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Year : 2016  |  Volume : 17  |  Issue : 2  |  Page : 68-72

Construction and validation of hindumathi, theodore and philip: Primary care givers perceived psychosocial wellbeing scale

1 Lecturer, Narayana Hrudyalaya College of Nursing, Bangalore, India
2 Principal, Narayana Hrudvalava College of Nursing, Bangalore, India
3 Asst Professor, Dept of Statistics, NIMHANS

Date of Web Publication9-Jun-2020

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Source of Support: None, Conflict of Interest: None

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Primary caregivers of hemodialysis patients experience burden of care giving because they are obliged to play an important role in supporting patients on hemodialysis. The patient prognosis and maintenance is dependent on the characteristics of the caregiver and the patient. Care giving is an important factor that determines psychosocial wellbeing of the primary caregivers. Psychosocial wellbeing comprises of their physical, psychological, spiritual and social dimension. The objective of this study was to evaluate the validity and reliability of the researchers’ prepared tool to assess the psychosocial wellbeing of the primary care givers of patients on hemodialysis. Fifty six samples were selected for the study through complete enumeration. The tool was compared with the standard WHO prepared subjective wellbeing inventory. The psychosocial wellbeing tool had a strong positive correlation with the subjective wellbeing inventory. This instrument can be used by the nurses in assessing psychosocial wellbeing of the primary care givers of patients on hemodialysis.

Keywords: Hindumathi, Theodore and Phillip Scale, validation, psychosocial wellbeing, primary care giver, hemodialysis

How to cite this article:
Bheeman H, Theodore DD, Phillip M. Construction and validation of hindumathi, theodore and philip: Primary care givers perceived psychosocial wellbeing scale. Indian J Cont Nsg Edn 2016;17:68-72

How to cite this URL:
Bheeman H, Theodore DD, Phillip M. Construction and validation of hindumathi, theodore and philip: Primary care givers perceived psychosocial wellbeing scale. Indian J Cont Nsg Edn [serial online] 2016 [cited 2021 May 8];17:68-72. Available from: https://www.ijcne.org/text.asp?2016/17/2/68/286303

  Introduction Top

According to World Health Organization (WHO) Global Burden of Disease Project, disease of the kidney and urinary tract contribute to approximately 850,000 deaths every year of which, End Stage Renal Disease (ESRD) is the 12[th] leading cause of death and 17th leading cause of disability in the world (Global Scenario of Chronic Kidney Disease, 2014). Approximate total burden of ESRD is 800 per million population (Schieppati & Remuzzi, 2005). Diabetes mellitus has been reported as the cause of ESRD in31.2-41%of patients in India (Jha, 2013). Most of the care of patients with end stage renal diseases takes place at home, where they rely on primary care givers to assist them with their daily living activities and medical needs (Suri et al., 2011). This care- giving is typically at the core of what sustains patients till the end of life.

The global dialysis population was 1.1 million in 2002 and with a 7% annual growth, is projected to exceed two million by 2012 (ESRD Patients in 2012, 2012). In one population-based study conducted in Bhopal, India the crude- and age-adjusted ESRD incidence rates were determined at 151 and 232 per million populations. If these figures are validated, it would mean that 170,000 - 250,000 new patients need hemodialysis treatment every year in India. The actual prevalence of ESRD in India is not known but is estimated to be 55,000 and growing by 10% every year (Jha, Wang & Wang, 2012).

Aspects of care provided by the primary care givers includes prevention of infection, adhering to dietary restrictions, thirst distress management, accompanying patient to hemodialysis treatment, adhering to dialysis regime, administration of medication, providing psychological support and many more (Cicolini, Palma, Simonetta, & Di Nicola, 2012). Therefore the primary care givers play an important role in the practical and emotional aspects of patient care including decision making.

