Seyedmohammad Mirhosseini1 
, Ali Abbasi2 , Anahita Divani3 , Fateme Askarinezhad4 , Soheila Hasanpournamaghi4 , Samuel Grimwood5 , Ali Montazeri6 , Hossein Ebrahimi7
, Ali Abbasi2 , Anahita Divani3 , Fateme Askarinezhad4 , Soheila Hasanpournamaghi4 , Samuel Grimwood5 , Ali Montazeri6 , Hossein Ebrahimi7
1- Department of Nursing, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran ; Student Research Committee, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
2- Department of Nursing, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
3- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
4- Student Research Committee, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
5- Human Sciences Research Centre, The University of Derby, Derby, United Kingdom
6- Imam Hossein Hospital, Shahroud University of Medical Sciences, Shahroud, Iran
7- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran ,ebrahimi@shmu.ac.ir
2- Department of Nursing, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
3- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
4- Student Research Committee, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
5- Human Sciences Research Centre, The University of Derby, Derby, United Kingdom
6- Imam Hossein Hospital, Shahroud University of Medical Sciences, Shahroud, Iran
7- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran ,
Abstract: (253 Views)
Background: Family caregivers of cancer patients encounter numerous challenges while providing care, and self-efficacy is a key factor in alleviating these negative effects. This study aimed to investigate the psychometric properties of the Persian version of the Caregiver Self-Efficacy Scale (CSES) among caregivers of cancer patients.
Methods: This methodological study employed a cross-sectional design involving 382 family caregivers of cancer patients in a teaching hospital in Iran, in 2024. The CSES was translated into Persian using the forward-backward procedure. The initial translation was assessed for face and content validity through both quantitative and qualitative methods. Construct validity was evaluated using exploratory and confirmatory factor analysis. Discriminant validity was examined using the Heterotrait–Monotrait (HTMT) ratio. Reliability was assessed by evaluating internal consistency using Cronbach's alpha and Mcdonald's omega, and stability was measured using intraclass correlation coefficients (ICCs).
Results: In this study, 53.7% of the participants were male, and the caregivers' mean age was 42.52 ± 11.83 years. Scale-level content validity index was reported 0.97 by expert panel during content validity stage. During the exploratory factor analysis, one item was excluded, leaving seven items were categorized into two factors: caregiver self-management and patient challenges. These factors collectively accounted for 43.9% of the variance in self-efficacy. Confirmatory factor analysis confirmed the adequacy of the model derived from the exploratory factor analysis (RMSEA = 0.05, GFI = 0.947, and CFI = 0.906). The factors demonstrated discriminant validity. Cronbach's alpha values for the patient challenges and caregiver self-management factors were 0.802 and 0.798, respectively. In addition, the ICC for these two factors was reported to be 0.830 and 0.802, respectively.
Conclusion: The Persian adaptation of the CSES demonstrates satisfactory validity and reliability for assessing the self-efficacy of family caregivers of cancer patients in Iran.
Methods: This methodological study employed a cross-sectional design involving 382 family caregivers of cancer patients in a teaching hospital in Iran, in 2024. The CSES was translated into Persian using the forward-backward procedure. The initial translation was assessed for face and content validity through both quantitative and qualitative methods. Construct validity was evaluated using exploratory and confirmatory factor analysis. Discriminant validity was examined using the Heterotrait–Monotrait (HTMT) ratio. Reliability was assessed by evaluating internal consistency using Cronbach's alpha and Mcdonald's omega, and stability was measured using intraclass correlation coefficients (ICCs).
Results: In this study, 53.7% of the participants were male, and the caregivers' mean age was 42.52 ± 11.83 years. Scale-level content validity index was reported 0.97 by expert panel during content validity stage. During the exploratory factor analysis, one item was excluded, leaving seven items were categorized into two factors: caregiver self-management and patient challenges. These factors collectively accounted for 43.9% of the variance in self-efficacy. Confirmatory factor analysis confirmed the adequacy of the model derived from the exploratory factor analysis (RMSEA = 0.05, GFI = 0.947, and CFI = 0.906). The factors demonstrated discriminant validity. Cronbach's alpha values for the patient challenges and caregiver self-management factors were 0.802 and 0.798, respectively. In addition, the ICC for these two factors was reported to be 0.830 and 0.802, respectively.
Conclusion: The Persian adaptation of the CSES demonstrates satisfactory validity and reliability for assessing the self-efficacy of family caregivers of cancer patients in Iran.
