Psychometric Evaluation of the Mutuality Scale in Older Adults with Multiple Chronic Conditions and Their Caregivers Living in a Low–Middle-Income Country

Vollständiger Abstract

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Background/Objectives: Multiple chronic conditions (MCCs) are highly prevalent among older adults and require effective collaboration between the patient and caregiver. Mutuality, reflecting the quality of the dyadic relationship, is associated with better self-care and health outcomes. However, the Mutuality Scale (MS) has not been validated on patient–caregiver dyads managing MCCs living in a low–middle-income country (LMIC). Aim: This study seeks to evaluate the structural and convergent validity and reliability of the MS among patient–caregiver dyads managing MCCs living in a LMIC. Methods: A cross-sectional study was conducted on MCC patients and their caregiver recruited from community and outpatient settings. The MS, Self-care of Chronic Illness Inventory (SC-CII) and Caregiver Contribution to self-care Inventory (CC-SCCII) were used for measuring mutuality, patient self-care, and Caregiver Contribution (CC) to patient self-care, respectively. Confirmatory factor analysis (CFA) was performed separately for patients and caregivers to evaluate the original four-factor structure of the MS. Convergent validity was examined through correlations with self-care and CC to patient self-care. Reliability was evaluated using composite reliability and the Global Reliability Index for multidimensional scale. Results: A sample of 406 patient–caregiver dyads was examined. Patients had a mean age of 73.9 (±6.2) years. Caregivers had a mean age of 47.8 (±15.5) years. The four-factor structure was supported in both samples, with acceptable model fit (patients: Comparative Fit Index (CFI) = 0.953 and Root Mean Square Error of Approximation (RMSEA) = 0.078; caregiver CFI = 0.945 and RMSEA = 0.085. The second-order CFA supported a hierarchical structure. Patient and caregiver mutuality scores were strongly correlated (r = 0.778, p < 0.01). Higher mutuality was associated with better patient self-care (r = 0.276–0.479) and CC to self-care (r = 0.174–0.556). Reliability indices ranged from 0.70 to 0.91 for patients and 0.66 to 0.89 for caregivers. Conclusions: The findings support the validity and reliability of the MS for assessing mutuality in patients and their caregivers managing MCCs in an LMIC characterized by limited healthcare resources and formal support. Its use provides empirical support for assessing relationship quality and facilitating dyadic care within this vulnerable population. Future longitudinal studies should evaluate its predictive validity, responsiveness, and measurement invariance across different groups and between patient and caregiver.