2.1. Step 1: Item Generation and Survey Development

Initial items for CHAT were generated by our study team with several rounds of development and consensus-building. Our study team, all with content and methodology expertise, included two occupational therapists and geriatric health services researchers (JR, BF), one social psychologist and caregiving researcher (RS), and one biostatistician and psychometrician (LT). We reviewed findings from our systematic review and the assessment framework recommended by the National Center on Caregiving at the Family Caregiving Alliance to inform the development of our initial items [4,9]. We selected the assessment framework to help guide the development of our initial CHAT items because it emphasizes that quality care results from identifying and assessing multiple needs of care partners. Representative domains from the framework included the following: context; care partner’s perception of health and functional status of the aging adult; care partner values and preferences; well-being of the care partner; skills, abilities, and knowledge to provide care to the aging adult; and potential resources that care partner could choose to use. Context includes information related to the physical environment, financial status, caregiving relationship, and duration of caregiving. Care partner’s perception of health and functional status of the aging adult captures information on activities of daily living, cognitive and/or behavioral impairments, medical procedures, and instrumental activities of daily living. Care partner values and preferences includes information such as their willingness to assume and accept care responsibilities and disposition for scheduling and delivering care. Well-being of the care partner refers to their self-rated health conditions and symptoms. Skills, abilities, and knowledge to provide care to the aging adult includes information related to the care partner’s confidence and competence to deliver care. Potential resources that the care partner could choose to use encompasses information on formal and informal social support services, coping strategies, and financial resources. Together, these domains represent the complexities, dynamic nature, and influence of the broad range of assistance care partners provide to aging adults that have unique characteristics, conditions, and comorbidities. To request a copy of the initial CHAT, email the corresponding author.

Our study team created a survey using Qualtrics to evaluate content validity. The survey consisted of an initial item pool representing the assessment framework domains, and questions that asked participants to (1) rate the clarity and relevance of each item on a 5-point Likert scale (1 = not at all relevant to 5 = extremely relevant), (2) provide open-ended feedback regarding content and wording immediately after each rating question, and (3) share suggestions for additional content that was overlooked in the initial item pool. Rating responses were dichotomized as ‘agree’ for those who reported 3 (somewhat relevant) or greater for each item. This cut-point follows the typical recommendation for computing content validity [10].