Psychometric assessment of the Zimbabwe caregiver challenges scale (ZCCS): development of a context-specific outcome measure in a low-resource setting.

Abstract

Routine assessment of caregiver burden in low-resource settings is constrained by limited culturally relevant measures. This study developed and initially evaluated the Zimbabwe Caregiver Challenges Scale (ZCCS) among caregivers of children with cerebral palsy (CP). We developed the ZCCS through a systematic review, caregiver interviews, and two rounds of expert content validation, then field-tested it with 461 caregivers of children with CP. We analysed data using content-validity indices, Rasch analysis, and exploratory factor analysis in SPSS and RUMM2030 (α = 0.005). The ZCCS yielded four factors: physical and economic burden, concerns for the child, family relations and community participation. Internal consistency was high across subscales (Cronbach's α = 0.765-0.841) and the total scale (α = 0.925). The four-week test-retest intraclass correlation coefficient for the total score was 0.880 (95% confidence interval, 0.793-0.930). Higher ZCCS scores were associated with greater psychiatric morbidity and poorer health-related quality of life. The ZCCS demonstrated acceptable initial psychometric properties and may support research and structured assessment of caregiving challenges. Further validation is needed before adopting clinical cut-offs or broader applications.