Type of study: Original Article |
Subject:
Nursing
References
1. Mirhosseini S, Bazghaleh M, Basirinezhad MH, Abbasi A, Ebrahimi H. Health-related quality of life and caregiver's burden in patients with chronic diseases: a cross-sectional study. Family Medicine & Primary Care Review. 2021;23(1):29-35. [View at Publisher] [DOI] [Google Scholar]
2. Guerra-Martín MD, Casado-Espinosa MDR, Gavira-López Y, Holgado-Castro C, López-Latorre I, Borrallo-Riego Á. Quality of life in caregivers of cancer patients: a literature review. Int J Environ Res Public Health. 2023;20(2):1570. [View at Publisher] [DOI] [PMID] [Google Scholar]
3. Abuatiq A, Brown R, Wolles B, Randall R. Perceptions of stress: patient and caregiver experiences with stressors during hospitalization. Clin J Oncol Nurs. 2020;24(1):51-7. [View at Publisher] [DOI] [PMID] [Google Scholar]
4. Palacio Gonzalez C, Roman‐Calderón JP, Limonero JT. The relationship between positive aspects of caring, anxiety and depression in the caregivers of cancer patients: The mediational role of burden. Eur J Cancer Care (Engl). 2021;30(1):e13346. [View at Publisher] [DOI] [PMID] [Google Scholar]
5. Zhang Y, Zhang S, Liu C, Chen X, Ding Y, Guan C, et al. Caregiver burden among family caregivers of patients with advanced cancer in a palliative context: A mixed‐method study. J Clin Nurs. 2023;32(21-22):7751-64. [View at Publisher] [DOI] [PMID] [Google Scholar]
6. Zhu Y, Pei X, Chen X, Li T. Family caregivers' experiences of caring for advanced cancer patients: A qualitative systematic review and meta-synthesis. Cancer Nurs. 2023;46(4):270-83. [View at Publisher] [DOI] [PMID] [Google Scholar]
7. Paterson C, Roberts C, Li J, Chapman M, Strickland K, Johnston N, et al. What are the experiences of supportive care in people affected by brain cancer and their informal caregivers: a qualitative systematic review. J Cancer Surviv. 2024;18(5):1608-29. [View at Publisher] [DOI] [PMID] [Google Scholar]
8. Bijnsdorp FM, Onwuteaka-Philipsen BD, Boot CR, van der Beek AJ, Pasman HRW. Caregiver's burden at the end of life of their loved one: insights from a longitudinal qualitative study among working family caregivers. BMC Palliat Care. 2022;21(1):142. [View at Publisher] [DOI] [PMID] [Google Scholar]
9. Oliveira C, Lourenço D, Sotero L, Relvas AP. Caregivers' concerns through health professionals' eyes. Palliat Support Care. 2024;22(3):499-510. [View at Publisher] [DOI] [PMID] [Google Scholar]
10. Cai Y, Simons A, Toland S, Zhang J, Zheng K. Informal caregivers' quality of life and management strategies following the transformation of their cancer caregiving role: A qualitative systematic review. Int J Nurs Sci. 2021;8(2):227-36. [View at Publisher] [DOI] [PMID] [Google Scholar]
11. Lee Y, Li L. Evaluating the positive experience of caregiving: A systematic review of the positive aspects of caregiving scale. Gerontologist. 2022;62(9):e493-e507. [View at Publisher] [DOI] [PMID] [Google Scholar]
12. Nemcikova M, Katreniakova Z, Nagyova I. Social support, positive caregiving experience, and caregiver burden in informal caregivers of older adults with dementia. Front Public Health. 2023;11:1104250. [View at Publisher] [DOI] [PMID] [Google Scholar]
13. Bandura A. A cognitive theory: An agentic perspective. Ann Rev Psychol. 2001;52:1-26. [View at Publisher] [DOI] [PMID] [Google Scholar]
14. Phongtankuel V, Moxley J, Reid M, Adelman RD, Czaja SJ. The relationship of caregiver self-efficacy to caregiver outcomes: a correlation and mediation analysis. Aging Ment Health. 2023;27(7):1322-8. [View at Publisher] [DOI] [PMID] [Google Scholar]
15. Hebdon MCT, Coombs LA, Reed P, Crane TE, Badger TA. Self-efficacy in caregivers of adults diagnosed with cancer: An integrative review. Eur J Oncol Nurs. 2021;52:101933. [View at Publisher] [DOI] [PMID] [Google Scholar]
16. Sato H, Nakaaki S, Sato J, Shikimoto R, Furukawa TA, Mimura M, et al. Caregiver self‐efficacy and associated factors among caregivers of patients with dementia with Lewy bodies and caregivers of patients with Alzheimer's disease. Psychogeriatrics. 2021;21(5):783-94. [View at Publisher] [DOI] [PMID] [Google Scholar]
