ASSESSMENT OF CAREGIVER'S COMPETENCE IN DEALING WITH THE BURDEN OF CAREGIVING FOR A DEMENTIA PATIENT: A SHORT SENSE OF COMPETENCE QUESTIONNAIRE (SSCQ) SUITABLE FOR CLINICAL PRACTICE

Abstract

To the Editor: Dementia is a burden not only for the patients who experience it but for their families as well. Thus, it is important to develop strategies to support relatives involved in caregiving. The first step in alleviating problems is recognizing them. However, nonprofessional caregivers rarely complain, and, therefore, general practitioners are often unaware of their problems.1 A concise instrument for assessing nonprofessional caregivers' problems could encourage practitioners to assess them. Several instruments have been developed that measure caregivers' problems.2–6 We based our 27-item Sense of Competence Questionnaire (SCQ)7 on the family-crisis model.8 Most issues were included in Zarit's Burden Scale.2 Sense of competence denotes caregivers' feelings of being capable of caring for a demented person. Three domains were distinguished: (1) satisfaction with the demented person as a recipient of care; (2) satisfaction with one's own performance as a caregiver; and (3) consequences of involvement in care for the personal life of the caregiver.7,9 A major advantage of the SCQ is the link between a model investigating problems (family-crisis model) and a model alleviating them (family-support model). A support program based on the family-support model had a favorable effect on the sense of competence of women living with the demented patient and delayed patient admission to an institution.9,10 The disadvantage of current questionnaires, including the SCQ, is their unsuitability for clinical practice; they are too long for history taking. A short list would facilitate paying attention to caregivers in an efficient, structured way. Our aim is to develop a short, valid, reliable diagnostic instrument measuring caregivers' sense of competence, appropriate for general practice, geriatric outpatient clinics, and community nurses, that can connect with strategies to alleviate these problems. The validity and reliability of the Short Sense of Competence Questionnaire (SSCQ) were assessed in a study of 141 caregivers of community-living dementia patients identified through general practitioners.7 To assess reliability, three more studies were involved: caregivers of dementia patients awaiting nursing home admission (n = 90)11; partners of noninstitutionalized stroke patients (n = 166)12; and daughters caring for disabled older parents (n = 293).13 Criteria and methods were developed for selection of SSCQ items: the questionnaire should be as short as possible and include the most relevant items within the original SCQ. The items with the highest factor loadings within each original SCQ domain were selected. Content validity should be ensured by including questions from the three domains. Content validity was assessed by a panel of 39 experts.5 Construct validity should indicate a high Pearson correlation between SSCQ and SCQ (>.80); Pearson correlations between the original SCQ and predicting characteristics should be similar to those between the short SSCQ and predicting characteristics. The measures for assessing the predicting characteristics have been described in detail elsewhere.7 Reliability measured by Cronbach's alpha should exceed .70; item-total correlations should exceed .20.14 The average age of the caregivers was 63; 67% (n = 95) were women. Sixty-three percent of female and 89% of male caregivers were living with the demented person. Fifty percent of the caregivers were spouses, 36% were children (including in-laws), and 14% were friends or neighbors of the demented person. The demented persons were, on average, 78 years of age, and 69% (n = 97) were women.7 The shortest version meeting all criteria comprised seven items and was assessed in less than 5 minutes (mean score = 4.44; SD = 1.96; range 0-7). Content validity was addressed by including questions of the three component domains of the SCQ. Thus a short sense of competence questionnaire covered all problem areas. The construct validity was supported by the high Pearson correlation between SSCQ and SCQ (0.88) and the similarity in correlation coefficients and significance thresholds between the original SCQ and predicting characteristics and the short SSCQ and its predicting characteristics. The reliability calculated by Cronbach's alpha was .76. Testing reliability in three other studies revealed satisfactory values: α = .68 (Fürst 1997), α = .76 (Scholte op Reimer 1997), and α = .87 (Dautzenberg 1997). The alpha in the group of caring daughters (n = 84) was similar to the alpha of the whole caregiver group (n = 293) (Dautzenberg 1997). Reliability was also ensured by satisfactory item-total correlations; they all exceeded .20 (Table 1). Management amenability was enhanced by relating the main management strategies of the family-support model to the domains of the SCQ (Figure 1). The connection with the original domains permits a focus on domain-specific management. . Management strategies. The Short Sense of Competence Questionnaire