Validity and reliability of Chinese version of Adult Carer Quality of Life questionnaire (AC-QoL) in family caregivers of stroke survivors

PLOS ONE, Nov 2019

The Adult Carer Quality of Life questionnaire (AC-QoL) is a reliable and valid instrument used to assess the quality of life (QoL) of adult family caregivers. We explored the psychometric properties and tested the reliability and validity of a Chinese version of the AC-QoL with reliability and validity testing in 409 Chinese stroke caregivers. We used item-total correlation and extreme group comparison to do item analysis. To evaluate its reliability, we used a test-retest reliability approach, intraclass correlation coefficient (ICC), together with Cronbach’s alpha and model-based internal consistency index; to evaluate its validity, we used scale content validity, confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) via principal component analysis with varimax rotation. We found that the CFA did not in fact confirm the original factor model and our EFA yielded a 31-item measure with a five-factor model. In conclusions, although some items performed differently in our analysis of the original English language version and our Chinese language version, our translated AC-QoL is a reliable and valid tool which can be used to assess the quality of life of stroke caregivers in mainland China. Chinese version AC-QoL is a comprehensive and good measurement to understand caregivers and has the potential to be a screening tool to assess QoL of caregiver.

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Validity and reliability of Chinese version of Adult Carer Quality of Life questionnaire (AC-QoL) in family caregivers of stroke survivors

November Validity and reliability of Chinese version of Adult Carer Quality of Life questionnaire (AC- QoL) in family caregivers of stroke survivors Yongxia Mei 0 1 2 Beilei Lin 1 2 Yingshuang Li 1 2 Chunge Ding 1 2 Zhenxiang Zhang 1 2 0 School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, Unites States of America , USA 1 School of Nursing, Zhengzhou University , Zhengzhou, Henan Province , People's Republic of China, 2 First Affiliated Hospital of Zhengzhou University , Zhengzhou, Henan Province , People's Republic of China 2 Editor: Chaojie Liu, La Trobe University , AUSTRALIA The Adult Carer Quality of Life questionnaire (AC-QoL) is a reliable and valid instrument used to assess the quality of life (QoL) of adult family caregivers. We explored the psychometric properties and tested the reliability and validity of a Chinese version of the AC-QoL with reliability and validity testing in 409 Chinese stroke caregivers. We used item-total correlation and extreme group comparison to do item analysis. To evaluate its reliability, we used a test-retest reliability approach, intraclass correlation coefficient (ICC), together with Cronbach's alpha and model-based internal consistency index; to evaluate its validity, we used scale content validity, confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) via principal component analysis with varimax rotation. We found that the CFA did not in fact confirm the original factor model and our EFA yielded a 31-item measure with a five-factor model. In conclusions, although some items performed differently in our analysis of the original English language version and our Chinese language version, our translated AC-QoL is a reliable and valid tool which can be used to assess the quality of life of stroke caregivers in mainland China. Chinese version AC-QoL is a comprehensive and good measurement to understand caregivers and has the potential to be a screening tool to assess QoL of caregiver. - Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Funding: This study was funded by China Scholarship Council (grant number 201707040006) and Science and Technology Department of Henan Province, China (grant number 134200510018 and 132102310108) and no author is the sponsor. The funders had no role in study design, data collection and analysis, Introduction According to the American Heart Association, on average, a stroke occurs every 40 seconds and a stroke fatality occurs every 4 minutes [ 1 ]. In the United Kingdom (UK), stroke is a major cause of morbidity, the third-most-common cause of death for women in England and Wales, and the fourth-most-common cause of death in men [ 2 ]. In China, stroke is the most frequent cause of death and the annual incidence rate of stroke is 8.7 per 1000, resulting in costs in excess of more than $100 billion [ 3,4 ]. About 75% of Chinese stroke survivors have at least some form of disability and experience difficulty in completing day-to-day chores [5]. decision to publish, or preparation of the manuscript. More than 80% of disabled stroke patients need long-term care from family caregivers [ 6 ]. Caring for patients with stroke results in burden and emotional distress, as well as hope and positive outcomes [7±9], all of which affect the QoL of their caregivers [ 10,11 ]. QoL is regarded as an established marker of biopsychosocial health and an increasingly-used measure of caregivers' health [ 11,12 ]. Reports from the literature indicate that the QoL of caregivers can affect the physical outcomes and QoL of patients [ 13,14 ]. QoL of Chinese caregivers has been found to be poor in both community and hospital setting (in the short term as well as the long term care contexts), suggesting that these caregivers need support from health providers [15±18]. Consequently, promoting the health of stroke patients may require acknowledging and ensuring the QoL of their caregivers. The World Health Organization (WHO) defines QoL as a broad multidimensional concept which includes subjective evaluations of both the positive and the negative aspects of life [19]. We focus here on health related QoL, which, according to the National Center for Chronic Disease Prevention and Health Promotion, includes perceptions of both physical and mental health, and their correlates on the individual level [20]. Researchers have used QoL (in the stress-coping framework of Lazarus and Folkman) as the outcome of the process of coping with stressor for caregivers when using the the stress-coping framework of Lazarus and Folkman to explain [21, 22]. White et al. [23] developed a model to evaluate the QoL of family caregivers of stroke survivors in the context of the caregiving situation, the caregiver's characteristics, and characteristics of the environment, including the balance of positive and negative effects of caregiving. Reports from the lit (...truncated)


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Yongxia Mei, Beilei Lin, Yingshuang Li, Chunge Ding, Zhenxiang Zhang. Validity and reliability of Chinese version of Adult Carer Quality of Life questionnaire (AC-QoL) in family caregivers of stroke survivors, PLOS ONE, 2017, Volume 12, Issue 11, DOI: 10.1371/journal.pone.0186680