Psychometric evaluation of the persian version of the EHFScBS-C: a confirmatory factor analysis

Abstract

Self-care, defined as the naturalistic decision-making process of maintaining physiological stability and responding to symptoms, is essential for effective heart failure (HF) management, and informal caregivers play a crucial role in supporting patients in these activities. While the European Heart Failure Self-Care Behaviour Scale for Caregivers (EHFScBS-C) is a standard measure for this contribution, a validated Persian version is lacking. This study aimed to evaluate the psychometric properties of the Persian version of the EHFScBS-C among Iranian caregivers. This cross-sectional methodological study was conducted with 260 informal caregivers of HF patients, recruited via convenience sampling from Ayatollah Mousavi Hospital in Zanjan, Iran, between October 2023 and February 2024. Following forward and backward translation and cultural adaptation, face and content validity were assessed. Construct validity was evaluated using Confirmatory Factor Analysis (CFA) to test the original two-factor structure. Convergent and discriminant validities were also examined. Reliability was assessed through internal consistency (Cronbach’s alpha and McDonald’s omega) and test-retest stability (Intraclass Correlation Coefficient, ICC) over a two-week interval. The translated scale demonstrated excellent content validity (Scale-level Content Validity Index average = 0.95). The CFA strongly supported the original two-factor structure (Medical Self-Care and Lifestyle Self-Care) with excellent model fit indices (χ²/df = 1.64, RMSEA = 0.049, CFI = 0.984, TLI = 0.978). All nine items exhibited statistically significant factor loadings ranging from 0.407 to 0.912. The scale established acceptable convergent and discriminant validity. Internal consistency was strong for the overall scale (Cronbach’s α = 0.834, McDonald’s ω = 0.894) and its subscales, and test-retest reliability was excellent (ICC = 0.89). The 9-item Persian version of the EHFScBS-C is a robust, valid, and reliable instrument for assessing informal caregivers’ contributions to HF self-care. The structural stability of the original two-factor model was successfully confirmed in the Iranian context without requiring item deletion, providing a valuable tool to foster family-centred heart failure management in clinical practice and research.