title: Caregiver Contribution to Heart Failure Self-Care (CACHS).
abstract: While caregivers (CGs) make an important contribution to the self-care of heart failure (HF) patients, there are no reliable and valid tools for measuring such contributions. Current interventions that strive to optimize patient outcomes through self-care strategies neglect to account for CG contributions, a potential confounder on outcomes. The aim of the study was to develop an instrument that measures CG contributions to HF patients' self-care.
  
  
  
  The study design follows an established process for instrument development.
  
  
  
  A systematic literature review and semi-structured interviews of CGs were conducted to identify measureable CG activities. Items were derived from thematic analysis of CG narratives. A content validity index was computed for each item (I-CVI). Items with an I-CVI of >0·70 were retained. Items with an I-CVI of 0·50-0·70 were revised for clarification and items with an I-CVI <0·5 were discarded, except in instances where fulsome theoretical or empirical evidence supported their retention.
  
  
  
  14 CGs completed interviews and 10 CGs with 4 expert nurses completed I-CVI testing. Major interview themes included arranging appointments, medication adherence, monitoring, coordinating care, encouraging independence and taking action. A total of 36 items were constructed and underwent I-CVI testing. Following I-CVI testing, 27 items were retained, seven items were retained after revision based on CG feedback and two items were removed. This newly developed 34-item questionnaire represents current literature, CGs' experiences, excellent I-CVI scores and ready for further psychometric testing.
authors.affiliation: School of Nursing McMaster University Hamilton ON Canada; Hamilton Health Sciences Hamilton ON Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: Harkness
authors.affiliation: Schreyer Honors College Hartford Center of Geriatric Nursing Excellence College of Nursing The Pennsylvania State University PA USA.
authors.forename: Harleah G
authors.initials: HG
authors.lastname: Buck
authors.affiliation: McMaster University Hamilton ON Canada.
authors.forename: Heather
authors.initials: H
authors.lastname: Arthur
authors.affiliation: School of Nursing McMaster University Hamilton ON Canada; Population Health Research Institute Hamilton ON Canada.
authors.forename: Sandra
authors.initials: S
authors.lastname: Carroll
authors.affiliation: School of Nursing McMaster University Hamilton ON Canada; Hamilton Health Sciences Hamilton ON Canada.
authors.forename: Tammy
authors.initials: T
authors.lastname: Cosman
authors.affiliation: School of Nursing McMaster University Hamilton ON Canada; Population Health Research Institute Hamilton ON Canada; Cardiovascular Nursing Research Hamilton ON Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: McGillion
authors.affiliation: School of Nursing McMaster University Hamilton ON Canada.
authors.forename: Sharon
authors.initials: S
authors.lastname: Kaasalainen
authors.affiliation: University of Saskatchewan College of Nursing Saskatoon SK Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Kryworuchko
authors.affiliation: Canadian Council of Cardiovascular Nurses/Ross Memorial Hospital Lindsay ON Canada.
authors.forename: Sheila
authors.initials: S
authors.lastname: O'Keefe-McCarthy
authors.affiliation: School of Nursing McMaster University Hamilton ON Canada; Diabetes Care and Research Program Hamilton Health Sciences Hamilton ON Canada.
authors.forename: Diana
authors.initials: D
authors.lastname: Sherifali
authors.affiliation: School of Nursing McMaster University Hamilton ON Canada.
authors.forename: Patricia H
authors.initials: PH
authors.lastname: Strachan
keywords: Caregiving; heart failure; instrument development