Document Type : Original Article

Authors

1 Department of Pharmacoeconomics and Pharmaceutical Administration, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran

2 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

3 Department of Neurology, Tehran University of Medical Sciences, Tehran, Iran Multiple Sclerosis Research Centre, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran

Abstract

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.

Keywords

  1. Van Houtven CH, Norton EC. Informal care and Medicare expenditures: Testing for heterogeneous treatment effects. J Health Econ 2008; 27(1): 134-56.
  2. Study on exploring the incidence and costs of informal long-term care in the EU. Brussels, Belgium: European Commission; 2021. p. 11.
  3. Grosse SD, Pike J, Soelaeman R, Tilford JM. Quantifying family spillover effects in economic evaluations: Measurement and valuation of informal care time. Pharmacoeconomics 2019; 37(4): 461-73.
  4. Sanders GD, Neumann PJ, Basu A, Brock DW, Feeny D, Krahn M, et al. Recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses: second panel on cost-effectiveness in health and medicine. JAMA 2016; 316(10): 1093-103.
  5. Neumann PJ, Sanders GD, Russell LB, Siegel JE, Ganiats TG. Cost-effectiveness in health and medicine. Oxford, UK: Oxford University Press; 2016. p. 536.
  6. Baji P, Brouwer WBF, van Exel J, Golicki D, Prevolnik Rupel V, Zrubka Z, et al. Validation of the Hungarian version of the CarerQol instrument in informal caregivers: results from a cross-sectional survey among the general population in Hungary. Qual Life Res 2021; 30(2): 629-41.
  7. Hoefman RJ, van Exel J, Brouwer W. How to include informal care in economic evaluations. Pharmacoeconomics 2013; 31(12): 1105-19.
  8. Neumann PJ, Goldie SJ, Weinstein MC. Preference-based measures in economic evaluation in health care. Annu Rev Public Health 2000; 21: 587-611.
  9. Lipscomb J, Drummond M, Fryback D, Gold M, Revicki D. Retaining, and enhancing, the QALY. Value Health 2009; 12(Suppl 1): S18-26.
  10. Brouwer WB, van Exel NJ, van Gorp B, Redekop WK. The CarerQol instrument: A new instrument to measure care-related quality of life of informal caregivers for use in economic evaluations. Qual Life Res 2006; 15(6): 1005-21.
  11. Hoefman RJ, van Exel NJ, Looren de Jong S, Redekop WK, Brouwer WB. A new test of the construct validity of the CarerQol instrument: Measuring the impact of informal care giving. Qual Life Res 2011; 20(6): 875-87.
  12. Hoefman RJ, van Exel NJ, Foets M, Brouwer WB. Sustained informal care: the feasibility, construct validity and test-retest reliability of the CarerQol-instrument to measure the impact of informal care in long-term care. Aging Ment Health 2011; 15(8): 1018-27.
  13. Hoefman RJ, van EJ, Rose JM, van de Wetering EJ, Brouwer WB. A discrete choice experiment to obtain a tariff for valuing informal care situations measured with the CarerQol instrument. Med Decis Making 2014; 34(1): 84-96.
  14. Hoefman R, Al-Janabi H, McCaffrey N, Currow D, Ratcliffe J. Measuring caregiver outcomes in palliative care: A construct validation study of two instruments for use in economic evaluations. Qual Life Res 2015; 24(5): 1255-73.
  15. Lutomski JE, van Exel NJ, Kempen GI, Moll van Charante EP, den Elzen WP, Jansen AP, et al. Validation of the Care-Related Quality of Life Instrument in different study settings: Findings from The Older Persons and Informal Caregivers Survey Minimum DataSet (TOPICS-MDS). Qual Life Res 2015; 24(5): 1281-93.
  16. Institute for Medical Technology Assessment [Online]. [cited 2022 Nov 8]; Available from: URL: https://www.imta.nl/questionnaires/carerqol/
  17. Thompson AJ, Banwell BL, Barkhof F, Carroll WM, Coetzee T, Comi G, et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol 2018; 17(2): 162-73.
  18. Kurtzke JF. Rating neurologic impairment in multiple sclerosis: An expanded disability status scale (EDSS). Neurology 1983; 33(11): 1444-52.
  19. Hoefman RJ, van Exel J, Brouwer WB. Measuring the impact of caregiving on informal carers: a construct validation study of the CarerQol instrument. Health Qual Life Outcomes 2013; 11: 173.
  20. Maydeu O, Shi D, Rosseel Y. Assessing fit in structural equation models: A Monte-Carlo evaluation of RMSEA versus SRMR confidence intervals and tests of close fit. Struct Equ Modeling 2018; 25(3): 389-402.
  21. Fitzgerald C, George S, Somerville R, Linnane B, Fitzpatrick P. Caregiver burden of parents of young children with cystic fibrosis. J Cyst Fibros 2018; 17(1): 125-31.
  22. Bentler PM. Can scientifically useful hypotheses be tested with correlations? Am Psychol 2007; 62(8): 769-82.
  23. Byrne BM. Structural equation modeling with Mplus: Basic concepts, applications, and programming. New York, NY: Routledge; 2013.
  24. Morin AJS, Arens AK, Marsh HW. A bifactor exploratory structural equation modeling framework for the identification of distinct sources of construct-relevant psychometric multidimensionality. Struct Equ Modeling 2016; 23(1): 116-39.