The Caregiver Health Self-assessment Questionnaire will help caregivers analyze their own behavior and health risks and, with their physician's help, make decisions that will benefit both the caregiver and the patient. The Caregiver Self-assessment Questionnaire will enable physicians to identify and provide preventive services to an at-risk but hidden population and improve communication and enhance the physician-family caregiver health partnership.
Download copies of the Caregiver Health Self-Assessment Questionnaires in English or Spanish to give to your patients/caregivers:
Development of the self-assessment questionnaire
A caregiver self-assessment questionnaire, with instructions for use, has been developed and tested for distribution to physician offices. The questionnaire is to be completed by the caregiver when he or she accompanies the patient for an office visit or when the physician identifies that a patient is providing long-term care to a family member. By using the self-assessment score as an index of caregiver distress, the need for supportive services can be discussed, and the physician can then encourage utilization and make appropriate referrals to community resources.
The self-assessment tool is a questionnaire with 16 "yes/no" items and two global scale items designed to measure indices of emotional and physical distress. It was tested on a national sample of caregivers who subscribe to a caregiver newsletter (n=60), employees participating in a work-site support group (n=30), and work-site seminars for family caregivers (n=60). The data were analyzed using the ODSC procedure of DBMS software in SPSS v. 9. The caregiver distress index was computed by summing the "yes" items (range=4 to 15) and correlating total score with the global scales. Cronbach’s alpha was calculated to assess internal consistency among items. The reliability coefficient alpha was .7804. Factor analysis identified Q1, Q4, Q9, Q10, Q11, Q13, and Q14 as factors predictive of caregiver stress as well as a score of 6 or higher on Q17 (perceived stress). Correlation of summed scores with Q18 (perceived health) was .0709.