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Health & social care in the community
09, 2021;29 (5): e79-e88.

Zarit burden interview among caregivers of community-dwelling older adults in a caribbean setting (Jamaica): Reliability and factor structure.

Kenneth James, Cameal Chin-Bailey, Desmalee Holder-Nevins, Camelia Thompson, Kayon Donaldson-Davis, Denise Eldemire-Shearer
Author Information
  1. Kenneth James: Department of Community Health and Psychiatry, The University of the West Indies, Mona, Jamaica.
  2. Cameal Chin-Bailey: Department of Community Health and Psychiatry, The University of the West Indies, Mona, Jamaica.
  3. Desmalee Holder-Nevins: Department of Community Health and Psychiatry, The University of the West Indies, Mona, Jamaica.
  4. Camelia Thompson: Department of Community Health and Psychiatry, The University of the West Indies, Mona, Jamaica. ORCID
  5. Kayon Donaldson-Davis: Mona Ageing and Wellness Centre, The University of the West Indies, Mona, Jamaica.
  6. Denise Eldemire-Shearer: Mona Ageing and Wellness Centre, The University of the West Indies, Mona, Jamaica.
PMID: 33252838 DOI: 10.1111/hsc.13244

Abstract

The Zarit Burden Interview has been the most popularly used tool for measuring caregiver burden and with the 60 years and over population in Jamaica and developing countries expected to increase, caregiver burden and its assessment assume increased importance. Establishing the reliability and underlying factor structure of instruments such as the ZBI is critical. This study sought to determine the reliability of the Zarit Burden Interview and to assess its underlying factor structure. The ZBI was administered to 180 caregivers of community dwelling older persons in Jamaica in a nationally representative sample across four geographic health regions in 2016. The factor structure was identified using exploratory factor analysis (EFA) with Varimax rotation. Cronbach's alpha was used to assess internal consistency/reliability of the instrument. The internal consistency/reliability of the ZBI instrument was high (Cronbach's α = 0.859) and the corrected item-total correlations ranged from 0.134 to 0.730. The ZBI mean score was found to be 16.92 ± 12.04. EFA produced a six-factor model comprised of 19 items which explained 48.97% of total variance, and was subsequently reduced to four (37.27% of total variance) via the use of parallel analysis and scrutiny of confidence intervals. The four factors identified were 'personal strain', 'social relations disruption', 'resource strain/imbalance' and 'role intensity'. The ZBI-22 tool is a reliable instrument for evaluating caregiver burden among community dwelling older persons in Jamaica. A four factor model has emerged providing greater insights on the underlying constructs of the ZBI, the most widely used caregiver burden assessment tool.

