Development and Validation of an “Informal Caregiver-related Forced Immobility Scale (ICFIS)” among frail older adults in Tabriz: a mixed-methods study (Sequential exploratory design)

Abstract

Introduction: Older adults informal caregivers can accidentally contribute to informal caregivers forced immobility (ICFI). So far, no comprehensive study or no comprehensive scale has been developed to examine the role of informal caregivers at ICFI. Aims: The aim of this study was to develop and validate an ICFI and its predisposition scale among frail older adults in Tabriz. Methods and Materials: This research is a mixed-methods study with a sequential exploratory design conducted in Tabriz in 2023. In the first phase, a qualitative study with conventional content analysis was carried out, which included semi -structured interviews to explain the concept of ICFI and its predisposition. Subsequently, codes and themes were extracted from qualitative quotes, and these codes and themes were supplemented through a fast literature review. Following this, ICFI and predisposition scale were developed. The psychometric properties of the scales were assessed in the quantitative phase. Results: Seniors and informal caregivers explained the concept of ICFI at three levels: prevention of social interaction/participation, prevention of daily activities and prevention of physical activity and exercise, and predisposing factors of ICFI at three levels: care process-related factors, behavioral factors and cognitive factors. An ICFI and its predisposition scale were developed and their content and face validity were confirmed. Confirmatory factor analysis for the developed scales indicated that the Comparative Fit Index (CFI) values were 1.00, 0.93, 0.95, and 0.88; the Normed Fit Index (NFI) values were 0.99, 0.91, 0.93, and 0.85; the Incremental Fit Index (IFI) values were 1.00, 0.99, 0.95, and 0.88; the Tucker-Lewis Index (TLI) values were 1.00, 0.87, 0.92, and 0.85; and Goodness of fit index (GFI) values were 0.94 and 0.91. The Root Mean Square Error of Approximation (RMSEA) for one tool indicated a good model fit (0.00), while for three tools, it was relatively acceptable (0.09, 0.09, and 0.09). The Cronbach's alpha values for the obtained tools were 0.88, 0.75, 0.93, and 0.88, while the intraclass correlation coefficients were estimated at 0.90, 0.98, 0.97, and 0.98. Conclusion: These scales are suitable for ICFI and its predisposing factors in older adults and informal caregivers and applicable, which makes them valuable resources for future research. Keywords: Frail elderly, Aged, Sedentary behavior, Caregivers, Psychometrics