Care givers often experience emotional stress, anxiety, depression, worsening health, feelings of isolation through loss of social activity, life restrictions, increased workload, negative economic consequences, overwhelming exhaustion, changed relationship with the patient, sexual problem, increased marital strain, decreased psychological health and negative feelings towards the patient when there is increased sense of care giver’s responsibility (Tong, Lowe, Sainsbury, & Craig, 2010). There is high risk of clinical depression. This risk increases when low social support is perceived (Belasco, Barbosa, Bettencourt, Diccini, & Sesso, 2006).

There are standardized scales used to assess the psychosocial wellbeing of adults in general. There is no specific scale to assess the psychosocial wellbeing of the care givers of patients undergoing hemodialysis. Initial discussion with caregivers revealed that the existing tool did not specifically address all their problems. Therefore the researchers undertook this project of constructing and validating a specific tool.


  • To construct psychosocial wellbeing scale to assess the perceived psychosocial wellbeing of the primary care givers of patients on hemodialysis
  • To establish the reliability and validity of psychosocial wellbeing scale that assesses the perceived psychosocial wellbeing of the primary care givers of patients on hemodialysis
  • To assess the relationship between the Hindumathi, Theodre and Philip: Primary care givers perceived psychosocial wellbeing scale and the WHO subjective wellbeing inventory

  Hypothesis Top

H,. There will be significant co relation between the Hindumathi, Theodore, and Philip: primary care givers perceived psychosocial wellbeing scale and Subjective Wellbeing Inventory at .05 level of significance.

  Methods Top

As a first step in the study the researchers developed the new tool for assessing psychosocial wellbeing of the caregiver. Researchers’ clinical encounters and dialogues with the caregivers of patients undergoing hemodialysis revealed unaddressed areas of psychosocial well being as far as caregiving was concerned. The listed areas of concerned needs along with constructs derived from extensive literature review helped the researchers to develop a culture and disease specific assessment scale called as “Primary caregivers perceived psychosocial wellbeing scale” (for hemodialysis population). A 5 point Likert scale was used to determine the psychosocial wellbeing of caregivers. It consisted of 52 psychosocial wellbeing questions in dimensions of physical- 8 items, psychological-19 items, spiritual-1 item, and social wellbeing-24 items. It had 35 positive items and 17 negative items. The minimum score was 53 and maximum score was 260. The researchers named the scale as Hindumathi, Theodre and Philip: Primary care givers perceived psychosocial well being scale. The scale was validated by 8 experts from different disciplines like nursing, social work and clinical psychology.

In the second step the researchers selected a standard instrument to have a comparison for the newly developed tool. The subjective well being inventory is the standardised tool prepared by WHO designed to measure feelings of well being or ill being as experienced by an individual or group of individuals in various day to day life concerns. It consisted of 40 items and was scored by attributing the values 3, 2, 1 to response categories of the positive items and 1, 2, and 3 to the negative items. The minimum score is 40 and maximum score is 120. The tool is reduction version of 130 item of subjective wellbeing and factorial analysis was done by administering it to 120 samples for 18 months and the tool is found to have correlation .43 between the positive and negative items whereas co relation of 130 items scale was .26. The 40 items scale had extra ordinary factorial structure stability which can be used as solid base for counselling practices (World Health Organization, 1992). Both the tools were translated to Tamil and Kannada. Reverse translation was done to check conceptual equivalence.

The quantitative approach with survey research design was adopted for the study to validate the newly developed psychosocial wellbeing scale. Setting of the study was a tertiary care hospital with 50 bedded hemodialysis unit where an average of about 60-70 patients come for hemodialysis in three shifts per day. The frequency of the visit for each patient is 2-3 days per week. While few patients come on their own to the dialysis unit, others are accompanied by care givers. Primary care givers who were coming consistently with the hemodialysis patients and those who could read and write Kannada, Tamil and English were included in the survey. Convenience sampling was used and 56 primary care givers fulfilling the inclusion criteria and who consented to participate in the study were selected to participate in the study

Data Collection Procedure

Administrative and ethical permission was obtained from the institution and the committee were included in the study. Informed consent from the participants was taken. Demographic data of primary care givers such as age, gender, religion, education, occupation, marital status, income per month, type of family, relationship with the patient, duration of relation with the patient, social support from family available, support from friends in working place, and socioeconomic support by government/voluntary agencies and Demographic profile of the patient such as age, gender, marital status, number of children, occupation, presence of financial supports and general well being of patient were collected using the demographic profile proforma. The Hindumathi, Theodre and Philip: Primary care givers perceived psychosocial well being scale and the WHO subjective wellbeing inventory were then administered to collect data. Subjects were asked to rate their wellbeing using the new tool and the WHO tool. The duration of data collection was one month.