Keywords

Jamaica Zarit Burden Interview care-giving psychometric reliability

References

  1. Al-Rawashdeh, S. Y., Lennie, T. A., & Chung, M. L. (2016). Psychometrics of the zarit burden interview in caregivers of patients with heart failure. Journal of Cardiovascular Nursing, 31(6), E21-E28. https://doi.org/10.1097/JCN.0000000000000348
  2. American Medical Association. (n.d.). Caregiver Self-Assessment Questionnaire. http://web.mit.edu/workplacecenter/hndbk/docs/questionnaire.pdf
  3. American Psychological Association. (2020). Zarit Burden Interview. https://www.apa.org/pi/about/publications/caregivers/practice-settings/assessment/tools/zarit
  4. Bachner, Y. G., & O’Rourke, N. (2007). Reliability generalization of responses by care providers to the Zarit Burden Interview. Aging and Mental Health, 11(6), 678-685. https://doi.org/10.1080/13607860701529965
  5. Bédard, M., Molloy, D. W., Squire, L., Dubois, S., Lever, J. A., &O’donnell, M. (2001). The Zarit Burden Interview: A new short version and screening version. Gerontologist, 41(5), 652-657. https://doi.org/10.1093/geront/41.5.652
  6. Bianchi, M., Flesch, L. D., da Costa Alves, E. V., Batistoni, S. S. T., & Neri, A. L. (2016). Indicadores psicométricos da Zarit Burden Interview aplicada a idosos cuidadores de outros idosos. Revista Latino-Americana De Enfermagem, 24, e2835. https://doi.org/10.1590/1518-8345.1379.2835
  7. Bland, J. M., & Altman, D. G. (1996). No Title. https://www.bmj.com/content/bmj/314/7080/572.full.pdf
  8. Carretero, S., Garcés, J., Ródenas, F., & Sanjosé, V. (2009). The informal caregiver’s burden of dependent people: Theory and empirical review. Archives of Gerontology and Geriatrics, 49(1), 74-79. https://doi.org/10.1016/j.archger.2008.05.004
  9. Cheng, S. T., Kwok, T., & Lam, L. C. W. (2014). Dimensionality of burden in Alzheimer caregivers: Confirmatory factor analysis and correlates of the Zarit Burden interview. International Psychogeriatrics, 26(9), 1455-1463. https://doi.org/10.1017/S104161021400101X
  10. Çokluk, Ö., & Koçak, D. (2016). Using Horn’s parallel analysis method in exploratory factor analysis for determining the number of factors. Educational Sciences: Theory and Practice, 16, 537-551. https://eric.ed.gov/?id=EJ1101205
  11. Family Caregiver Alliance. (2019). Caregivers Count Too! Section 4: Examples of Caregiver Assessment Tools. https://www.caregiver.org/caregivers-count-too-section-4-examples-caregiver-assessment-tools
  12. Field, A. (2005). Factor Analysis Using SPSS. In Discovering statistics using SPSS (2nd edition). London: Sage. https://www.discoveringstatistics.com/repository/factor.pdf
  13. Flynn Longmire, C. V., & Knight, B. G. (2011). Confirmatory factor analysis of a brief version of the Zarit Burden interview in Black and White dementia caregivers. Gerontologist, 51(4), 453-462. https://doi.org/10.1093/geront/gnr011
  14. Forsythe-Brown, I., Taylor, R. J., Chatters, L. M., Govia, I. O., Matusko, N., & Jackson, J. S. (2017). Kinship Support in Jamaican Families in the USA and Jamaica. Journal of African American Studies (New Brunswick, N.J.), 21(2), 187-202. https://doi.org/10.1007/s12111-017-9355-7
  15. Goodwyn, F. (2012). Question Number 2: How many factors? Annual Meeting of the Southwest Educational Research Association. https://files.eric.ed.gov/fulltext/ED529100.pdf
  16. Gray, R. S., Hahn, L., Thapsuwan, S., & Thongcharoenchupong, N. (2016). Strength and stress: Positive and negative impacts on caregivers for older adults in Thailand. Australasian Journal on Ageing, 35(2), E7-E12. https://doi.org/10.1111/ajag.12266
