The Validation of the ‘CARe Burn Scale: Parent/Caregiver Form’—A Patient Reported Outcome Measure (PROM) Using Rasch Measurement Theory (RMT) to Assess Quality of Life for Parents or Caregivers Supporting a Child with a Burn Injury
Abstract
:1. Introduction
2. Methods
2.1. Background Scale Development Process
2.1.1. Item Generation
2.1.2. Field Testing for Item Reduction and Psychometric Evaluation and Validation
2.1.3. Description of Individual Scales
- Physical Health: measured parents’ physical health and their physical abilities.
- Confidence with Managing Burn Wound/Scar Treatments: the extent to which parents feel confident with supporting their child during a range of different wound/scar treatments such as washing, dressing, physiotherapy exercises, and dressing or bandage changes.
- Social Situations: the extent to which parents feel confident during challenging social situations in which other people may look, touch, or ask questions about their child’s burn wounds/scarring.
- Social Support: measured parents’ perceptions of the quality of the social support available to them from friends, family, and health professionals.
- Work Life: measured parents’ perceptions of the quality of their work life.
- Family Life: measured parents’ perceptions of the quality of their family life and relationships.
- Partner Relationship: measured parents’ perceptions of the quality of their partner relationship whilst supporting a child with a burn injury.
- Self-worth: the extent to which a parent has positive feelings about themselves.
- Negative Mood: the extent to which a parent reports low/negative mood.
- Parent Concerns about the Appearance of their Child’s Burn Wounds/Scars: how bothered parents are about the appearance of their child’s burn wound/scarring.
- Parent Avoidance Behaviours in Social Situations: the extent to which parents avoid looking at and touching their child’s burn wound/scars and avoid public places and discussing their child’s wound/scars with others.
- Trauma Symptoms: the extent to which parents experience negative psychological and behavioural symptoms such as negative thoughts, flashbacks, bad dreams, and anxiety related to the event that injured their child, or the events/treatment that happened afterwards.
- Adaptive Coping Parenting: the extent to which a parent engages in ways of coping and supporting their child that are adaptive and proactive.
- Avoidance Coping Parenting: the extent to which parents find it difficult and avoid challenging situations and making decisions when supporting their child after their burn injury.
- Worries about their Child’s Future: the extent to which parents are concerned about how their child’s burn injury will impact their future in terms of their appearance, physical and psychological health, romantic relationships, and work.
- Worries about their own Future: the extent to which parents are concerned about how their child’s burn injury will impact their own future in terms of their physical and psychological health, partner relationship, and career.
- Positive Growth: the extent to which parents report positive outcomes or personal development after supporting a child with a burn injury.
2.2. Data Analysis
2.2.1. Rasch Measurement Theory Analyses
2.2.2. Item Fit Statistics
2.2.3. Person Separation Index (PSI)
2.2.4. Local Dependency
2.2.5. Unidimensionality
2.2.6. Differential Item Functioning
2.2.7. Targeting and Item Locations
2.2.8. Item Thresholds
2.2.9. Internal Consistency
