(309) Preliminary Reliability and Predictive Validity of the CF Self-Efficacy and Stressors Scale for Caregivers

Background: Caregiver depression is a risk factor for poor child health outcomes in CF. To optimize child health outcomes, we must identify risk and protective factors for caregiver depression and anxiety. In other populations, self-efficacy and stress predict mental health symptoms; further, these constructs can predict adherence to complex regimens above and beyond depression alone [1,2]. The CF Self-Efficacy and Stressors Scale for Caregivers (CF-SAS) was developed using open-ended interviews (n=20) [3] and cognitive interviews (n=16) with caregivers of children with CF. Items were based on caregivers' most frequent, salient stressors using a modified Transactional Stress and Coping Framework. The purpose of this study was to examine preliminary reliability and validity.

Methods: Caregivers (n=30, 70% mothers) of children with CF ages 2-12 years (M=6.8, SD=3.26, 27% female, FEV₁% predicted M=98.9, SD=22.97) completed the preliminary CF-SAS online (48 items on 6 subscales), along with the PHQ-8 (depressive symptoms) and GAD-7 (anxiety symptoms). Preliminary internal consistency was examined using item-total correlations and Cronbach’s α. Predictive validity was assessed using Pearson’s correlations between CF-SAS subscales and the PHQ-8 and GAD-7. Associations between child age and CF-SAS scores were examined with ANOVA. Subscales with the highest mean stress were identified.

Results: All CF-SAS subscales had good internal consistency (Cronbach’s α’s .74 to .80). All item-total correlations were >.3, except for 6 items on 3 subscales; these were retained due to high clinical importance as reported by caregivers in qualitative interviews. The Role Functioning/Social Support, Emotional Functioning, and Distress Tolerance subscales had strong correlations with the PHQ-8 (r’s -.6 to -.62, p< .001) and GAD-7 (r’s -.5 to -.59, p< .01). The PHQ-8 was moderately correlated with subscales Helping Child in Medical Settings (r = -.43, p< .05) and CF Regimen-Related Efficacy (r = -.37, p< .05). Caregivers with a child < 4 years reported greater symptoms of depression (M difference = 4.75, p< .05) and poorer emotional functioning (M difference = -2.38, p< .05) vs caregivers with children between 5-8 years.

Conclusions: Preliminary data support the reliability and predictive validity of the CF-SAS. Caregivers with more depressive symptoms reported poorer distress tolerance and more challenges with social support, helping their child in medical settings, and navigating their daily CF regimen. Once item reduction and large-scale validation is complete, the CF-SAS can be used prospectively to identify risk factors for caregiver mental health concerns and inform intervention development.

Acknowledgements: This study was funded by CFF Pilot and Feasibility Award ALPERN19A0. Participants for cognitive interviews and preliminary validation were recruited via CF Community Voice.

References: [1] Robinson EM, Weaver P, Chen R, Streisand R, Holmes CS. A model of parental distress and factors that mediate its link with parental monitoring of youth diabetes care, adherence, and glycemic control. J Health Psychol. 2016;35(12):1373-1382. doi:10.1037/hea0000406
[2] Harshida P, Sumana G. The Impact of Self-Efficacy and Depression on Self-Care in Patients with Heart Failure: An Integrative Review. Int Arch Nurs Health Care. 2017;3(4). doi:10.23937/2469-5823/1510087
[3] Graham DM, Alpern AN, Oviatt JR, Cortesi A, Ardo JC. Development of the CF Caregiver Self Efficacy Scale, Phase 1: Item Generation. Pediatr. Pulmonol. 2020;55(S2): 270.