  17. Grün, D., Mph, V. P., Vaillant Phd, M., & Diederich, N. J. (2016). Contributory Factors to Caregiver Burden in Parkinson Disease (Vol 17, 7th edition, 626-632). https://doi.org/10.1016/j.jamda.2016.03.004
  18. Hajjar, S. T. (2018). Statistical analysis: internal-consistency reliability and construct validity. International Journal of Quantitative and Qualitative Research Methods, 6(1), 27-38. ISSN 2056-3639
  19. Hayton, J. C., Allen, D. G., & Scarpello, V. (2004). Factor retention decisions in exploratory factor analysis: A tutorial on parallel analysis. Organizational Research Methods, 7(2), 191-205. https://doi.org/10.1177/1094428104263675
  20. Higginson, I. J., & Gao, W. (2008). Caregiver assessment of patients with advanced cancer: Concordance with patients, effect of burden and positivity. Health and Quality of Life Outcomes, 6(1), 42. https://doi.org/10.1186/1477-7525-6-42
  21. Higginson, I. J., Gao, W., Jackson, D., Murray, J., & Harding, R. (2010). Short-form Zarit Caregiver Burden Interviews were valid in advanced conditions. Journal of Clinical Epidemiology, 63(5), 535-542. https://doi.org/10.1016/j.jclinepi.2009.06.014
  22. Holder-Nevins, D., James, K., McKoy-Davis, J., Willie-Tyndale, D., Thompson, C., & Eldemire-Shearer, D. (2018). Who Cares? Sociodemographic and Health Characteristics of Carers of Older Persons in Jamaica. West Indian Medical Journal, 67(5), 465.
  23. International Organization for Migration. (2018). Migration in Jamaica: A Country Profile 2018. https://caribbeanmigration.org/sites/default/files/repository/migration_in_jamaica_-_profile_2018.pdf
  24. Irfan, B., Irfan, O., Ansari, A., Qidwai, W., & Nanji, K. (2017). Impact of caregiving on various aspects of the lives of caregivers. Cureus, 9(5), e1213. https://doi.org/10.7759/cureus.1213
  25. James, K., Holder-Nevins, D., Morris, C., Eldemire-Shearer, D., Powell, J., & Laws, H. (2012). Ageing in place: Implications of morbidity patterns among older persons - findings from a cross-sectional study in a developing country (Jamaica). Australasian Journal on Ageing, 31(3), 170-175. https://doi.org/10.1111/j.1741-6612.2011.00565.x
  26. James, K., Thompson, C., Holder-Nevins, D., Willie-Tyndale, D., McKoy-Davis, J., & Eldemire-Shearer, D. (2020). Caregivers of older persons in Jamaica: Characteristics, burden, and associated factors. Journal of Applied Gerontology, 0733464819898315. Epub ahead of print. PMID: 31920135. https://doi.org/10.1177/0733464819898315
  27. Kasuya, R. T., Polgar-Bailey, P., & Takeuchi, R. (2000). Caregiver burden and burnout A guide for primary care physicians - ProQuest. Poastgraduate Medicine; Minneapolis, 108(7), 119. https://search.proquest.com/docview/203963826?pq-origsite=gscholar
  28. Lambert, S. D., Bowe, S. J., Livingston, P. M., Heckel, L., Cook, S., Kowal, P., & Orellana, L. (2017). Impact of informal caregiving on older adults’ physical and mental health in low-income and middle-income countries: A cross-sectional, secondary analysis based on the WHO’s Study on global AGEing and adult health (SAGE). British Medical Journal Open, 7(11), 1-14. https://doi.org/10.1136/bmjopen-2017-017236
  29. Larsen, R., & Warne, R. T. (2010). Estimating confidence intervals for eigenvalues in exploratory factor analysis. Behavior Research Methods, 42(3), 871-876. https://doi.org/10.3758/BRM.42.3.871
  30. Liew, T. M., & Yap, P. (2019). A 3-item screening scale for caregiver burden in dementia caregiving: Scale development and score mapping to the 22-Item Zarit Burden interview. Journal of the American Medical Directors Association, 20(5), 629-633.e12. https://doi.org/10.1016/j.jamda.2018.11.005