17. Zeiss AM, Gallagher-Thompson D, Lovett S, Rose J, McKibbin C. Self-efficacy as a mediator of caregiver coping: Development and testing of an assessment model. J Clin Neuropsychol. 1999;5(3):221-30. [View at Publisher] [DOI] [Google Scholar]
18. Steffen AM, McKibbin C, Zeiss AM, Gallagher-Thompson D, Bandura A. The revised scale for caregiving self-efficacy: reliability and validity studies. J Gerontol B Psychol Sci Soc Sci. 2002;57(1):P74-86. [View at Publisher] [DOI] [PMID] [Google Scholar]
19. Merluzzi TV, Philip EJ, Vachon DO, Heitzmann CA. Assessment of self-efficacy for caregiving: the critical role of self-care in caregiver stress and burden. Palliat Support Care. 2011;9(1):15-24. [View at Publisher] [DOI] [PMID] [Google Scholar]
20. Ritter P, Sheth K, Stewart A, Gallagher-Thompson D, Lorig K. Development and Evaluation of the 8-item Caregiver Self-Efficacy Scale (CSES-8). The Gerontologist. 2022;62(3):e140-9. [View at Publisher] [DOI] [PMID] [Google Scholar]
21. Munro BH. Statistical methods for health care research. Philadelphia:lippincott williams & wilkins;2005. [View at Publisher] [Google Scholar]
22. Mirhosseini S, Moslemi F, Sharif-Nia H, Minaei-Moghadam S, Khajeh M, Abbasi A, et al. Psychometric evaluation of the Persian version of the Family Caregiver-Specific Quality of Life Scale (FAMQOL) among family caregivers of patients with chronic psychiatric disorders. BMC Psychol. 2025;13(1):222. [View at Publisher] [DOI] [PMID] [Google Scholar]
23. Gudmundsson E. Guidelines for translating and adapting psychological instruments. Nordic Psychology. 2009;61(2):29-45. [View at Publisher] [DOI] [Google Scholar]
24. Mirhosseini S, Ameri F, Rahmani H, Sharif-Nia H, Fazel G, Khajeh M, et al. Psychometric assessment of the persian version of the study anxiety questionnaire in medical sciences students. BMC Med Educ. 2024;24(1):1517. [View at Publisher] [DOI] [PMID] [Google Scholar]
25. Polit-O'Hara D, Hungler BP. Essentials of nursing research: Methods, appraisal, and utilization. Lippincot;1993. [View at Publisher] [Google Scholar]
26. Lawshe CH. A quantitative approach to content validity. Personnel psychology. 1975;28(4):563-75. [View at Publisher] [DOI] [Google Scholar]
27. Lenz ER. Measurement in nursing and health research. New York:Springer publishing company;2010. [View at Publisher] [Google Scholar]
28. Mabel OA, Olayemi OS. A comparison of principal component analysis, maximum likelihood and the principal axis in factor analysis. American Journal of Mathematics and Statistics. 2020;10(2):44-54. [View at Publisher] [Google Scholar]
29. Cattell RB. The scree test for the number of factors.Multivariate Behav Res. 1966;1(2):245-76. [View at Publisher] [DOI] [PMID] [Google Scholar]
30. Feng P, Yang H-L, Xu L, Ojo O, Lu X-Y, Zhang H-Y, et al. Development and psychometric testing of a questionnaire to assess Nurse's perception of risks during enteral nutrition. BMC Nurs. 2021;20(1):6. [View at Publisher] [DOI] [PMID] [Google Scholar]
31. Pett MA, Lackey NR, Sullivan JJ. Making sense of factor analysis: The use of factor analysis for instrument development in health care research. US:sage;2003. [View at Publisher] [DOI] [Google Scholar]
32. Sharif-Nia H, Sivarajan Froelicher E, She L, Jafari-Koulaee A, Hejazi S, Mosazadeh H, et al. The Persian version of the body esteem scale among Iranian adolescents: a translation, psychometrics, and network analysis. Front Psychol. 2024;15:1296498. [View at Publisher] [DOI] [PMID] [Google Scholar]
33. Franke G, Sarstedt M. Heuristics versus statistics in discriminant validity testing: a comparison of four procedures. Internet research. 2019;29(3):430-47. [View at Publisher] [DOI] [Google Scholar]
34. Henseler J, Ringle CM, Sarstedt M. A new criterion for assessing discriminant validity in variance-based structural equation modeling. Journal of the academy of marketing science. 2015;43:115-35. [View at paplisher] [DOI] [Google Scholar]
35. Cho E. Neither Cronbach's alpha nor McDonald's omega: A commentary on Sijtsma and Pfadt. Psychometrika. 2021;86(4):877-86. [View at Publisher] [DOI] [PMID] [Google Scholar]
