Psychometric evaluation of the Shared Care Instrument in a sample of home health care family dyads.

Researchers have studied negative effects of caregiving on a family caregiver; however, less is known about positive aspects of exchanging assistance for both members of a family caregiving dyad. In a previous naturalistic inquiry the author indentified a basis for studying caregiving interactions was a construct called shared care. The three components of shared care identified in the naturalistic inquiry were communication, decision making, and reciprocity. The Shared Care Instrument (SCI) was developed to measure the construct. The purpose of this study was to assess the psychometric properties of the SCI, and to assess its construct and criterion-related validity. A sample of home care family dyads (110 patients and 109 family members) returned usable survey questionnaires. Results indicated the Cronbach's alphas for the patient group for the SCI subscales ranged from .78 to .84, and .77 to .79 for family members. Factor analysis supported the underlying theoretical basis and factor structure of the SCI. Criterion-related validity was also supported. Therefore, the results of this study provide initial evidence for the reliability and validity of the SCI for use with family caregiving dyads. The findings support the need for additional testing of the SCI. Keywords: caregivers; caregiving dyads; elders; factor analysis; family caregivers; reliability; validity A major focus in the elder family care literature has been on caregivers and negative aspects of providing care, with the exclusion of care recipients. Yet by its nature, caregiving is a dyadic process. Several researchers suggested that care recipients not only receive support from, but also provide substantial support to their family, and these acts of reciprocity are important to well-being (Beach, Schulz, Yee, & Jackson, 2000; Liang, Krause, & Bennett, 2001). Reinardy and colleagues (Reinardy, Kane, Huck, Call, & Shen, 1999) pointed out that positive consequences of informal caregiving are under-reported because many instruments measure negative aspects of caregiving (e.g., burden), and are based on experiences of family members assisting cognitively impaired patients. Progress in the area of family care for elders can be enhanced through conceptualizing and measuring positive aspects of care for both members of the dyad and developing interventions to strengthen those aspects. In a previous study using naturalistic inquiry, Sebern (1996) studied cognitively intact home health care patients and family members, assisting them to describe their care interactions used to prevent pressure ulcers. This study revealed that a theoretical basis for a care giving and receiving interaction was a construct called shared care. Although there are many possible components of interactions, the three components of shared care identified in the naturalistic inquiry were communication, decision making, and reciprocity (see Figure 1). These three components were defined as: 1. Communication (exchanging information about an illness experience) 2. Decision making (making care decisions) 3. Reciprocity (partnership, empathy, and listening when exchanging advice, aid, and emotional support) The Shared Care Instrument (SCI) was developed to measure the construct. The purpose of this study was to assess the psychometric properties of the SCI including criterionrelated and construct validity. BACKGROUND Conceptual Framework Shared care is a dyadic process. Dyadic processes are based on the premise that each participant affects and is affected by the other (Gayle & Preiss, 2002). The most obvious requirement for shared care is a chronically ill patient and a family member providing assistance. A family member assisting a patient is whomever the patient identifies; this person could be a relative or friend who is just like family. Shared care interactions require cognitive ability to communicate, make decisions, and engage in reciprocal actions. …