3. Results
3.1. Participants
3.2. Item Reduction and Scale Formation
3.3. Internal Consistency
3.4. Checklist
4. Discussion
4.1. Strengths
4.2. Limitations
4.3. Future Recommendations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Demographics | N | % | |
---|---|---|---|
Parent Age | Mean 36.5 (SD 7.30), range 20 to 63 | 182 | |
Parent Gender | Male | 14 | 6.9 |
Female | 170 | 83.3 | |
Parent Marital Status | Married | 125 | 61.3 |
Civil Partnership | 5 | 2.5 | |
Single, never married | 12 | 5.9 | |
Separated | 3 | 1.5 | |
Divorced | 12 | 5.9 | |
Cohabiting | 25 | 12.3 | |
In a relationship but not living together | 2 | 1.0 | |
Parent Ethnicity | White British | 150 | 73.5 |
White Other | 13 | 6.4 | |
Asian or Asian British: Indian | 5 | 2.5 | |
Asian or Asian British: Pakistani | 4 | 2.0 | |
Asian or Asian British: Other | 1 | 0.5 | |
Black or Black British: Black African | 3 | 1.5 | |
Chinese or Other Ethnic Group: Chinese | 2 | 1.0 | |
Mixed: White and Black Caribbean | 3 | 1.5 | |
Mixed: Other Mixed | 2 | 1.0 | |
Other | 1 | 0.5 | |
Rather not say | 2 | 1.0 | |
Child Current Age | Mean 4.7 (SD 4.13), range 0 to 18 | 186 | |
Child Age at Injury | Mean 3.3 (SD 3.84), range 0 to 16 | 184 | |
Time Since Injury (Years) | Mean 1.4 (SD 2.02), range 0 to 17 | 182 | |
Child Gender | Male | 104 | 51.0 |
Female | 80 | 39.2 | |
Child Injury Status | Burn wound | 7 | 3.4 |
Burn scar | 99 | 48.5 | |
Both wound and scar | 5 | 2.5 | |
No wound scar | 71 | 34.8 | |
Child’s Body Part Affected | Head or face | 47 | 23.0 |
Neck | 35 | 17.2 | |
Chest | 60 | 29.4 | |
Abdomen | 26 | 12.7 | |
Back | 19 | 9.3 | |
Lower arms | 36 | 17.6 | |
Upper arms | 49 | 24.0 | |
Hands | 70 | 34.3 | |
Bottom | 5 | 2.5 | |
Upper legs | 33 | 16.2 | |
Lower legs | 20 | 9.8 | |
Feet | 25 | 12.3 | |
Cause of burn | Flame | 11 | 5.4 |
Liquid | 110 | 53.9 | |
Contact | 46 | 22.5 | |
Electricity | 2 | 1.0 | |
Chemical/acid | 1 | 0.5 | |
Other | 16 | 7.8 |
Rasch Analyses | Traditional Psychometric Analyses | |||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
CARe Burn Scale | Number of Items Retained in Final Version | Item-Trait Interaction X2; df; p | Person Separation Index | Number of Items with Fit Statistics Residuals Outside the Band of −2.5, +2.5 | Items with Significant Χ2 Value * | Items with Significant F-Statistic Value * | Number of Items with Thresholds Reversed | Number of Pairs of Items with Residual Correlation > 0.2 Above the Average | Number of Items with DIF **** | Unidimensionality Tests: Highest Eigenvalue ** (Proportion of Significant t-Tests ***) | Item Locations Logits (Range of Items) [Range of Category Thresholds] | Person Location Logits (Mean, SD) and Person Fit Residual [mean, SD] | Cronbach’s Alpha | Item-Total Correlation Mean (Range) |
Physical health | 3 | 6.17; 6; 0.404 | 0.827 | 0 | 0 | 0 | 0 | 0 | 1 | 1.634 (3%) | (−0.415, 0.395) [−4.330, 4.331] | (1.455, 2.597) [−0.510, 0.948] | 0.876 | 0.778 (0.744–0.823) |
Social situations | 3 | 6.30; 6; 0.390 | 0.714 | 0 | 0 | 0 | 0 | 0 | 0 | 1.637 (3%) | (−0.185, 0.208) [−4.020, 3.306] | (2.137, 2.294) [−0.874, 1.479] | 0.877 | 0.763 (0.742–0.829) |
Partner relationship | 4 | 8.68; 8; 0.370 | 0.687 | 0 | 0 | 0 | 0 | 0 | 1 | 1.502 (2%) | (−0.641, 1.198) [−2.329, 3.831] | (2.401, 1.919) [−0.315, 0.763] | 0.810 | 0.637 (0.587–0.703) |
Positive Mood | 5 | 11.22; 10; 0.340 | 0.894 | 0 | 0 | 0 | 0 | 0 | 0 | 1.535 (5%) | (−0.997, 1.264) [−6.881, 5.087] | (1.382, 2.547) [−0.387, 0.956] | 0.909 | 0.771 (0.733–0.814) |
