The Family Caregiver Activation in Transitions (FCAT) Tool: A New Measure of Family Caregiver Self-Efficacy.

BACKGROUND Family caregivers play an instrumental role in executing the care plan of patients during care transitions and yet may lack preparation and confidence to be effective. Yet there has been little attempt by health care professionals to identify and strengthen family caregivers' sense of preparation and confidence. The Family Caregiver Activation in Transitions™ (FCAT™) tool was developed to guide the care team in better understanding patient and family needs and deploying appropriate resources accordingly. METHODS The development and psychometric testing of the FCAT tool was guided by a "partial credit" Rasch model. The validation was completed in three phases. In Phase 1, cognitive testing was conducted in convenience samples of family caregivers (N=54) participating in support groups in two geographic locations. In Phase 2, pilot testing was conducted (N=50) to determine item fit and item difficulty. In Phase 3, the tool's psychometric properties were examined in two waves of recruitment (N=187; N=247) from Web-based national samples. RESULTS Participants recommended revising the script, reducing redundancy, and simplifying item structure and language. Analysis of item fit and difficulty guided subsequent item reduction. The estimated person-separation reliability was 0.84. CONCLUSIONS The FCAT tool was developed to foster more productive interactions between health care professionals and family caregivers. Because it was developed with direct input from family caregivers, the items are both relevant to actual experience and relatively easy to understand. Psychometric testing supports the hypothesis that the FCAT tool items function as a unidimensional construct with a high level of reliability. The FCAT tool has the potential to guide interventions intended to enhance family caregiver preparation and confidence, and thereby positively influence clinical practice during care transitions.