title: The inclusion of positive aspects of caring in the Caregiver Strain Index: tests of feasibility and validity.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Health Economics Unit, University of Birmingham, Birmingham, UK. h.aljanabi@bham.ac.uk
authors.forename: Hareth
authors.initials: H
authors.lastname: Al-Janabi
authors.forename: Emma
authors.initials: E
authors.lastname: Frew
authors.forename: Werner
authors.initials: W
authors.lastname: Brouwer
authors.forename: David
authors.initials: D
authors.lastname: Rappange
authors.forename: Job
authors.initials: J
authors.lastname: Van Exel
mesh_terms: D017028:Caregivers / Q000523:psychology*; D005240:Feasibility Studies; D006801:Humans; D009426:Netherlands; D013315:Stress, Psychological