Reliability and Validity of the Malay Version of Patient-Caregiver Relationship Questionnaire for Older Adults with Dementia

Background

The quality of the relationship between a person with dementia and their primary family caregiver is increasingly recognised as a critical factor in the experience and outcomes of informal dementia care. A positive, warm, and supportive dyadic relationship is associated with better quality of life for both the person with dementia and the caregiver, reduced caregiver burden, and delayed need for institutional placement. Conversely, relationships characterised by conflict, criticism, or emotional distance are linked to poorer outcomes including accelerated cognitive decline, increased behavioural symptoms, and greater caregiver psychological distress.

Malaysia, as an upper-middle-income country with a rapidly ageing population, faces growing challenges related to dementia care. The prevalence of dementia among older adults aged 60 years and above in Malaysia has been estimated at 8.5%, with higher rates among women, those with no formal education, and those in rural areas. The majority of persons with dementia in Malaysia are cared for at home by family members, making the quality of the patient-caregiver relationship a highly relevant factor for both clinical practice and policy development.

Despite the importance of dyadic relationship quality, no validated instrument existed in Malay for measuring this construct in dementia care settings. The Quality of the Patient-Caregiver Relationship (QCPR) questionnaire, developed internationally as a 14-item instrument assessing the perceived quality of the care relationship from both the patient’s and caregiver’s perspectives, represented a suitable candidate for cross-cultural adaptation. This study undertook the systematic translation, adaptation, and psychometric evaluation of the QCPR in Malay.

Study Design and Methods

A cross-sectional study design was employed, recruiting 70 patient-caregiver dyads from the psychogeriatric clinic at Universiti Kebangsaan Malaysia Medical Centre. Eligible patients were those with a clinical diagnosis of mild to moderate dementia, as assessed by a minimum Mini-Mental State Examination (MMSE) score criteria. Each patient was paired with their primary informal caregiver — typically a spouse, adult child, or other family member.

The QCPR questionnaire was translated into Malay following the established international guidelines for cross-cultural adaptation of health measurement instruments, including forward translation, back-translation, expert committee review, and pilot testing. The person with dementia and their caregiver each completed the QCPR Malay version independently. Internal consistency and test-retest reliability were assessed, along with construct validity through principal component factor analysis.

Reliability Results

The patient version of the QCPR Malay questionnaire demonstrated good internal consistency, with a Cronbach’s alpha coefficient of 0.86. Test-retest reliability was also strong, with an intraclass correlation coefficient (ICC) of 0.85, indicating that scores were stable across repeated administrations.

For the caregiver version, one item (Item 11) was identified as having poor correlation with the corrected item-total score and was omitted from the final scale. The resulting 13-item caregiver QCPR Malay version demonstrated satisfactory reliability, with a Cronbach’s alpha of 0.89 and an ICC of 0.91. These reliability values compare favourably with published psychometric data from other language versions of the QCPR and exceed commonly accepted thresholds for clinical and research use.

Validity Results

Principal component factor analysis was conducted to examine the underlying factor structure of the Malay QCPR. For the patient version, the analysis extracted four factors that collectively explained 69.44% of the total variance. For the caregiver version, three factors were extracted, explaining 61.20% of the total variance. These multi-factor structures suggest that the dyadic relationship in dementia care is a multidimensional construct encompassing distinct but related aspects of warmth, conflict, criticism, and affective quality.

Clinical and Research Applications

The validated Malay QCPR addresses a significant gap in the assessment toolkit available to Malaysian clinicians and researchers working in dementia care. The instrument can be used in clinical settings to screen for dyadic relationships that may be at risk of breakdown, enabling targeted psychosocial interventions such as dyadic counselling, caregiver education, and relationship-focused support programmes.

From a research perspective, the instrument enables investigation of the associations between relationship quality and outcomes including caregiver burden, institutionalisation risk, and patient quality of life within the Malaysian cultural context. Such research is essential for developing culturally appropriate dementia care models that support both the person with dementia and their family caregiver.

The Malaysian Dementia Care Context

Malaysia’s dementia care landscape is shaped by strong cultural values of filial piety and family responsibility, which generally promote home-based care by family members. However, these cultural strengths are increasingly challenged by demographic and social changes including smaller family sizes, greater female workforce participation, and internal migration patterns that may separate older adults from their adult children. Understanding and supporting the patient-caregiver relationship is therefore essential for maintaining the viability of family-based dementia care as these social transformations unfold.

The development of validated assessment tools in Malay is a necessary foundation for building a robust evidence base for dementia care in Malaysia. As the country’s older population continues to grow and dementia prevalence rises correspondingly, investment in the psychosocial dimensions of care — including relationship quality — will become increasingly important for ensuring that persons with dementia and their families receive the support they need.

Limitations

The study sample was drawn from a single tertiary care centre, which may limit generalisability to the broader Malaysian population. The sample size, while adequate for initial psychometric evaluation, was relatively modest. The study focused on patients with mild to moderate dementia; the applicability of the instrument to those with severe dementia, who may have greater difficulty completing self-report measures, requires further investigation. Cultural factors specific to Malaysia’s multiethnic population may also warrant exploration in future validation studies across Malay, Chinese, and Indian communities.

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