Caregiver Physical Health Assessment LONGSCAN

1991

Description of Measure

Purpose

To obtain a brief global self-report of a caregiver’s recent health status.

Conceptual Organization

The assessment consists of three questions: one global question about current health

status (Excellent, Good, Fair, or Poor), one about major illnesses in the past year, and one about

the extent to which poor health affected the caregiver’s ability to care for the child. The CAGE

Questionnaire, an alcoholism screening tool, is included in the health assessment at the Pre-age 4

and Age 4 interviews. (See CAGE for a description of that measure.)

Item Origin/Selection Process

The global health rating was selected as one of the most reliable and widely used

indicators of physical health (Krause & Jay 1994). The other items were chosen as indicators of

the caregiver's experience of morbidity, which has implications for the ability to provide

adequate care to the study child.

Materials

Non-copyrighted form is included in this manual.

Time Required

Less than 5 minutes

Administration Method

Interviewer-administered

Training

Minimal

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Scoring

Score Types

Individual items.

LONGSCAN Use

Data Points

Pre-Age 4: MW & NW sites only

Age 4, 6, 8, 12: all sites. At Age 8, the caregiver health assessment questions were

incorporated into the services utilization form (SUA).

Respondent

Primary maternal caregiver

Mnemonic and Version

Pre-Age 4 and Age 4: MHLA.

Age 6: MH6A. Does not include the CAGE Questionnaire; no other modifications.

Age 8: SUA questions 24-25. The question, "Has illness affected your ability to care for

your child", is omitted.

Age 12: MHLB, MHLC. B is the paper version and C is the audio-CASI version.

Age 14: MHLC.

Rationale

A caregiver’s health may affect her ability to care for her child. The global health rating

has been shown to be one the most reliable indicators of physical health (Krause & Jay, 1994).

Results

Table 1 presents Pre-Age 4 data collected at the MW and NW sites. Approximately one-

quarter (27.3%) of the MW caregivers reported their health status as fair or poor, and slightly

less than one–quarter (23.2%) had experienced a major illness in the past year. At the NW site,

approximately one-third (31.8%) of the participants reported fair or poor health, and almost one-

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half (47.9%) reported a major illness in the past year. Of those reporting major illness at the NW

site, 61.5% said the illness affected their ability to care for their child(ren). Analysis by racial

group showed that White, Multiracial, and Other racial groups reported worse health than Blacks

and Hispanics.

Table 1 about here

At Age 4 (Table 2) Hispanic caregivers reported poorer health status than the other racial

groups, although White caregivers were more likely to report a major illness. When analyzed by

site, the poorest health status on all three indicators was observed at the NW site.

Table 2 about here

At Age 6 (Table 3), 25.1% of the entire sample reported having fair or poor health, and

32.5% of the caregivers reported a major illness in the past year. Interestingly, there was little

relationship between having had a major illness in the past year and a report of one’s health as

fair or poor. While Hispanic caregivers reported poorer health than caregivers of other racial

groups, they were less likely to report a major illness. Caregivers from the MW site reported the

worst overall health status in terms of global health ratings and the incidence of a major illness or

injury affecting their ability to care for their child.

Table 3 about here

At Age 8 (Table 4), 31.7% of the total sample reported having experienced fair or poor

health. White caregivers reported poorer health than caregivers of other racial groups. Caregivers

from the NW (38.4%) and MW sites (38.3%) reported the poorest overall health.

Table 4 about here

Validity

Numerous studies have documented a relationship between physical health and mental

health, particularly depression (Brown, Ahmed, Gary, & Milburn, 1995; Flaskerud & Tabora,

1998; Hays, Krishnan, George, Pieper, Flint, & Blazer, 1997; Heidrich, 1998). We examined

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concurrent validity of the Caregiver Physical Health Assessment by comparing scores on the

four categories of the global health rating to the caregivers’ mean scores on the Center for

Epidemiologic Studies Depression Scale (CES-D) at the Age 4 interview. Primary caregivers

who reported poor health were significantly more likely to report higher depression scores

compared to those who report fair, good, or excellent health (F(3,709) = 13.8, p <.0001). The

mean depression score among primary caregivers reporting “poor” health was 23, compared to a

mean of 10.2 among those reporting excellent health (p = 0.0003).

