Development and validation of the role dilemma scale for family caregivers of people living with dementia

Dementia prevalence rises alongside global population aging, and family caregivers of people living with dementia undertake primary care duties. Persistent role dilemmas impair the physical and mental health of caregivers and patients, while current tools mainly focus on care burden, lacking targeted scales for caregivers of people living with dementia. Based on Role Stress Theory, items were generated via literature review and semi-structured interviews with 21 family caregivers, and subsequently refined through two rounds of Delphi consultation with eight experts and a pre-test with 30 family caregivers. For psychometric evaluation, 354 family caregivers participated in the formal survey and were randomly divided into two subsamples of approximately 40:60, with the smaller subsample used for item analysis and exploratory factor analysis (EFA) and the larger subsample used for confirmatory factor analysis (CFA). Internal consistency reliability was evaluated using the full formal survey sample. In addition, 30 participants completed a second assessment after 14 days so that test-retest reliability could be assessed. The final scale contained 23 items across five dimensions: Role Ambiguity, Role Incapacity, Role Conflict, Role Overload and Role Rigidity. All items showed good psychometric performance. The S-CVI/UA was 0.957, and the five factors explained 67.92% of the total variance. CFA demonstrated a good model fit (χ²/df = 1.296, RMSEA = 0.038, CFI = 0.971). The total Cronbach’s α was 0.892, with Cronbach’s α coefficients ranging from 0.830 to 0.895 across the five dimensions. This scale has sound reliability and validity. It can comprehensively assess role dilemmas among family caregivers of people living with dementia and support targeted supportive interventions. This validated scale enables healthcare professionals to systematically identify multifaceted role dilemmas among dementia family caregivers. It facilitates targeted, individualized support and intervention design, helps relieve care pressure, and maintains the stability of home-based dementia care services.