36. Kalkbrenner MT. Alpha, omega, and H internal consistency reliability estimates: Reviewing these options and when to use them. Counseling Outcome Research and Evaluation. 2023;14(1):77-88. [View at paplisher] [DOI] [Google Scholar]
37. Zygmont C, Smith MR. Robust factor analysis in the presence of normality violations, missing data, and outliers: Empirical questions and possible solutions. The Quantitative Methods for Psychology. 2014;10(1):40-55. [View at Publisher] [DOI] [Google Scholar]
38. Zhang SY, Edwards H, Yates P, Ruth E, Guo Q. Preliminary reliability and validity testing of a Self-Efficacy Questionnaire for Chinese Family Caregivers. Aging Ment Health. 2013;17(5):630-7. [View at Publisher] [DOI] [PMID] [Google Scholar]
39. Serpentini S, Guandalini B, Tosin G, Ronconi L, Cristaldi G, Amatulli R, et al. Assessment of self-efficacy for caregiving in oncology: Italian validation of the caregiver inventory (CGI-I). BMC Palliat Care. 2021;20(1):166. [View at Publisher] [DOI] [PMID] [Google Scholar]
40. Kazanowski M. Family caregivers' medication management of symptoms in patients with cancer near death. J Hosp Palliat Nurs. 2005;7(3):174-81. [View at Publisher] [DOI] [Google Scholar]
41. Lewandowska A, Rudzki G, Lewandowski T, Rudzki S. The problems and needs of patients diagnosed with cancer and their caregivers.Int J Environ Res Public Health. 2020;18(1):87. [View at Publisher] [DOI] [PMID] [Google Scholar]
42. Cheng HL, Leung DYP, Ko PS, Lam WM, Lam PT, Luk AL, et al. Mediating role of self‐efficacy between unmet needs and quality of life in palliative cancer caregivers. Psychooncology. 2023;32(3):457-64. [View at Publisher] [DOI] [PMID] [Google Scholar]
43. Bandura A. Social cognitive theory: An agentic perspective. Annu Rev Psychol. 2001;52(1):1-26. [View at Publisher] [DOI] [PMID] [Google Scholar]
44. Zhang SY, Edwards H, Yates P, Ruth E, Guo QH. Development of self‐efficacy questionnaire for chinese family caregivers. Int J Ment Health Nurs. 2012;21(4):358-65. [View at Publisher] [DOI] [PMID] [Google Scholar]
45. Jun WH, Cha KS, Lee KL. The mediating effect of depression on the relationship between social support, spirituality and burnout in family members of patients with cancer. Int J Environ Res Public Health. 2021;18(4):1727. [View at Publisher] [DOI] [PMID] [Google Scholar]
46. De Maria M, Iovino P, Lorini S, Ausili D, Matarese M, Vellone E. Development and psychometric testing of the caregiver self-efficacy in contributing to patient self-care scale. Value Health. 2021;24(10):1407-15. [View at Publisher] [DOI] [PMID] [Google Scholar]
47. Lee JY, Chang HK. Factors influencing family caregivers' self-management of acute stroke survivors. Korean Journal of Adult Nursing. 2018;30(6):669-80. [View at Publisher] [DOI] [Google Scholar]
48. Hong M, Kim K, Casado BL. Psychometric evaluation of the caregiver self-efficacy scale with Korean Americans. Soc Work Health Care. 2016;55(10):861-73. [View at Publisher] [DOI] [PMID] [Google Scholar]
49. Suwanno J, Klinjun N, Srisomthrong K, Kelly M, Mayeng M, Suwanno J. Validating the caregiver self‐efficacy in contribution to self‐care scale Thai version for stroke: A psychometric evaluation. Nurs Open. 2023;10(11):7360-7. [View at Publisher] [DOI] [PMID] [Google Scholar]
50. Greenhawt M, DunnGalvin A. Preliminary psychometric analyses and clinical performance of a caregiver self-efficacy scale for food allergy self-management. Ann Allergy Asthma Immunol. 2018;120(1):73-9. [View at Publisher] [DOI] [PMID] [Google Scholar]
51. Márquez-González M, Losada A, López J, Peñacoba C. Reliability and validity of the Spanish version of the revised scale for caregiving self-efficacy. Clinical Gerontologist. 2009;32(4):347-57. [View at Publisher] [DOI] [Google Scholar]
52. Giromini L, Young G, Sellbom M. Assessing negative response bias using self-report measures: New articles, new issues. Psychol Inj Law. 2022;15(1):1-21. [View at Publisher] [DOI] [Google Scholar]
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
