Browsing by Author "Mlambo, Tecla"

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    Open Access
    A critical evaluation of the effectiveness of interventions for improving the well-being of caregivers of children with cerebral palsy: a systematic review protocol
    (BioMed Central, 2016-07-13) Dambi, Jermaine M; Jelsma, Jennifer; Mlambo, Tecla; Chiwaridzo, Matthew; Tadyanemhandu, Cathrine; Chikwanha, Mildred T; Corten, Lieselotte
    Background: Over the years, family-centered care has evolved as the “gold standard” model for the provision of healthcare services. With the advent of family-centered approach to care comes the inherent need to provide support services to caregivers in addition to meeting the functional needs of children with physical disabilities such as cerebral palsy (CP). Provision of care for a child with CP is invariably associated with poor health outcomes in caregivers. As such, there has been a surge in the development and implementation of interventions for improving the health and well-being of these caregivers. However, there is a paucity of the collective, empirical evidence of the efficacy of these interventions. Therefore, the broad objective of this review is to systematically review the literature on the effectiveness of interventions designed to improve caregivers’ well-being. Methods/design: This is a systematic review for the evaluation of the effectiveness of interventions designed to improve caregivers’ well-being. Two independent, blinded, reviewers will search articles on PubMed, Scopus, Web of Science, CINAHL, Psych Info, and Africa-Wide Information using a predefined criterion. Thereafter, three independent reviewers will screen the retrieved articles. The methodological quality of studies meeting the selection criterion will be evaluated using the Briggs Institute checklists. Afterwards, two independent researchers will then apply a preset data-extraction form to collect data. We will perform a narrative data analysis of the final sample of studies included for the review. Discussion: The proposed systematic review will provide the empirical evidence of the efficacy of interventions for improving the well-being of caregivers of children with physical disabilities. This is important given the great need for evidenced-based care and the greater need to improve the health and well-being of caregivers. Systematic review registration: PROSPERO CRD42016033975.
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    A systematic review of the psychometric properties of the cross-cultural translations and adaptations of the Multidimensional Perceived Social Support Scale (MSPSS)
    (BioMed Central, 2018-05-02) Dambi, Jermaine M; Corten, Lieselotte; Chiwaridzo, Matthew; Jack, Helen; Mlambo, Tecla; Jelsma, Jennifer
    Background Social support (SS) has been identified as an essential buffer to stressful life events. Consequently, there has been a surge in the evaluation of SS as a wellbeing indicator. The Multidimensional Perceived Social Support Scale (MSPSS) has evolved as one of the most extensively translated and validated social support outcome measures. Due to linguistic and cultural differences, there is need to test the psychometrics of the adapted versions. However, there is a paucity of systematic evidence of the psychometrics of adapted and translated versions of the MSPSS across settings. Objectives To understand the psychometric properties of the MSPSS for non-English speaking populations by conducting a systematic review of studies that examine the psychometric properties of non-English versions of the MSPSS. Methods We searched Africa-Wide Information, CINAHL, Medline and PsycINFO, for articles published in English on the translation and or validation of the MSPSS. Methodological quality and quality of psychometric properties of the retrieved translations were assessed using the COSMIN checklist and a validated quality assessment criterion, respectively. The two assessments were combined to produce the best level of evidence per language/translation. Results Seventy articles evaluating the MSPSS in 22 languages were retrieved. Most translations [16/22] were not rigorously translated (only solitary backward-forward translations were performed, reconciliation was poorly described, or were not pretested). There was poor evidence for structural validity, as confirmatory factor analysis was performed in only nine studies. Internal consistency was reported in all studies. Most attained a Cronbach’s alpha of at least 0.70 against a backdrop of fair methodological quality. There was poor evidence for construct validity. Conclusion There is limited evidence supporting the psychometric robustness of the translated versions of the MSPSS, and given the variability, the individual psychometrics of a translation must be considered prior to use. Responsiveness, measurement error and cut-off values should also be assessed to increase the clinical utility and psychometric robustness of the translated versions of the MSPSS. Trial registration PROSPERO-CRD42016052394.
