Stress, Sleep, and Caregiver Burden Evaluation

The primary outcome in this study was the participants’ stress level, which was measured at baseline (T0), immediately after the intervention (T1), and at the 3-month follow-up (T2). The Chinese version of the Perceived Stress Scale (CPSS; CPSS-10) was used to measure the caregivers’ stress levels. The CPSS-10 is a 5-point Likert scale with 10 items (Cronbach α=.91, intraclass correlation coefficient=0.69), with 0=never to 4=very often [60 (link)]. The total score ranged from 0 to 57, with higher scores denoting a higher level of perceived stress. The secondary outcomes were the participants’ sleep quality, caregiver burden, and mindful attention and awareness, which were measured at T0, T1, and T2. The Chinese version of the Pittsburgh Sleep Quality Index (CPSQI), a 4-point Likert scale with 19 items (Cronbach α=.83), was used to assess 7 components of sleep quality: the use of sleep medication, sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbances, and daytime dysfunction. Higher scores indicated greater levels of insomnia. The CPSQI has demonstrated satisfactory internal consistency and test-retest reliability in Chinese populations [61 (link)]. Caregiver burden was measured using the Chinese version of the Zarit Burden Interview, which is a 5-point Likert scale with 22 items (Cronbach α=.87) used to address the perceived impact of the act of providing care on the physical health, emotional health, social activities, and financial situation of the caregiver [62 (link)]. The Chinese version of the Mindful Attention and Awareness Scale, a 15-item single-dimension measure of mindfulness, measures the frequency of open and receptive attention and awareness of ongoing events and experiences. Response options range from 1 (almost always) to 6 (rarely). Scoring involves calculating the mean performance across items, with higher scores indicating greater mindfulness (Cronbach α=.85) [63 (link)]. The Chinese version of the FRAIL, a simple 5-item scale (intraclass correlation coefficient=0.708), was used to assess frailty in older adults [64 (link)]. It consists of 5 components: fatigue, resistance, ambulation, illness, and weight loss. FRAIL scores range from 0 to 5 (ie, 1 point for each component), with 0 representing robust, 1 to 2 prefrail, and 3 to 5 frail statuses [65 (link)].