Development and Validation of a Multidimensional Short Version Zarit Burden Interview (ZBI-9) for Caregivers of Persons With Cognitive Impairment

Abstract

Background: There is a lack of appreciation of the full dimensionality of the original 22-item Zarit Burden Interview (ZBI) in the development of short versions. Existing short versions are premised upon a 1-factor or 2-factor structure or statistical techniques for item selection. Thus, there is a need for ZBI short versions that considers the multidimensional constructs of role strain, personal strain, and worry about performance (WaP) during item selection to provide a more holistic and comprehensive evaluation. Purpose: To develop and validate a short version of ZBI through a combined quantitative and qualitative approach that incorporates the validated 4-factor structure of role strain demands; role strain-control; personal strain, and WaP. Patients: We studied 202 caregivers of patients with dementia (84.2%) or mild cognitive impairment (15.8%) attending a memory clinic in Singapore. Methods: Confirmatory factor analysis and qualitative considerations from expert consensus were used for item selection. Confirmatory factor analysis fit statistics support the 4-factor structure. The 9-item ZBI-9 showed good internal consistency (Cronbach’s α=0.87) and convergent validity with anxiety and depression (Pearson correlation: Hospital Anxiety and Depression sub-scales, r≥0.56, P <0.001; ZBI- 22, r=0.95, P <0.001). Using a cut-off score of ≥13, ZBI-9 displayed good discriminatory ability for depressive symptoms (area under curve=0.79, P <0.001; sensitivity=70%, specificity=75%). The ZBI-9 also displayed comparable performance to the 22-item full version and three 12-item short versions. Conclusion: The ZBI-9 is a multidimensional short-version assessment tool for caregivers of persons with dementia and mild cognitive impairment that is reliable, valid, and discriminates depressive symptoms.

Developing a theory of change to guide the design and implementation of a Caregiver- Centric Support Service

“…The multi-pronged strategy included the following interventions: 1) Identi cation of family caregivers of hospitalised older persons (65 years old and above) by inpatient ward nurses, 2) Ward nurses engaged and referred family caregivers to the project nurses, 3) Caregivers were prompted to complete the needs assessment form. Caregivers who were unable to complete the form independently were assisted by project nurses, 4) Caregivers were provided with an educational resource package customised to their needs, 5) Caregivers identi ed at risk of high burden and stress (via a needs assessment [32]) were provided with tele-support by project nurses, 6) Caregivers attended caregiving training courses to enhance their caregiving knowledge and skills, 7) Project nurses linked up with community health partners to ensure continuity of support for caregivers and their care-recipients in the long run, and 8) Caregivers in need were connected to groups of relevant community healthcare providers and supported by peer caregivers through group-based programmes and activities.…”