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    An evaluation of psychometric properties of caregiver burden outcome measures used in caregivers of children with cerebral palsy: a systematic review protocol
    (BioMed Central, 2016-03-09) Dambi, Jermaine M; Jelsma, Jennifer; Mlambo, Tecla; Chiwaridzo, Matthew; Dangarembizi-Munambah, Nyaradzai; Corten, Lieselotte
    Background: Cerebral palsy (CP) is the most common, life-long paediatric disability. Taking care of a child with CP often results in caregiver burden/strain in the long run. As caregivers play an essential role in the rehabilitation of these children, it is therefore important to routinely screen for health outcomes in informal caregivers. Consequently, a plethora of caregiver burden outcome measures have been developed; however, there is a dearth of evidence of the most psychometrically sound tools. Therefore, the broad objective of this systematic review is to evaluate the psychometrical properties and clinical utility of tools used to measure caregiver burden in caregivers of children with CP. Methods/design: This is a systematic review for the evaluation of the psychometric properties of caregiver burden outcome tools. Two independent and blinded reviewers will search articles on PubMed, Scopus, Web of Science, CINAHL, PsychINFO and Africa-Wide Google Scholar. Information will be analysed using predefined criteria. Thereafter, three independent reviewers will then screen the retrieved articles. The methodological quality of studies on the development and validation of the identified tools will be evaluated using the four point COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. Finally, the psychometric properties of the tools which were developed and validated from methodological sound studies will then be analysed using predefined criteria. Discussion: The proposed systematic review will give an extensive review of the psychometrical properties of tools used to measure caregiver burden in caregivers of children with CP. We hope to identify tools that can be used to accurately screen for caregiver burden both in clinical setting and for research purposes.
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    Evaluation of the mental health profile of caregivers of children with cerebral palsy in a low-resourced setting: development, translation and validation of patient-reported outcome measures
    (2018) Dambi, Jermaine Matewu; Jelsma, Jennifer; Mlambo, Tecla
    Background & aims: Several systematic reviews have demonstrated that caring for a child with functional limitations leads to poor caregiver mental health outcomes. For instance, depression, anxiety and caregiver burden are endemic in informal (unpaid) caregivers of children with cerebral palsy (CP), a common paediatric disability. However, caregivers who receive an adequate amount of social support are likely to better adjust to the caregiving role. Given the increasing move towards family-centred care and evidence-based care, there is a need to evaluate caregivers’ mental health and to develop and implement context-specific caregiver well-being programs. The valid measurement of the impact of these programs is dependent on the availability of psychometrically robust patient-reported outcomes (PROMs). Unfortunately, most available PROMs have been developed in high-income settings, and their applicability in low-resource settings such as Zimbabwe may be questionable. The present study thus aimed to develop a context-specific caregiver strain outcome, to adapt, translate, and validate a social support outcome measure and finally to profile the mental health of caregivers of children with CP residing in Zimbabwe. Methods: The Zimbabwean Caregiver Challenges Scale (ZCCS) was developed through the amalgamation of findings from a systematic review, caregivers’ interviews and two rounds of content validation by a panel of experts. A systematic review was then undertaken to appraise the psychometric properties of the Multidimensional Scale of Perceived Social Support (MSPSS). The MSPSS was then adapted, translated into Shona, a Zimbabwean native language, and validated. In the final phase, further validation of the ZCCS and the MSPSS was done, and structural equation modelling was used to profile the mental health profile of caregivers. Results: The ZCCS yielded four factors which were ; physical & economic burden, concerns for the child, family relations and community participation. The ZCCS was found to be a reliable tool as it yielded excellent Internal Consistency (IC) ratings at both sub-scale [α range: 0.765- 0.841] and scale level [α=0.925]. The Interclass Correlation (ICC) (95% CI) for ZCCS scores at baseline and after four weeks was 0.880 (0.793: 0.930), demonstrating the stability of the ZCCS. We replicated the original 3-factor structure of the MSPSS through factor analysis. Further, dichotomisation of scoring options and the deletion of one item resulted in a parsimonious solution as the 11-items solution met Rasch modelling requirements. The MSPSS-Shona version is reliable; it yielded excellent IC ratings at both sub-scale [α range: 0.833-0.892] and scale levels[α=0.8685]. The ICC rating (95% CI) for MSPSS scores at baseline and after four weeks was 0.980 (0.959: 0.990) demonstrating the stability of the MSPSS, and the person separation index (PSI) was 0.731. Both the ZCCS and MSPSS displayed construct validity; higher caregiver burden was associated with greater psychiatric morbidity and lower health related quality of life. Caregivers who received a higher amount of social support had the best mental health outcomes. Further, structural equation modelling provided evidence of the multidimensionality of the caregiver burden. Contextual factors, such as increased child age, increased caregiving duration, lower child functional capacity/more severe CP, and lower socioeconomic status were associated with poor mental health functioning. Conclusion: The thesis contributes to the body of knowledge by documenting the validation of caregivers' mental health outcomes and determination of mental health functioning of caregivers residing in low-resource settings. The ZCSS and MSPSS were both found to be valid and reliable measures within the context of Shona speaking rural and urban Zimbabweans. It is therefore suggested that both measures can be used with confidence in these contexts. Efforts should be made to integrate patient-reported outcome measures (PROMs) in routine clinical care and research and in developing and implementation of tailor-made caregiver wellness programs, within the validation contexts.