The Family Assessment Device: A Clinimetric Analysis

The Italian version of the FAD [4] was administered to a sample of 456 parents with Italian as their mother tongue (222 males, 234 females; mean age: 41.72 ± 5.67 years; 93% married; 98.4% employed) contacted via five primary schools placed in three towns in Tuscany (North Italy). The participation was voluntary and, according to the Italian law on the treatment of personal data in research activities (law No. 196, June 30, 2003), ethics committee approval was not required, but respondents had to provide a signed consent including a privacy protection disclaimer. We conducted an exploratory factor analysis using the maximum likelihood extraction method and a varimax rotation to clarify the factor structure of the FAD. In order to reduce the number of items and retain the clinical validity of the questionnaire, the principal component extraction method and the Mokken analysis were performed. In particular, the Mokken analysis was used to test scalability, i.e. the extent to which an additional item fits into the structure of a scale, and how the total summed item score was a sufficient statistic. This non-parametric item response theory model is based on Loevinger’s coefficient of homogeneity (adequate unidimensionality and homogeneity for coefficients ≥ 0.40; no more than acceptable for coefficients 0.30–0.39). Internal consistency for the 60-item version of the FAD was high (Cronbach’s alpha = 0.94), suggesting that the questionnaire had an item redundancy. Exploratory factorial analysis was performed, and the number of factors retained was based on the 7 dimensions of the FAD. The percentage of explained variance of the 7 factors was good (43.78%), but the exploratory factor analysis showed that most of the items were spread out in more than one factor. Thus, the principal component analysis was performed, and a first component with a higher eigenvalue (eigenvalue: 15.67) than the second component (eigenvalue: 2.3) was identified, therefore the first principal component was retained. Since its 41 item loadings were bidirectional, we found a general factor of family functioning separated by different factor loadings that were negative versus positive. The 18 items with negative loadings were positively worded and covered the well-being aspects of family functioning; the 23 positively loaded items were negatively worded and covered the ill-being aspects of family functioning. The Mokken analysis was used to test whether items with negative loadings measured the degree of well-being and items with positive loadings measured the degree of ill-being. Loevinger’s coefficient of homogeneity for the negatively loaded items was acceptable (0.40), while Loevinger’s coefficient for the positive loaded items was below the acceptance level (0.36). Thus, to improve the measure of scalability, 5 items (items 17, 58, 21, 54, and 27), which had the lowest coefficients of homogeneity, were excluded. The resulting 18-item scale with positively loaded items had an acceptable coefficient of homogeneity (0.41). These findings indicated that the 36-item version of the FAD has an adequate internal consistency, and the total score of the two scales had a sufficient degree of statistical validity ( table 1 ). The Family Assessment Device (FAD) [1] is a widely used 60item self-report questionnaire measuring the ability of the family to work together to satisfy the basic needs of its members, according to the McMaster Model of Family Functioning [2] . It has 6 subscales and a General Functioning scale, which assesses the overall health/pathology of the family. The FAD has shown an adequate internal consistency [3–5] and moderated correlations with other self-report family assessment questionnaires [6] . Its discriminant validity, between families of medical patients and families of controls, has been studied with heterogeneous results [6] , while the discriminant validity among families of different groups of psychiatric patients and normal samples is good [6] . The test-retest reliability has been evaluated only for the General Functioning scale (correlation coefficient: 0.60 after 12 weeks and 0.76 after 6 months), while the FAD responsiveness in detecting changes in the family functioning subsequent to a therapeutic intervention was found acceptable [6] . The FAD factor structure is debated: some authors found a substantial subscale overlap and suggested using only the General Functioning scale [7] , while other authors proposed a factor solution different from the original one (e.g. 3 factors [6] ; 7 factors [3] ). The FAD has elicited a growing interest in the clinimetric perspective, a domain concerned with indexes, rating scales, and other expressions used to describe or measure symptoms, physical signs, as well as other distinctly clinical phenomena [8] . Differently from the classical psychometric approach, the clinimetric analysis proposed convergent, discriminant, and incremental validity (adding a test gives a better prediction if compared to the information provided by the test ordinarily available) [9] as important features that determine the sensibility of a clinical measurement. In this framework, Staccini et al. [6] showed the FAD utility in providing information on family functioning in relation to patient characteristics, clinical outcomes, and caregiver’s psychological distress, burden, and low satisfaction with caregiving activities. Since the FAD has shown moderate/good psychometric properties and disputed low factor validity, we made a clinimetric analysis of the Italian version by combining an initial principal component analysis with the Mokken analysis for scalability. Received: January 28, 2016 Accepted after revision: March 12, 2016 Published online: May 27, 2016