Development and Psychometric Evaluation of Family Caregivers’ Hardiness Scale: A Sequential-Exploratory Mixed-Method Study

Abstract

ObjectiveCaring for patients with Alzheimer’s disease (AD) is a stressful situation and an overwhelming task for family caregivers. Therefore, these caregivers need to have their hardiness empowered to provide proper and appropriate care to these older adults. From the introduction of the concept of hardiness, few studies have been conducted to assess the hardiness of caregivers of patients with AD. Presumably, one reason for this knowledge gap is the lack of a proper scale to evaluate hardiness in this group. This study was conducted to develop a reliable and valid Family Caregivers’ Hardiness Scale (FCHS) to measure this concept accurately among Iranian family caregivers sample.MethodsThis study is a cross-sectional study with a sequential-exploratory mixed-method approach. The concept of family caregivers’ hardiness was clarified using deductive content analysis, and item pools were generated. In the psychometric step, the samples were 435 family caregivers with a mean age of 50.26 (SD ± 13.24), and the data were gathered via an online form questionnaire. In this step, the items of the FCHS were evaluated using face and content validity. Then, the factor structure was determined and confirmed using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) followed by convergent and divergent validity, respectively. Finally, scale reliability, including stability, and internal consistency were evaluated.ResultsThe finding revealed that FCHS consists of five factors, namely, “Religious Coping” (5 items), “Self-Management” (6 items), “Empathic Communication” (3 items), “Family Affective Commitment” (3 items), and “Purposeful Interaction” (4 items) that explained 58.72% of the total variance. The results of CFA showed a good model fit. Reliability showed acceptable internal consistency and stability.ConclusionBased on the results of the psychometric evaluation of the FCHS, turned out that the concept of hardiness in Iranian family caregivers is a multidimensional concept that is most focused on individual-cultural values, emotional family relationships, and social relationships. The designed scale also has acceptable validity and reliability features that can be used in future studies to measure this concept in family caregivers.

Evaluation of Psychometric Properties of Hardiness Scales: A Systematic Review

“…One study was a doctoral thesis ( Ferrara, 2019 ) and the 32 other articles were original and were published in journals. The majority of them were conducted in the United States ( n = 12) ( Funk and Houston, 1987 ; Pollock and Duffy, 1990 ; Bartone, 1991 ; Benishek, 1996 ; Velasco-Whetsell and Pollock, 1999 ; Wang, 1999 ; Benishek and Lopez, 2001 ; Benishek et al, 2005 ; Maddi et al, 2006 ; Madrigal et al, 2016 ; Weigold et al, 2016 ) after that Iran ( n = 4) ( Mohsenabadi and Fathi-Ashtiani, 2021 ; Soheili et al, 2021a , b ; Hosseini et al, 2022 ), Canada ( n = 2) ( McNeil et al, 1986 ; Lang et al, 2003 ), Brazil ( n = 1) ( Solano et al, 2016 ), China ( n = 1) ( Wong et al, 2014 ), Netherlands ( n = 2) ( Gebhardt et al, 2001 ; Dymecka et al, 2020 ), Greece ( n = 1) ( Kamtsios and Karagiannopoulou, 2013 ), Croatia ( n = 1) ( Kardum et al, 2012 ), Italia ( n = 1) ( Picardi et al, 2012 ), Spain ( n = 2) ( Moreno-Jiménez et al, 2014 ; Luceño-Moreno et al, 2020 ), Australia ( n = 1) ( Creed et al, 2013 ), Sweden ( n = 1) ( Persson et al, 2016 ), Taiwan ( n = 1) ( Cheng et al, 2019 ), Japan ( n = 1) ( Yamaguchi et al, 2020 ), South Korea ( n = 1) ( Ko et al, 2018 ), and Norway ( n = 1) ( Hystad et al, 2010 ). Only one study was published in the Persian language ( Mohsenabadi and Fathi-Ashtiani, 2021 ).…”

“…Also, only 39.3% of the studies (13 articles) scored “very good” on both internal structure boxes. The third part of the risk of bias assessment includes 4 boxes that only 4 studies reported on 3 of 4 boxes as not very good; just one study got a “very good” score in 2 boxes ( Hosseini et al, 2022 ). Details of the risk of bias have been reported in Table 2 .…”

“…From these 33 studies, 31 studies tested internal consistency, 16 tested test-retest reliability, two studies tested criterion validity ( Ko et al, 2018 ; Dymecka et al, 2020 ), and 30 studies tested construct validity. Most of the studies evaluated internal consistency and stability using Cronbach’s alpha, but four studies evaluated stability using ICC ( Picardi et al, 2012 ; Kamtsios and Karagiannopoulou, 2013 ; Solano et al, 2016 ; Hosseini et al, 2022 ). The criterion validity was tested in two studies ( Ko et al, 2018 ; Dymecka et al, 2020 ).…”

“…The main quality criteria to evaluate reliability are ICC or weighted Kappa ≥ 0.70 ( Terwee et al, 2007 ). Five studies were evaluated as “Excellent,” ( Picardi et al, 2012 ; Kamtsios and Karagiannopoulou, 2013 ; Solano et al, 2016 ; Ko et al, 2018 ; Hosseini et al, 2022 ), eight studies were evaluated as “poor” because they did not report ICC or Kappa value; and 20 studies did not evaluated reliability and were deemed of “poor” quality.…”

“…The means of measurement error is the systematic and random error of a score that cannot be attributed to true changes in the construct reported by the Standard Error of Measurement (SEM). Just one study reported measurement errors ( Hosseini et al, 2022 ).…”