  Results Top

The data were analysed using SPSS 16 version. Among the 56 primary care givers who participated in the study 42.9% were in the age group of 19-30 years, 66% were males, 86 % were Hindus, 39% had an educational qualification of 9-12 standard 50% were employed. Majority were married (64%). Most of them were having family income below Rs. 5000 per month (33.9%) and from nuclear family (59%). Most of them were fathers and wives of the hemodialysis patient (23.2%). Majority and had no economic support from government/ voluntary agencies (95%), while 51.8% had no support from family.

The demographic data of hemodialysis patient showed that 50% of them belonged to age group of 50 years and above and 62% were males. Among the subjects 46.4% had 1 to 5 years of duration of illness, 48 % had 2 to 3 children and 33.9% had no job. Majority had no financial support (54%) and were partially able to carry out the activities of daily living (47%).

Validity of the Hindumathi, Theodore, and Philip: primary care givers perceived psychosocial wellbeing scale

To establish validity of the new tool the content validity and construct validity were assessed.

Content validity

The content validity was established by circulating the tools to experts from multidisciplinary team involving nurses, psychiatric social worker, clinical psychologist and statistician. Each item on the tool was scored for its applicability and relevance on a Likert scale. The content validity index was 0.7 which showed the tool to be valid.

Construct validity

The multitriat- multimethod matrix method (MTMM) is significant construct validation tool (Campbell & Fiske, 1959). This procedure involves the concepts of convergence and discriminability. Convergence is the evidence that different methods of measuring a construct yield similar results. The most directive evidence (convergent validity) comes from the co relation between the two different methods measuring same trait. The co efficient of .6 is reasonably high. The MTMM is a valuable tool for exploring construct validity.

In this study the WHO standardized subjective wellbeing inventory was used as a standard against which the researchers prepared tool (Hindumathi, Theodore, and Philip: primary care givers perceived psychosocial wellbeing scale) was compared to assess the concept of psychosocial wellbeing.

Correlation co efficient was calculated using the Spearman Rho formula for detemining the convergent validity of the Hindumathi, Theodore, and Philip: Primary care givers perceived psychosocial wellbeing scale.The ‘r’ value was found to be .687 which was highly significant at p = 0.00 level. The scatter plot [Figure 1] depicts a strong positive correlation between the two scales.
Figure 1: Correlation between the Hindumathi, Theodore, and philip: primary care givers perceived psychosocial wellbeing scale and WHO subjective wellbeing inventory scale.

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Reliability of Hindumathi, Theodore, and Philip: Primary caregivers perceived psychosocial wellbeing scale

The reliability check for internal consistency of the Hindumathi, Theodore, and Philip: Primary care givers perceived psychosocial wellbeing scale was done using the split half method and Cronbach’s alpha. The r value for split half was found to be of0.824 which was highly significant at p<0.00 levels. Cronbach’s Alpha value was 0.884 which showed that internal consistency of the tool was good. Hence the scale was found to have internal stability.

  Discussion Top

Since renal failure is considered to be a chronic progressive disease and the dialysis a long term procedure, it is important that the care givers1 psychosocial wellbeing is optimal in order to provide effective care. In this study primary care givers mental health and vitality was the most affected emotional dimension. As the mental health of primary care givers of patient on hemodialysis decreased the vitality of the patient decreased, as the perceived burden of primary care giver increased the mental health of the primary care giver decreased (Christensen & Ehlers, 2002). Nurse’s play a vital role in providing comprehensive care to the patients as well as the family. To provide comprehensive nursing care the first step would be assessment. This study has helped to develop a tool to assess the primary care givers wellbeing more accurately. This acts as a stepping stone to purposive and specific goal oriented care plan and intervention for the primary care givers of patients on hemodialysis.

