Psychometric properties of the Positive Aspects of Caregiving Scale for unpaid caregivers of people living with dementia in the Brazilian context: a validation study
Propiedades psicométricas de la Escala de Aspectos Positivos
Keywords:
Validation study, Caregivers, Dementia, Mental health, Psychometric properties, Family caregivers, Positive aspects of caregiving, Major neurocognitive disorderAbstract
BACKGROUND: The Positive Aspects of Caregiving Scale (PAC) assesses the satisfaction and psychosocial benefits perceived by caregivers in the caregiving experience.
OBJECTIVE: To analyze the psychometric properties of the PAC among unpaid caregivers of people living with dementia in the Brazilian context.
DESIGN AND SETTING: Validation study of the instrument conducted online with caregivers from different regions of Brazil.
METHODS: The sample comprised 100 unpaid caregivers of people living with dementia. Sociodemographic characteristics, positive aspects of caregiving, burden, depressive symptoms, anxiety symptoms, and quality of life were assessed using an online form. Evidence of validity based on internal structure was examined using confirmatory factor analysis, reliability testing, and criterion validity analysis.
RESULTS: Most participants were women (95%), daughters of the care recipient (85%), with an average age of 54.5 years, a high educational level, and residence in the Southeast region of Brazil. Depressive symptoms (70%), anxiety (65%), moderate to severe burden (42%), and low quality of life (62%) were prevalent. Factor analysis indicated satisfactory fit for the PAC, and the high correlation between factors supported consideration of a one-dimensional scoring structure. The scale showed high internal consistency (α = 0.89) and significant correlations with burden, anxiety symptoms, depressive symptoms, and quality of life.
CONCLUSION: The PAC showed good psychometric properties in the Brazilian context, supporting its validity and reliability for assessing positive aspects of caregiving among unpaid caregivers of people living with dementia.
Downloads
References
1. World Health Organization (WHO). WHO [Internet]. Geneva; 2025 [cited 2026 Apr 7]. Dementia. Available from: https://www.who.int/news-room/fact-sheets/detail/dementia
2. Wimo A, Seeher K, Cataldi R, et al. The worldwide costs of dementia in 2019. Alzheimers Dement. 2023;9(7):2865–73. PMID: 36617519; https://doi.org/10.1002/alz.12901.
3. Lindeza P, Rodrigues M, Costa J, Guerreiro M, Rosa MM. Impact of dementia on informal care: a systematic review of family caregivers' perceptions. BMJ Support Palliat Care. 2020 Oct 14:bmjspcare-2020-002242. PMID: 33055092; https://doi.org/10.1136/bmjspcare-2020-002242.
4. Brini S, Hodkinson A, Davies A, et al. In-home dementia caregiving is associated with greater psychological burden and poorer mental health than out-of-home caregiving: a cross-sectional study. Aging Ment Health. 2022;26(4):709–15. PMID: 33554655; https://doi.org/10.1080/13607863.2021.1881758.
5. Asfia SKBM, Bucholc J, McCaffrey N, Mihalopoulos C, Muldowney A, Engel L. Understanding the quality of life impacts of providing informal care to people with dementia: a systematic review of qualitative studies. Journal of Alzheimer’s Disease. 2022;88(4):1293–309. PMID: 35754273; https://doi.org/10.3233/JAD-220219.
6. Wang J, Li X, Liu W, Yang B, Zhao Q, Lü Y, Xiao M. The positive aspects of caregiving in dementia: A scoping review and bibliometric analysis. Front. Public Health. 2022;10(14):985391. PMID: 36187613; https://doi.org/10.3389/fpubh.2022.985391.
7. Tarlow BJ, Wisniewski SR, Belle SH, Rubert M, Ory MG, Gallagher-Thompson D. Positive aspects of caregiving: Contributions of the REACH project to the development of new measures for Alzheimer’s caregiving. Res Aging. 2004;26(4):429–53. https://doi.org/10.1177/ 0164027504264493.
8. Lee Y, Li L. Evaluating the positive experience of caregiving: a systematic review of the positive aspects of caregiving scale. Gerontologist. 2022;62(9):e493–e507. PMID: 34216215; https://doi.org/10.1093/geront/gnab092.
9. Pysklywec A, Plante M, Auger C, et al. The positive effects of caring for family carers of older adults: a scoping review. International Journal of Care and Caring. 2020;4(3):349–75. https://doi.org/10.1332/239788220X15925902138734.
10. Cheng ST. Positive aspects of caregiving attenuate the relationship between behavioral bother and anxiety and depressive symptoms in dementia family caregivers. Epidemiology, Clinical Practice And Health. 2023;23(5):366–70. PMID: 37070249; https://doi.org/10.1111/ggi.14581.
11. Roth DL, Dilworth-Anderson P, Huang J, Gross AL, Gitlin LN. Positive aspects of family caregiving for dementia: differential item functioning by race. J Gerontol B Psychol Sci Soc Sci. 2015;70(6):813–9. PMID: 26033356; https://doi.org/10.1093/geronb/gbv034.
12. Gonçalves-Pereira M, Carmo I, Silva JA, Papoila AL, Mateos R, Zarit SH. Caregiving experiences and knowledge about dementia in Portuguese clinical outpatient settings. Int Psychogeriatr. 2010;22(2):270–80. PMID: 19891814; https://doi.org/10.1017/S1041610209991050.
13. Tsatali M, Egkiazarova M, Toumpalidou M, Karagiozi K, Margaritidou P, Tsolaki M. Greek adaptation of the Positive Aspects of Caregiving (PAC) scale in dementia caregivers. Clin Gerontol. 2022;45(3):538–47. PMID: 31684839; https://doi.org/10.1080/07317115.2019.1685047.
