Factor Analysis of the Caregiver Quality of Life Index-Cancer (CQOLC) Scale for Chinese Cancer Caregivers: A Preliminary Reliability and Validity Study of the CQOLC-Chinese Version

Abstract

The English version of the Caregiver Quality of Life Index-Cancer (CQOLC) was translated into simplified Chinese (CQOLC-C), following cultural translation, back-translation and pretest steps. Three hundred and sixty one cancer caregivers participated in this study. Cronbach’s alpha was used to assess CQOLC-C reliability. Exploratory factor analyses (EFA) was used to generate two models of the measure’s factor structure, and confirmatory factor analyses (CFA) were used to test each model, such that the best model to explain the latent structure of the CQOLC-C was identified. EFA using different factor extraction methods yielded two models including four and eight factors. According to the CFA results, model 2 was better fit for the original study data, based on the RMSEA criterion [0.058(90% CI = 0.051-0.065)], χ2 (531) = 853.92, p < 0.0001; CFI (0.96), NNFI (0.96), IFI (0.97), and NFI (0.92). We also examined the effect of removing three items on the CQOLC-C factor structure and discuss the resulting differences from other versions. These results indicate that the CQOLC-C’s factor structure does not fully fit the original theorized model. This study provides preliminary support for further use of the CQOLC-C. However, the present work provides only partial support for the relevance and construct validity of the scale for Chinese caregivers.

Validity and reliability of Chinese version of Adult Carer Quality of Life questionnaire (AC-QoL) in family caregivers of stroke survivors

“…White et al [ 23 ] developed a model to evaluate the QoL of family caregivers of stroke survivors in the context of the caregiving situation, the caregiver’s characteristics, and characteristics of the environment, including the balance of positive and negative effects of caregiving. Reports from the literature indicate that the QoL of caregivers for patients with cancer was multidimensional, including psychological, social, mental and physical and behavioral components [ 22 , 24 ]. However, the QoL of caregivers for patients with stroke has not been studied widely in China, possibly due to the lack of a proper assessment tool.…”

"Assessing Quality-of-Life of Cancer Caregivers in Spain: Validation of CQOLC-Spain Scale and Elements of a Cross- Cultural Analysis"

“…Our research confirms that the CQOLC scale is an important tool for oncologists, and that country-of-origin impacts its psychometric properties: some research reports 4-factors solutions, the USA [2], Iran [17], Korea [19], Portugal [20] and Turkey [4]). Others studies differ: Singapore [1] concludes to 5 factors, France [3] mentions"1 or 9 Factors" without a clear conclusion), China [18] finds"4 Factors+free items" (they do not conclude more clearly). Moreover, common language and/or geographical area are not the only influential consideration: for instance, in a largely "Chinese cultural area", we still see that the Singaporean, Chinese and Taiwanese scale structures do differ from each other.…”

“…We also accepted all types of solid tumor cancer diagnoses and this is a major improvement in the literature on the question as for example, the original US study only considered 3 types, the Iranian 1 type, the Portuguese 3 types only [2,17,20]. Moreover, other studies do not specify the types of cancer diagnoses [1,3,4,18,19]. In summary, this study not only addresses the use of a Spanish CQOLC, but is also the first CQOLC psychometric study with such high generalizability to all types of cancer patients, and of cancer-caregivers.…”

“…We see that the 3 first factors adequately mirror the original American factors of the seminal research by Weitzner et al [2]: F1=Burden, F2=Disruptiveness, F3=Positive adaptation. Weitzner et al [2] had then conserved 8 items called « single items », not included in one specific factor, as did the Duan et al [18] and the Chinese team. We find a similar situation in a pseudo « factor F6 » which displays a low internal consistency and cannot be considered as a real factor (Alpha = 0.463< 0.6): it includes an item of the US scale factor F4 (Q8-Financial concern) and 2 other items expressing concern for the future (Q20-Impact on family members, Q25-Adverse effects of treatment).…”

Cancer Diagnosis Disclosure and Quality of Life in Elderly Cancer Patients

“…The caregivers' quality of life was evaluated using Chinese Caregiver Quality of Life (CQOL) Scale [18,19], which was developed and provided by BECKMAN National Medical Research Center, and then translated and validated by other Chinese researchers [18]. It had 37 items measuring four dimensions: Physical function, psychological function, social function, and spiritual life.…”