Testing the psychometric properties of a Chinese version of Dyadic Relationship Scale for families of people with hypertension in China

According to the recommendations of the International Society of Hypertension and Chinese guidelines for the management of hypertension, hypertension is diagnosed when the office/clinic systolic blood pressure (SBP) is 140 mmHg or above and/or the diastolic blood pressure (DBP) is 90 mmHg or above [1, 2]. Hypertension is a major risk factor for cardio-cerebrovascular disease and its morbidity and mortality; and the increased risk of cardiovascular disease among adults with BP above 140/90 mmHg is well established [3].

Pharmacological and lifestyle modifications are the two main treatments for hypertension [1,2,3]. Hypertension management is an everyday, long-term process that needs continuous help and support from health care providers and family. Interventions involving family members are widely adopted in chronic illness care (e.g., stroke and diabetes) and hypertension management, especially in the community care settings [3, 4]. Patients with more support from family caregivers may show higher improved health-related knowledge, self-efficacy, better adherence behaviors, quality of life, and other important health outcomes [3, 4]. For family caregivers, they may have reduced caregiving burden and improved satisfaction with family care when they have shown good relationships with patients and other family members [4, 5]. On the other hand, if having a poor patient-family relationship, family caregiving can induce high burden of care and significant negative impacts on both patients’ and their caregivers’ physical and psychological health [6]. For example, the family dyads (patients and family caregivers) may feel very stressful in caregiving process and negative interpersonal interactions and relationships such as criticisms and nagging in communication, blaming and guilty feelings, and conflicts among family members [6, 7]. There would also be challenges in decision making on illness management and even over-controlling and protective behaviors to patients [8,9,10].

Testing the psychometric properties of a Chinese version of Dyadic Relationship Scale for families of people with hypertension in China

Indeed, most studies in chronic illness care have focused on either patients’ or caregivers’ interventions and outcomes. As a result, the interactive and reciprocal influence between the family dyads may often be neglected or underestimated. To measure the quality of this family dyadic relationship in hypertensive care, a psychometrically sound instrument should be available for an accurate and valid assessment [11, 12].

In China and worldwide, family care for people with hypertension has been an increasing important health care research topic. A systematic review of 94 randomized controlled trials evaluated their effectiveness of interventions for hypertension care in different Chinese communities, of which 13 studies used psychosocial interventions to improve family support [13]. Particularly, Chinese family culture and values highly emphasize the responsibilities and obligations of family members in caring for sick family members, considering to be the moral obligation and norms of Chinese societies [14]. Family caregivers often devote most of their time and efforts to ensure that the ill relatives can obtain adequate and appropriate medical treatment and assistance in daily living activities.

To date, very few instruments have been developed to measure patient and family or caregiver relationship, and none available in Chinese language. Dyadic Relationship Scale (DRS), including two independent scales (DRS-patient and DRS-caregiver versions), was the sole instrument measuring dyadic relationship in family care for people with chronic illnesses [15]. The DRS-patient and DRS-caregiver measure respective patient and caregiver viewpoints about how family caregiving to their patients impacts the interpersonal interactions between family members. Both DRS scales have demonstrated satisfactory internal consistency and good construct and concurrent validities among families of people with chronic illnesses in the United States [15]. For example, the Cronbach’s alpha coefficients of the DRS-patient and DRS-caregiver were 0.86 and 0.89, respectively. In addition, a best-fit model of two factors (i.e., positive interaction and dyadic strain) was identified with confirmatory factor analysis, with a root mean square error of approximation (RMSEA) of 0.07 and a comparative fit index (CFI) of 0.96. Concurrent validity was supported in the structural equation modelling and the partial standardized regression coefficient between the Centre for Epidemiologic Studies–Depression scale (CES-D) and the ‘dyadic strain’ subscale scores of the DRS-patient and DRS-caregiver were 0.53 and 0.47, respectively, both p 

The DRS scales are valid and useful to measure the quality of the perceived dyadic relationship between patients with chronic illness and their family caregivers [12].

For measuring such family dyad relationship in Chinese communities, this validation study aimed to translate the English DRS scales into simplified Chinese language followed by face and content validity and semantic equivalence testing, and to examine psychometric properties of the two translated Chinese version in Chinese families of people with hypertension.