References and Bibliography

Brown, D. R., Ahmed, F., Gary, L. E., & Milburn, N. G. (1995). Major depression in a

community of African Americans. American Journal of Psychiatry, 152, 373-378.

Flaskerud, J., & Tabora, B. (1998). Health problems of low-income female caregivers

with HIV/AIDS. Health Care for Women International, 19, 23-36.

Hays, J. C., Krishnan, K. R., George, L. K., Pieper, C., Flint, E. P., & Blazer, D. G.

(1997). Psychosocial and physical correlates of chronic depression, Psychiatry Research, 72,

149-159.

Heidrich, S. M. (1998). Older women’s lives through time. Advances in Nursing Science,

20, 65-75.

Krause, N., & Jay, G. (1994). What do global health items measure? Medical Care, 9,

930-942.

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Table 1. Caregiver Health Status by Caregiver Race and Study Site. Pre-Age 4 Interview (MW and NW sites)

N

Health Reported as Fair or Poor

%

Major Illness/Injury in Past Year

%

Major Illness/Injury Affected Childcare

% Total 536 29.1 33.2 52.8 Race

White 215 31.6 40.9 55.7 Black 208 26.9 28.4 52.5 Hispanic 52 19.2 17.3 33.3 Multiracial 42 35.7 42.9 55.6 Other 19 78.9 21.1 25.0

Site MW 319 27.3 23.2 40.5 NW 217 31.8 47.9 61.5

Source. Based on data received at the LONGSCAN Coordinating Center through 7/8/97. Note. SW, SO, and EA did not collect data at the Pre-Age 4 interview.

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Table 2. Caregiver Health Status by Caregiver Race and Study Site. Age 4 Interview

N

Health Reported as Fair or Poor

%

Major Illness/Injury in Past Year

%

Major Illness/Injury Affected Childcare

% Total 1148 24.7 30.1 47.0 Race

White 397 23.9 36.3 53.5 Black 584 24.4 25.9 43.0 Hispanic 82 29.3 29.3 37.5 Multiracial 37 21.6 37.8 28.6 Other 44 27.9 27.3 58.3

Site EA 237 25.4 23.6 44.6 MW 123 30.9 24.4 50.0 SO 221 21.8 21.8 50.0 SW 317 18.4 28.2 33.7 NW 250 31.6 43.2 56.5

Source. Based on data received at the LONGSCAN Coordinating Center through 7/8/97.

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Table 3. Caregiver Health Status by Caregiver Race and Study Site. Age 6 Interview

N

Health Reported as Fair or Poor

%

Major Illness/Injury in Past Year

%

Major Illness/Injury Affected Childcare

% Total 1217 25.1 32.5 48.7 Race

White 394 24.6 37.6 52.7 Black 663 24.3 29.9 45.7 Hispanic 91 35.2 27.5 60.0 Multiracial 34 26.5 44.1 40.0 Other 30 13.3 26.7 25.0

Site EA 250 23.2 27.6 42.7 MW 216 32.9 30.6 59.1 SO 220 20.9 28.6 41.3 SW 297 22.9 30.6 46.2 NW 234 26.5 45.3 52.8

Source. Based on data received at the LONGSCAN Coordinating Center through 8/24/01.

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Table 4. Caregiver Health Status by Caregiver Race and Study Site. Age 8 Interview

N

Health Reported as Fair or Poor

% Total 1036 31.7 Race

White 283 36.4 Black 418 33.7 Hispanic 46 21.7 Multiracial 23 34.8 Other 17 35.3

Site EA 235 31.1 MW 128 38.3 SO 184 28.8 SW 270 25.6 NW 219 38.4

Source. Based on data received at the LONGSCAN Coordinating Center through 8/24/01. Note. At Age 8 Interview data were not gathered on major illnesses and injuries.