Preliminary assessment of the psychometric properties of the abridged Arabic version of the Zarit Burden Interview among caregivers of cancer patients

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Abstract

Purpose

The Zarit Burden Interview (ZBI) is one of the most commonly used measures of caregiver burden. Although it has been translated into and validated in many languages, an Arabic version of the scale was lacking. This study examines the psychometric properties and factor structure of an abridged Arabic version of this measure—the ZBI-A—among caregivers of cancer patients.

Methods

A total of 96 caregivers completed a questionnaire consisting of the ZBI-A, the Hamilton Depression Rating Scale, the World Health Organization Well-Being Index and the Emotional Exhaustion subscale of the Maslach Burnout Inventory. The ZBI-A was assessed using exploratory factor analysis (EFA). Concurrent validity was also examined.

Results

The EFA supported a two-factor structure identical to that of the original ZBI scale. Concurrent validity was supported by the ZBI-A's significant negative association with caregiver well-being and positive association with depression and emotional exhaustion.

Conclusion

These findings suggest that this abridged Arabic version of the Zarit Burden Interview is appropriate for use for assessing caregiving burden.

Introduction

The Zarit Burden Interview (ZBI) is one of the most commonly used measures of caregiver burden (Knight et al., 2000). Initially developed and validated more than 25 years ago (Zarit et al., 1980), the ZBI has been used to measure strain associated with the care of individuals with dementia. The scale's 22 items are divided into two factors: personal strain and role strain (Zarit et al., 1985), and it has been found to demonstrate adequate concurrent and construct validity (Pratt et al., 1986), as well as high internal reliability (Bachner and Ayalon, 2010). A recent meta-analytic study concluded that responses to this scale are reliable across populations of caregivers (i.e., spouses/partners, children, parents) and care recipients (i.e., cancer, dementia, physical illness, mental illness) (Bachner and O'Rourke, 2007).

Over the years, abridged versions of the ZBI have been introduced. One of the most widely used is the 12-item scale proposed by Bédard et al. (2001). Its scale items were selected through a combination of high factor loadings and high item – total correlations across different points in time and diagnoses. As in the full 22-item scale, two distinct factors were identified—personal strain and role strain—both demonstrating adequate internal consistency (ά = 0.89 and ά = 0.77, respectively). The concurrent validity of responses was also established (Bédard et al., 2001). O'Rourke and Tuokko (2003) examined the psychometric properties of this scale within a large representative Canadian caregiver sample and reported similar findings. As the population ages and new effective treatments are offered for chronic and terminal patients, the burden of care posed upon a patient's informal caregivers is constantly rising. Thus, the importance of developing and translating valid and reliable tools for measuring caregiving burden is a necessity.

While the ZBI has been translated into and validated in many languages, to the best of my knowledge, an Arabic version of the scale was lacking. Given the number of people that speak Arabic worldwide and the fact that life expectancy is increasing in the Arab world (UN, 2010), translation and validation of a research tool for measuring caregiving burden is warranted. The current study examines the psychometric properties, factor structure and concurrent validity of the Arabic version of Bédard et al.'s (2001) abridged ZBI scale among caregivers of cancer patients (ZBI-A).

Section snippets

Sample and procedure

Ninety-six Bedouin Arabs, who were primary caregivers of cancer patients, were recruited from the Oncology Institute of Soroka Medical Center, the largest university medical facility in the northern Negev of Israel. The Bedouins are a subgroup within the Arab minority in the State of Israel and constitute approximately 25 percent of the population in the Negev region (210,000).

The prospective respondents were approached by a research assistant who described the study and requested their

Results

The average age of the caregivers was 38.1 years, and most were women. About half were adult children of patients, and more than half defined their level of religiosity as conservative (Table 2).

Discussion

This study examined the psychometric properties and factor structure of an Arabic version of Bédard et al.'s (2001) abridged ZBI scale. Factor analysis gave support to the two-factor structure previously reported. The structure of the two factors (personal strain and role strain) and their respective items was similar to that in the 2001 version. The scale also demonstrated a high percentage of explained variance, as well as adequate internal consistency for the entire scale and each of the

Conflict of interest

None declared.

Acknowledgments

This study has been made possible by a research grant from the Robert H. Arnow Center for Bedouin Studies and Development.

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