Translation, validity and reliability of the Malay version of the adult carer quality of life questionnaire (AC-QOL) in informal caregivers of stroke survivors in Kelantan, Malaysia

BACKGROUND: The caregiving role for stroke survivors profoundly impacts one's quality of life, presenting distinct challenges and rewards. The Adult Carer Quality of Life Questionnaire (AC-QoL) methodically evaluates caregivers' well-being across diverse dimensions. This study aims to translate, culturally adapt and validate the Malay version of AC-QoL.

METHODS: A cross-sectional study was done. The translation was conducted in ten steps including forwards and back translation. Six experts were recruited for content validation of clarity, comprehension and relevancy of the items. Ten subjects from the target population were recruited for face validation of clarity and comprehension. For confirmatory factor analysis (CFA), all eligible caregivers were recruited until the sample size of 222 subjects was satisfied.

RESULTS: For content validity, two items had low Item-level Content Validity Index and were suggested for rephrasing. The following face validity had an acceptable Item-level Face Validity Index between 0.9 and 1 for all items. In CFA, four items were suggested to be removed due to low factor loading. The final model had Robust Comparative Fit Index of 0.889, Robust Tucker-Lewis Index of 0.877, Robust Root Mean Square Error of Approximation of 0.066 (95%CI: 0.059,0.072) and Standardized Root Mean Square Residual of 0.064. The composite reliability for all factors were between 0.77 and 0.91 respectively. Significant difference was observed when the mean total quality of life score was compared among caregivers with different depression, anxiety and stress status. As for test-retest reliability, it was found that the questionnaire had good intraclass correlation coefficient of 0.86 (95%CI: 1.08,4.35).

CONCLUSIONS: The Malay version of AC-QoL demonstrates satisfactory validity and reliability, suitable for evaluating the quality of life among informal caregivers of stroke survivors in Malaysia. The questionnaire serves as a comprehensive tool for one-time assessments and holds promise for gauging intervention effectiveness.