Implications for nursing practice

Psychosocial wellbeing and subjective wellbeing are important aspects of mental health of the primary care givers. Assessment of these aspects helps in divising careplans for the health of caregivers and the patients as well. Culture specific disease oriented assessment tool such as Hindumathi, Theodore, and Philip: Primary care givers perceived psychosocial wellbeing scale will help nurses to identify the needs and problems of caregivers and will assist them in developing support interventions.

  Conclusion Top

Nurses in dialysis unit provide care for the patient for a period of 4 hours per day. The remaining 20 to 22 hours of patient care is provided by the primary care givers in order to maintain the patient wellbeing. It is important that nurses provide educative and psychological support to the primary care givers. This tool may be used to assess the primary care givers’ psychosocial wellbeing and identify the areas needing attention. Researchers interested in interventional studies for care givers may use this validated tool.

Conflicts of Interest: The authors have declared no conflicts of interest.

  References Top

Belasco, A., Barbosa, D., Bettencourt, A. R., Diccini, S., & Sesso, R. (2006). Quality of life of family caregivers of elderly patients on hemodialysis and peritoneal dialysis. American Journal of Kidney Diseases, 48(6), 955-963.  Back to cited text no. 1
Campbell, D. T., & Fiske, D. W. (1959). Convergent and discriminant validation by the multitrait-multimethod matrix. Psychological Bulletin, 56(2), 81.  Back to cited text no. 2
Christensen, A. J., & Ehlers, S. L. (2002). Psychological factors in end-stage renal disease: An emerging context for behavioral medicine research. Journal of Consulting and Clinical Psychology, 70(3), 712.  Back to cited text no. 3
Cicolini, G, Palma, E., Simonetta, C., & Di Nicola, M. (2012). Influence of family carers on haemodialyzed patients’ adherence to dietary and fluid restrictions: an observational study. Journal of Advanced Nursing, 68(11), 2410-2417.  Back to cited text no. 4
ESRD Patients in 2012. (2012). A global perspective. Retrieved from http ://w w w. vi si on- finc.com/files/pdf_2/ESRD_Patients_2012.pdf  Back to cited text no. 5
Global Scenario of Chronic Kidney Disease. Advances in CAD.Retrieved from http://www.renalcareindia.org/ Statistics.aspx on December 10,2014  Back to cited text no. 6
Jha, V. (2013). Current status of end-stage renal disease care in India and Pakistan. Kidney International Supplements, 5(2), 157-160.  Back to cited text no. 7
Jha, V., Wang, A. Y. M., & Wang, H. (2012). The impact fo CKD identification in large countries: The burden of illness. Nephrology Dialysis Transplantation, 27(suppl 3), iii32-iii38.  Back to cited text no. 8
Schieppati, A., & Remuzzi, G. (2005). Chronic renal diseases as a public health problem: Epidemiology, social, and economic implications. Kidney International, 68, S7- S10.  Back to cited text no. 9
Suri, R. S., Larive, B., Garg, A. X., Hall, Y. N., Pierratos, A., Chertow, G. M.,… & FHN Study Group. (2011).Burden on caregivers as perceived by hemodialysis patients in the Frequent Hemodialysis Network (FHN) trials. Nephrology Dialysis Transplantation, gfr007.  Back to cited text no. 10
Tong, A., Lowe, A., Sainsbury, P., & Craig, J. C. (2010). Parental perspectives on caring for a child with chronic kidney disease: An in - death interview study, child care, Health and Development, 36 (4), 549 - 557  Back to cited text no. 11
World Health Organization. (1992) Assessment of subj ective wellbeing. The subjective well being inventory (SUBI). Regional health paper. SEARO No. 24. Retrieved from http://apps.searo.who.int/PDS_DOCS/B0081.pdf  Back to cited text no. 12


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