Negative Mood | 10 | 17.21; 20; 0.639 | 0.881 | 0 | 0 | 0 | 0 | 0 | 0 | 1.646 (3%) | (−1.020, 0.740) [−3.460, 4.461] | (2.266, 2.076) [−0.346, 1.073] | 0.924 | 0.719 (0.636–0.788) |
Parent concerns about the appearance of their child’s burn wounds/scars | 4 | 4.73; 8; 0.786 | 0.830 | 0 | 0 | 0 | 0 | 0 | 0 | 1.476 (3%) | (−0.771, 0.597) [−3.090, 3.979] | (2.680, 2.692) [−0.363, 0.920] | 0.937 | 0.854 (0.839–0.879) |
Positive Growth | 4 | 7.51; 8; 0.483 | 0.724 | 0 | 0 | 0 | 0 | 0 | 0 | 1.487 (5%) | (−0.335, 0.239) [−1.569, 2.288] | (0.729, 1.694) [−0.674, 1.375] | 0.824 | 0.649 (0.564–0.720) |
Parent Confidence Managing Burn Wound/Scar Treatments I Feel Confident Helping My Child with… | Not at All | A Little Bit | A Bit | Quite a Bit | A Lot | N/A | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Scale/Item | N | % | N | % | N | % | N | % | N | % | N | % |
1 …dressing/bandage changes | 3 | 1.5 | 4 | 2.0 | 0 | 0.0 | 9 | 4.4 | 40 | 19.6 | 65 | 31.9 |
2 …creaming/massaging their burn scars | 1 | 0.5 | 8 | 3.9 | 3 | 1.5 | 16 | 7.8 | 102 | 50.0 | 26 | 12.7 |
3 …washing and dressing/using the toilet | 1 | 0.5 | 1 | 0.5 | 2 | 1.0 | 9 | 4.4 | 109 | 53.4 | 33 | 16.2 |
4 …physiotherapy exercises/stretching/putting on pressure garments/splinting | 3 | 1.5 | 1 | 0.5 | 3 | 1.5 | 10 | 4.9 | 38 | 18.6 | 73 | 35.8 |
5 …taking their medication | 1 | 0.5 | 0 | 0.0 | 2 | 1.0 | 5 | 2.5 | 41 | 20.1 | 68 | 33.3 |
6 …managing their discomfort (e.g., pain, itching) | 1 | 0.5 | 6 | 2.9 | 6 | 2.9 | 18 | 8.8 | 54 | 26.5 | 51 | 25.0 |
7 …wound/scar treatments (e.g., dressing changes, creaming/massage, washing and dressing, physiotherapy exercises, pressure garments, splinting, taking medication) | 2 | 1.0 | 3 | 1.5 | 4 | 2.0 | 17 | 8.3 | 75 | 36.8 | 46 | 22.5 |
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© 2025 by the authors. Published by MDPI on behalf of the European Burns Association. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
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Griffiths, C.; Pickles, T.; Guest, E.; Harcourt, D. The Validation of the ‘CARe Burn Scale: Parent/Caregiver Form’—A Patient Reported Outcome Measure (PROM) Using Rasch Measurement Theory (RMT) to Assess Quality of Life for Parents or Caregivers Supporting a Child with a Burn Injury. Eur. Burn J. 2025, 6, 22. https://doi.org/10.3390/ebj6020022
Griffiths C, Pickles T, Guest E, Harcourt D. The Validation of the ‘CARe Burn Scale: Parent/Caregiver Form’—A Patient Reported Outcome Measure (PROM) Using Rasch Measurement Theory (RMT) to Assess Quality of Life for Parents or Caregivers Supporting a Child with a Burn Injury. European Burn Journal. 2025; 6(2):22. https://doi.org/10.3390/ebj6020022
Chicago/Turabian StyleGriffiths, Catrin, Timothy Pickles, Ella Guest, and Diana Harcourt. 2025. "The Validation of the ‘CARe Burn Scale: Parent/Caregiver Form’—A Patient Reported Outcome Measure (PROM) Using Rasch Measurement Theory (RMT) to Assess Quality of Life for Parents or Caregivers Supporting a Child with a Burn Injury" European Burn Journal 6, no. 2: 22. https://doi.org/10.3390/ebj6020022
APA StyleGriffiths, C., Pickles, T., Guest, E., & Harcourt, D. (2025). The Validation of the ‘CARe Burn Scale: Parent/Caregiver Form’—A Patient Reported Outcome Measure (PROM) Using Rasch Measurement Theory (RMT) to Assess Quality of Life for Parents or Caregivers Supporting a Child with a Burn Injury. European Burn Journal, 6(2), 22. https://doi.org/10.3390/ebj6020022