  31. Lu, L., Wang, L., Yang, X., & Feng, Q. (2009). Zarit caregiver burden interview: Development, reliability and validity of the Chinese version. Psychiatry and Clinical Neurosciences, 63(6), 730-734. https://doi.org/10.1111/j.1440-1819.2009.02019.x
  32. Nagata, C., Yada, H., & Inagaki, J. (2018). Exploration of the Factor Structure of the Burden Experienced by Individuals Providing End-of-Life Care at Home. Nursing Research and Practice, 2018, 1-9. https://doi.org/10.1155/2018/1659040
  33. National Policy Senior Citizens: Jamaica. (2018). National Policy Senior Citizens. https://mof.gov.jm/downloads/associatedentities/goj-policies/green-paper-national-policy-senior-citizens-2018.pdf
  34. O’Connor, B. P. (2000). SPSS and SAS programs for determining the number of components using parallel analysis and Velicer’s MAP test. Behavior Research Methods, Instrumentation, and Computers, 32, 396-402. https://people.ok.ubc.ca/brioconn/nfactors/nfactors.html
  35. O’Rourke, N., & Tuokko, H. A. (2003). Psychometric properties of an abridged version of the Zarit Burden Interview within a representative Canadian caregiver sample. Gerontologist, 43(1), 121-127. https://doi.org/10.1093/geront/43.1.121
  36. Onega, L. L. (2008). Helping those who help others: The modified Caregiver strain index. American Journal of Nursing, 108(9), 62-69. https://doi.org/10.1097/01.NAJ.0000334528.90459.9a
  37. Oyegbile, Y. O., & Brysiewicz, P. (2017). Exploring caregiver burden experienced by family caregivers of patients with End-Stage Renal Disease in Nigeria. International Journal of Africa Nursing Sciences, 7, 136-143. https://doi.org/10.1016/j.ijans.2017.11.005
  38. Özer, N., Yurttaş, A., & Akyıl, R. Ç. (2012). Psychometric evaluation of the Turkish version of the Zarit Burden interview in family caregivers of inpatients in medical and surgical clinics. Journal of Transcultural Nursing, 23(1), 65-71. https://doi.org/10.1177/1043659611423830
  39. Pan American Health Organization. (2017). Health in the Americas Country Report: Jamaica. https://www.paho.org/salud-en-las-americas-2017/?page_id=135
  40. Prince, M., Brodaty, H., Uwakwe, R., Acosta, D., Ferri, C. P., Guerra, M., & Liu, Z. (2012). Strain and its correlates among carers of people with dementia in low-income and middle-income countries. A 10/66 Dementia Research Group population-based survey. International Journal of Geriatric Psychiatry, 27(7), 670-682. https://doi.org/10.1002/gps.2727
  41. Rabin, F., Nahar, J. S., Mullick, M. S. I., & Ahmed, H. U. (2016). Adaptation, linguistic and clinimetric validation of the Bangla version of Zarit Burden Interview. Bangabandhu Sheikh Mujib Medical University Journal, 9(4), 181-187.
  42. Scazufca, M., Menezes, P. R., & Almeida, O. P. (2002). Caregiver burden in an elderly population with depression in São Paulo. Brazil. Social Psychiatry and Psychiatric Epidemiology, 37(9), 416-422. https://doi.org/10.1007/s00127-002-0571-6
  43. Seng, B. K., Luo, N., Ng, W. Y., Lim, J., Chionh, H. L., Goh, J., & Yap, P. (2010). Validity and reliability of the Zarit Burden Interview. Annals of the Academy of Medicine, Singapore, 39(10), 758-763.
  44. Siegert, R. J., Jackson, D. M., Tennant, A., & Turner-Stokes, L. (2010). Factor analysis and rasch analysis of the zarit burden interview for acquired brain injury carer research. Journal of Rehabilitation Medicine, 42(4), 302-309. https://doi.org/10.2340/16501977-0511
  45. Souza, A. L. R., Guimarães, R. A., de Araújo Vilela, D., de Assis, R. M., de Almeida Cavalcante Oliveira, L. M., Souza, M. R., Nogueira, D. J., & Barbosa, M. A. (2017). Factors associated with the burden of family caregivers of patients with mental disorders: A cross-sectional study. BMC Psychiatry, 17(1), 1-10. https://doi.org/10.1186/s12888-017-1501-1
