The inclusion of positive aspects of caring in the Caregiver Strain Index: Tests of feasibility and validity

Hareth Al-Janabi, Emma Frew, W Brouwer, D Rappange, J Van Exel

Research output: Contribution to journalArticle

36 Citations (Scopus)


Background and objective: Positive aspects of caring are commonly cited by carers and can potentially mediate carer strain. However, in outcome assessment for carers, it is still common practice to focus on the negative aspects of caring. This study explored the feasibility and validity of including positive items in a commonly used outcome measure-the Caregiver Strain Index (CSI). Methods: Five positive items were inserted into the CSI. The resulting 'CSI+' questionnaire was included in a postal survey of carers in the Netherlands. Feasibility was assessed through completion rates for the CSI+ and individual items. Validity was assessed through tests of the association of the positive items and the CSI+ scores with relevant characteristics of the care (construct validity) and related scales (convergent validity). Factor analysis was carried out the CSI+ scale. Results: The addition of the positive items did not noticeably affect the feasibility of the CSI, but did appear to improve the convergent validity of the measure. The multivariable analysis and factor analysis suggests that positive aspects of care could be grouped into 'coping' factors and 'attitudinal' factors. Conclusion: These findings support the use of positive items in outcome assessment for carers and provide some support for the use of the CSI+ as an instrument for doing this. (C) 2010 Elsevier Ltd. All rights reserved.
Original languageEnglish
Pages (from-to)984-993
Number of pages10
JournalInternational Journal of Nursing Studies
Issue number8
Publication statusPublished - 1 Aug 2010


  • Caregivers
  • Positive aspects of caring
  • Questionnaire design
  • Outcome assessment
  • Caregiver Strain Index
  • Psychometrics


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