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Caregiver Contribution to Heart Failure Self-Care (CACHS)
Nursing Open
  • Karen Harkness, McMaster University, Canada
  • Harleah G. Buck, Pennsylvania State University
  • Heather Arthur, McMaster University, Canada
  • Sandra Carroll, McMaster University, Canada
  • Tammy Cosman, McMaster University, Canada
  • Michael McGillion, McMaster University, Canada
  • Sharon Kaasalainen, McMaster University, Canada
  • Jennifer Kryworuchko, University of Saskatchewan, Canada
  • Sheila O'Keefe-McCarthy, Canadian Council of Cardiovascular Nurses/Ross Memorial Hospital, Canada
  • Diana Sherifali, McMaster University, Canada
  • Patricia H. Strachan, McMaster University, Canada
Document Type
Publication Date
  • Caregiving,
  • heart failure,
  • instrument development
Digital Object Identifier (DOI)


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.

This article was written while the author, Harleah G. Buck, was at a previous institution.
Rights Information
Creative Commons Attribution 4.0
Citation / Publisher Attribution

Nursing Open, v. 3, issue 1, p. 51-60.

Citation Information
Karen Harkness, Harleah G. Buck, Heather Arthur, Sandra Carroll, et al.. "Caregiver Contribution to Heart Failure Self-Care (CACHS)" Nursing Open Vol. 3 Iss. 1 (2016) p. 51 - 60
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