  46. Stagg, B., & Larner, A. J. (2015). Zarit Burden Interview: Pragmatic study in a dedicated cognitive function clinic. Progress in Neurology and Psychiatry, 19(4), 23-27. https://doi.org/10.1002/pnp.390
  47. Stinson, J. M., Collins, R. L., Maestas, K. L., Pacheco, V., LeMaire, A., & Benge, J. (2014). Dependency aspect of caregiver burden is uniquely related to cognitive impairment in veterans. Journal of Rehabilitation Research and Development, 51(8), 1177-1188. https://doi.org/10.1682/JRRD.2013.11.0246
  48. Stommel, M., Given, C. W., & Given, B. (1990). Depression as an overriding variable explaining caregiver burdens. Journal of Aging and Health, 2(1), 81-102. https://doi.org/10.1177/089826439000200106
  49. Tang, B., Yu, Y., Liu, Z., Lin, M., Chen, Y., Zhao, M., & Xiao, S. (2017). Factor analyses of the Chinese Zarit Burden Interview among caregivers of patients with schizophrenia in a rural Chinese community. British Medical Journal Open, 7(9), e015621. https://doi.org/10.1136/bmjopen-2016-015621
  50. Torres, A. R., Hoff, N. T., Padovani, C. R., & de Ramos-Cerqueira, A. T. D. A. (2012). Dimensional analysis of burden in family caregivers of patients with obsessive-compulsive disorder. Psychiatry and Clinical Neurosciences, 66(5), 432-441. https://doi.org/10.1111/j.1440-1819.2012.02365.x
  51. United Nations, Department of Economic and Social Affairs, Population Division. (2019). World Population Ageing 2019 Highlights. New York: United Nations. https://www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPopulationAgeing2019-Highlights.pdf
  52. Warne, R. T., & Larsen, R. (2014). Evaluating a proposed modification of the Guttman rule for determining the number of factors in an exploratory factor analysis. Psychological Test and Assessment Modeling, 56(1), 104-123.
  53. Whalen, K. J., & Buchholz, S. W. (2009). The reliability, validity and feasibility of tools used to screen for caregiver burden: A systematic review. JBI Library of Systematic Reviews, 7(32), 1373-1430. https://doi.org/10.11124/jbisrir-2009-213
  54. Yoon, E., & Robinson, M. (2005). Psychometric Properties of the Korean Version of the Zarit Burden Interview (K-ZBI): Preliminary Analyses. Journal of Social Work Research and Evaluation, 6(1), 75-86. https://search.proquest.com/docview/206567061/fulltextPDF/BA74CBC3A8B34320PQ/1?accountid=42530
  55. Yu, J., Yap, P., & Liew, T. M. (2019). The optimal short version of the Zarit Burden Interview for dementia caregivers: Diagnostic utility and externally validated cutoffs. Aging & Mental Health, 23(6), 706-710. https://doi.org/10.1080/13607863.2018.1450841
  56. Zachariou, A., & Filiponi, Μ. (2016). Investigation of the factors affecting the burden on caregivers of elderly patients with urinary incontinence : A cross-sectional study in Greece. Hellenic Urology, 28(3), 45-54.
  57. Zarit, S. H., Reever, K. E., & Bach-Peterson, J. (1980). Relatives of the impaired elderly: Correlates of feelings of burden. Gerontologist, 20(6), 649-655. https://doi.org/10.1093/geront/20.6.649
  58. Zarit, S. H., & Zarit, J. M. (1990). The Memory and Behavior Problems Checklist and the Burden Interview. Pennsylvania State University, Gerontology Center.
  59. Zwick, W. R., & Velicer, W. F. (1986). Comparison of five rules for determining the number of components to retain. Psychological Bulletin, 99(3), 432-442. https://doi.org/10.1037/0033-2909.99.3.432

MeSH Term

Aged
Aged, 80 and over
Caregivers
Cost of Illness
Humans
Independent Living
Jamaica
Psychometrics
Reproducibility of Results
Surveys and Questionnaires
Journal Article

Word Cloud

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