The contribution of caregivers to selfcare in heart failure: development of an instrument

Purpose. The purpose of this study was to develop an instrument for measuring the caregiver contribution to self-care in people with heart failure (HF). This instrument, referred to as the Caregiver Contribution to Self-Care of Heart Failure Index (CC-SCHFI), was developed modifying the Self-Care of Heart Failure Index version 6.2 (Riegel et l., 2008) in a caregiver version. Methods. A descriptive design was used to study 291 caregivers of people with HF recruited in 16 cardiovascular centers located across Italy. The used instrument were a Socio-demographic and Clinical Questionnaire; the CC-SCHFI that is composed of three scales: the self-care maintenance (10 items) that measures the caregiver contribution to symptom monitoring and adherence behaviors; the self-care management (six items) that evaluates symptom recognition, treatment implementation and treatment evaluation by caregivers; and the self-care confidence that measures caregiver’s confidence to manage his/her contribution to self-care. Results. Caregivers were mainly female (65.7%) with a mean age of 59.16 years old (SD 14.56). In the 89% of cases caregivers were the spouses or the children of the patients. Test-retest reliability showed excellent Intraclass Correlation Coefficient (0.92 for the self-care maintenance, 0.94 for the self-care management and 0.93 for the self-care confidence scales). Comparing the CC-SCHFI scores of caregivers who had received HF education versus caregivers who had not, significant and clinical differences were found (p < 0.001). At the Confirmatory Factor Analysis the factor structure of the CC-SCHFI revealed god model fit: Self-care maintenance, Chi-square 33.47, p 0.11; Self-care management, Chi-square 11.74, p 0.16; Self-care confidence, Chi-square 5.86, p 0.31. Conclusions. The CC-SCHFI showed good psychometric properties and can be used to measure the extent to which caregivers contribute to HF self-care. Since caregivers are very important to maintain patients’ quality of life, to save HF costs and to prevent hospitalization, the CC-SCHFI allows to monitor the contribution of caregivers to self-care. Researchers can use the CC-SCHFI to identify predictors of caregivers’ contribution, clinicians can use the instrument to monitor caregivers and give them educational support in case they need it.