a disease that is frequently associated with significant caregiving burden. The seminal study by Whitlatch and colleagues was the first to outline the dual-factor structure of role and personal strain as distinct constructs measured by the ZBI [5]. Subsequent studies have built upon the general structure of role and personal strain and partially replicated the factor structure [6,7,8,9,10]. This partial replication across diverse populations with cultural and societal differences [11] raises the possibility of a latent dimension beyond the general structure of role and personal strain

Methods

Results

Conclusion