{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T15:14:08Z","timestamp":1788275648132,"version":"build-2803163510"},"reference-count":28,"publisher":"Scientific Scholar","content-domain":{"domain":["jpalliativecare.com"],"crossmark-restriction":true},"short-container-title":["IJPC"],"abstract":"<jats:sec id=\"st1\">\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>This study aimed to compare the Malayalam versions of the 9-item Achutha Menon Centre\u2013Caregiver Burden Inventory (AMC-CBI) with the 22-item Zarit Burden Interview (ZBI-22), hypothesising that caregiver burden in palliative home care settings could be measured comparably using either tool. We also tried to identify a global question or brief screening items for caregiver burden based on the performance of the AMC-CBI items relative to the ZBI-22. In addition, we explored how participants understood and interpreted the ZBI-22 items.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"st2\">\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>\n                      The study used a convergent mixed-methods design comprising a quantitative survey and qualitative interviews. The survey covered 60 adult primary caregivers of palliative care patients receiving home care in rural Kollam, Kerala, who were interviewed telephonically using a structured interview schedule with the ZBI-22 and the AMC-CBI scales and demographic, socioeconomic and caregiving-related details. Analysis was through descriptive statistics, internal consistency assessments using alpha and omega coefficients and validity assessments using agreement methods on z-transformed scores available in the SimplyAgree package for R and Jamovi, including average bias and limits of agreement and Receiver Operating Characteristic (ROC) analyses. Qualitative interviews were conducted telephonically, audio recorded and done by AMC-CBI. Cognitive interviews (\n                      <jats:italic>n<\/jats:italic>\n                      = 7) were conducted with four experts and three caregivers, using a semi-structured guide, to explore item clarity, relevance, redundancy and comprehension of ZBI-22. In-depth interviews (\n                      <jats:italic>n<\/jats:italic>\n                      = 4) were conducted with four additional caregivers (2 cancer, 2 non-cancer cases; one each with low and high burden) to explore caregiving experiences, and transcripts were analysed to compare narrative alignment with ZBI-22 and AMC-CBI items by two independent reviewers.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"st3\">\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Internal consistency was high for both tools (\u03b1 and \u03c9 &gt; 0.8). Three AMC-CBI items (\u2018lost hope\u2019, \u2018feel sad\u2019, and \u2018financial burden\u2019) were selected for a Brief AMC-CBI (\u03c9 = 0.787). Both AMC-CBI\n                      <jats:italic>p<\/jats:italic>\n                      = 0.747) and Brief AMC-CBI\n                      <jats:italic>p<\/jats:italic>\n                      = 0.731) strongly correlated with ZBI-22. Agreement analyses with z-scores (Bland-Altman, Deming regression) demonstrated good agreement, though one outlier was noted. ROC analysis showed AMC-CBI \u226512 and Brief AMC-CBI \u22653 as optimal cut-offs. Identity-related strain over a long caregiving duration might lead to discordant classification with ZBI-22 more likely to elicit burden. Qualitative interviews highlighted some item complexity and translation issues in ZBI-22, especially with the word \u2018\n                      <jats:italic>duritham<\/jats:italic>\n                      \u2019. Reviewers found the AMC-CBI easier to apply during transcript coding.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"st4\">\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Both tools, the AMC-CBI and Brief AMC-CBI correctly categorised caregiver burden levels in comparison to the ZBI-22, but AMC-CBI was more contextually appropriate. Selecting the full or the Brief AMC-CBI for caregiver burden assessments would be a thoughtful decision that considers the unique requirements and considerations present in palliative care settings. Further studies on the AMC-CBI or its short form for inter-rater reliability assessments and concordance with the ZBI-22 in larger samples would be useful for enhancing the applicability of these tools.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.25259\/ijpc_243_2025","type":"journal-article","created":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T09:34:09Z","timestamp":1784712849000},"page":"296-303","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of Two Caregiver Burden Scales in a Low-resource Primary Palliative Care Setting and Deriving a Three-item Caregiver Burden Inventory"],"prefix":"10.25259","volume":"32","author":[{"given":"Arsha","family":"Kochuvilayil","sequence":"first","affiliation":[{"name":"Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ravi Prasad","family":"Varma","sequence":"additional","affiliation":[{"name":"Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India,"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10894","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"key":"10.25259\/IJPC_243_2025\/ref-1","doi-asserted-by":"publisher","first-page":"641","DOI":"10.1111\/j.1468-0009.2007.00504.x","article-title":"Labor market work and home care's unpaid caregivers: A systematic review of labor force participation rates, predictors of labor market withdrawal, and hours of work","volume":"85","author":"Lilly","year":"2007","journal-title":"Milbank Q"},{"key":"10.25259\/IJPC_243_2025\/ref-2","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1186\/1472-6963-14-207","article-title":"Cost and burden of informal caregiving of dependent older people in a rural Indian community","volume":"14","author":"Brinda","year":"2014","journal-title":"BMC Health Serv Res"},{"key":"10.25259\/IJPC_243_2025\/ref-3","doi-asserted-by":"publisher","first-page":"649","DOI":"10.1093\/geront\/20.6.649","article-title":"Relatives of the impaired elderly: Correlates of feelings of burden","volume":"20","author":"Zarit","year":"1980","journal-title":"Gerontologist"},{"key":"10.25259\/IJPC_243_2025\/ref-4","first-page":"1","volume-title":"Conceptual and methodological issues in family caregiver research","author":"Zarit","year":"1992"},{"key":"10.25259\/IJPC_243_2025\/ref-5","doi-asserted-by":"publisher","first-page":"2939","DOI":"10.1111\/liv.14614","article-title":"Quality of life, caregiver burden and mental health disorders in primary caregivers of patients with Cirrhosis","volume":"40","author":"Hareendran","year":"2020","journal-title":"Liver Int"},{"key":"10.25259\/IJPC_243_2025\/ref-6","doi-asserted-by":"publisher","DOI":"10.1136\/spcare-2024-005220","article-title":"Caregiver burden and quality of life in palliative care: Cross-sectional study","author":"Shefeek","year":"2024","journal-title":"BMJ Supportive & Palliative Care"},{"key":"10.25259\/IJPC_243_2025\/ref-7","doi-asserted-by":"publisher","first-page":"486","DOI":"10.4103\/jehp.jehp_273_24","article-title":"Caregiver burden and quality of life among family caregivers of hemodialysis patients from South India","volume":"13","author":"Azeez","year":"2024","journal-title":"J Educ Health Promot"},{"key":"10.25259\/IJPC_243_2025\/ref-8","article-title":"Zarit burden interview","author":"Mapi Research Trust","year":"2025","journal-title":"Licensed use Under License no. 7947,3 Via the ePROVIDE\u2122 Platform. 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