14. Devi F, Yuan Q, Wang P, et al. Positive aspect of caregiving among primary informal dementia caregivers in Singapore. PLoS One. 2020;15(8):e0237677. PMID: 32817648; https://doi.org/10.1371/journal.pone.0237677.
15. Furukawa H, Greiner C. Reliability and validation of the Positive Aspects of Caregiving scale among Japanese caregivers of people with dementia. Int J Nurs Sci. 2021;8(2):210–4. PMID: 33997136; https://doi.org/10.1016/j.ijnss.2021.03.007.
16. Siow JYM, Chan A, Østbye T, Cheng GH, Malhotra R. Validity and reliability of the Positive Aspects of Caregiving (PAC) scale and development of its shorter version (S-PAC) among family caregivers of older adults. Gerontologist. 2017;57(4):e75–e84. PMID: 28082275; https://doi.org/10.1093/geront/gnw198.
17. Pavarini SCI, Gratão ACM, Campos CRF, et al. Translation and cultural adaptation of the Positive Aspects of Caregiving Scale for caregivers of people living with dementia in Brazilian context: a methodological study. Sao Paulo Med J. 2024;142(2):e2023325. PMID: 38511815; https://doi.org/10.1590/1516-3180.2023.0325.R1.23012024.
18. Gratão ACM, Cardoso AM, Ottaviani AC, et al. Efficacy of iSupport-Brasil for unpaid caregivers of people living with dementia: protocol for a randomized and controlled clinical trial. Dementia Neuropsychol. 2023;24:17:e20230040. PMID: 38053642; https://doi.org/10.1590/1980-5764-DN-2023-0040.
19. Hair JF, Black WC, Babin BJ, Anderson RE, Tatham RL. Análise multivariada de dados. 6th ed. Porto Alegre: Bookman; 2009. 688 p. ISBN 978-85-7780-534-1.
20. Zarit SH, Reever KE, Bach-Peterson J. Relatives of the impaired elderly: correlates of feelings of burden. Gerontologist. 1980;20(6):649–55. PMID: 7203086; https://doi.org/10.1093/geront/20.6.649.
21. Taub A, Andreoli SB, Bertolucci PH. Dementia caregiver burden: reliability of the Brazilian version of the Zarit caregivers burden interview. Cad de Saude Publica. 2004;20(2):372–6. PMID: 15073616; https://doi.org/10.1590/S0102-311X2004000200004.
22. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361–70. PMID: 6880820; https://doi.org/10.1111/j.1600-0447.1983.tb09716.x.
23. Botega NJ, Bio MR, Zomignani MA, Garcia C Jr, Pereira WA. Transtornos do humor em enfermaria de clínica médica e validação de escala de medida (HAD) de ansiedade e depressão [Mood disorders among inpatients in ambulatory and validation of the anxiety and depression scale HAD]. Rev Saude Publica. 1995 Oct;29(5):355–63. PMID: 8731275; https://doi.org/10.1590/s0034-89101995000500004.
24. Logsdon RG, Gibbons LE, McCurry SM, Teri L. Assessing quality of life in older adults with cognitive impairment. Psychosom Med. 2002;64(3):510–9. PMID: 12021425; https://doi.org/10.1097/00006842-200205000-00016.
25. Novelli MM, Nitrini R, Caramelli P. Validation of the Brazilian version of the quality of life scale for patients with Alzheimer’s disease and their caregivers (QOL-AD). Aging Ment Health. 2010;14(5):624–31. PMID: 20480421; https://doi.org/10.1080/13607861003588840.
26. Bentler PM. Comparative fit indexes in structural models. Psychological bulletin. 1990;107(2):238–46. PMID: 2320703; https://doi.org/10.1037/0033-2909.107.2.238.
27. Brown TA. Confirmatory factor analysis for applied research. 1st ed. New York: Guilford; 2006.
28. Yu CY. Evaluating cutoff criteria of model fit indices for latent variable models with binary and continuous outcomes [PhD Thesis]. Los Angeles: University of California; 2002.
29. Dancey C, Reidy J. Estatística sem matemática para psicologia. 7th ed. Porto Alegre: Penso; 2018. 624 p.
30. Jiménez García-Tizón S, Navarro Prados AB, Bueno Martínez MB. Towards a comprehensive psychosocial profile of the family caregiver of people with dementia. Psicol Reflex Crit. 2025 Mar 20;38(1):6. PMID: 40111622; https://doi.org/10.1186/s41155-025-00342-5.
31. 1. Brasil. Ministério da Saúde. Sumário executivo ReNaDe: relatório nacional sobre a demência no Brasil: necessidades de cuidado, custos, produção científica e investimento em pesquisa [Internet]. Brasília (DF): Ministério da Saúde; 2023. Available from: https://static.poder360.com.br/2023/12/pesquisa-cuidados-demencia.pdf.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Sofia Cristina Iost Pavarini, Aline Cristina Martins Gratão, Camila Rafael Ferreira Campos, Diana Quirino Monteiro, Elizabeth Joan Barham, Fabiana de Souza Orlandi, Gabriela Martins, Gustavo Carrijo Barbosa, Keila Cristianne Trindade da Cruz, Larissa Corrêa, Luana Aparecida Rocha, Ludmyla Caroline de Souza Alves , Ana Carolina Ottaviani
This work is licensed under a Creative Commons Attribution 4.0 International License.
