Development and validation of the Family Vulnerability Index to
					Disability and Dependence (FVI-DD)

This exploratory, descriptive, cross-sectional, and quantitative study aimed to develop and validate an index of family vulnerability to disability and dependence (FVI-DD). This study was adapted from the Family Development Index, with the addition of social and health indicators of disability and dependence. The instrument was applied to 248 families in the city of Sao Paulo, followed by exploratory factor analysis. Factor validation was performed using the concurrent and discriminant validity of the Lawton scale and Katz Index. The descriptive level adopted for the study was p < 0.05. The final vulnerability index comprised 50 questions classified into seven factors contemplating social and health dimensions, and this index exhibited good internal consistency (Cronbach’s alpha = 0.82). FVI-DD was validated using both the Lawton scale and Katz Index. We conclude that FVI-DD can accurately and reliably assess family vulnerability to disability and dependence.

Family; Family Health Program; Indicators; Health vulnerability; Validation studies

Authorship

Fernanda Amendola

Ph.D. in Health Sciences, School of Nursing, University of São Paulo, State of São Paulo, Brazil. kfamendola@usp.brUniversity of São PauloBrazilSão Paulo, BrazilPh.D. in Health Sciences, School of Nursing, University of São Paulo, State of São Paulo, Brazil. kfamendola@usp.br

Márcia Regina Martins Alvarenga

Assistant Professor, School of Nursing, State University of Mato Grosso do Sul. marciaregina@uems.brState University of Mato Grosso do Sul.BrazilCampo Grande, BrazilAssistant Professor, School of Nursing, State University of Mato Grosso do Sul. marciaregina@uems.br

Maria do Rosário Dias de Oliveira Latorre

Tenured Professor, Department of Epidemiology, School of Public Health, University of São Paulo, State of São Paulo, BrazilUniversity of São Paulo.BrazilSão Paulo, BrazilTenured Professor, Department of Epidemiology, School of Public Health, University of São Paulo, State of São Paulo, Brazil

Maria Amélia de Campos Oliveira

Full Professor, Department of Community Health Nursing, School of Nursing, University of São Paulo, State of São Paulo, BrazilUniversity of São Paulo.BrazilSão Paulo, BrazilFull Professor, Department of Community Health Nursing, School of Nursing, University of São Paulo, State of São Paulo, Brazil

Correspondence: Fernanda Amendola, Escola de Enfermagem da USP - Depto. ENS, Av. Dr. Enéas de Carvalho Aguiar, 419 - Cerqueira César, CEP - 05403-000 - São Paulo - SP, Brazil

SCIMAGO INSTITUTIONS RANKINGS

Tables

Tables (4)

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Table 1 - Questions and description of factors of FVI-DD - São Paulo, 2011

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Table 2 - Descriptive statistic of FVI-DD - São Paulo, 2011.

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Table 3 - Descriptive statistics of indicators of FVI-DD, depending on the presence of dependence on basic activities of daily living (BADL) of the Katz Index and on the instrumental activities of the Lawton Scale - São Paulo, 2011.

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Table 4 - Spearman correlation coefficients (rsp) between the indicators of FVI-DD and Katz and Lawton mean family scores - São Paulo, 2011.

Table 1 - Questions and description of factors of FVI-DD - São Paulo, 2011

Factors	Number of questions	Question	r*
1. Favorable social conditions	11	17. Has at least one adult completed school up to ninth grade?	0.573
		18. Has anyone completed high school?	0.685
		19. Does anyone have higher education?	0.692
		22. Has the head of the household completed school up to ninth grade?	0.55
		23. Has the head of the household completed high school?	0.581
		24. Does the head of the household have an undergraduate degree?	0.573
		30. Is anyone employed and earning more than two minimum wages?	0.55
		59. Is there a landline phone in the house?	0.42
		60. Is there a computer in the house?	0.762
		61. Is there a computer with Internet access?	0.722
		62. Does anyone own a motorcycle or a car for private use?	0.5
2. Aging	9	7. Is an elderly person living in the house (aged 60 or more)?	0.495
		8. Is there an elderly person aged 80 or more?	0.502
		9. If there is only one person living in the house, is he/she an elderly person (aged 60 or more)?	0.567
		10. Are there only elderly people living in the house (aged 60 or more)?	0.629
		25. Do over half the people of working age engage in paid work? *In this case, consider only members of 16 years or above (exclude child labor)	0.52
		26. Has anyone been performing their current job for over six months?	0.642
		27. Is anyone working in official employment (with a signed contract)?	0.508
		87. Has any elderly person suffered a fall within the last 12 months?	0.446
		91. Is anyone unable to take public transportation to their health-care center?	0.439
3. Chronic disease	9	78. Is anyone in the family suffering from at least one chronic disease?	0.604
		79. Is anyone in the family suffering from at least two chronic diseases?	0.643
		80. Is anyone in the family suffering from three or more chronic diseases?	0.512
		81. Is anyone suffering from a chronic disease and having difficulty in following their drug treatment owing to personal reasons or lack of access to medicine?	0.427
		82. Is anyone with a chronic disease having difficulty in following a non-drug related treatment, such as performing physical activities, following a recommended diet, quitting smoking?	0.42
		83. Is anyone continuously using prescription drugs?	0.6
		84. Is anyone continuously using five or more prescription drugs at the same time (multidrugs)?	0.594
		88. Does anyone believe that his/her health is poor or very poor?	0.525
		99. Is anyone unable to perform any of the following activities without assistance: cleaning the house, taking care of laundry, preparing food, using household appliances, shopping, using personal or public transportation, and controlling their own medication or finances? (instrumental activities of daily living - IADL)	0.437
4. Unfavorable social conditions	5	2. Has any woman given birth to a living child in the last 24 months?	0.513
		5. Is there any child or adolescent up to the age of 14 in the house?	0.858
		6. Is there any child or adolescent up to the age of 17 in the house?	0.838
		32. Is the family income between a quarter and a half of the minimum wage per person?	0.451
		46. Is the total number of residents divided by the number of bedrooms greater than two?	0.596
5. Social support	6	72. Does anyone not have someone they can count on if they need assistance in performing their domestic duties such as preparing food and cleaning the house?	0.742
		73. Does anyone not have someone they can count on if they need assistance for material goods?	0.684
		74. Does anyone not have someone they can count on if they need financial assistance?	0.696
		75. Does anyone not have someone they can count on if they need company?	0.758
		76. Does anyone not have someone they can count on if they need health assistance?	0.821
		77. Does anyone not have someone they can count on to accompany them when they need to leave the house (for medical consultations, shopping, walks, etc.)?	0.752
6. Illiteracy	3	15. Is there an illiterate adult in the household or someone who can only read and write their own name?	0.763
		16. Is there an adult with reading and writing difficulties (functional illiteracy)?	0.695
		20. Is the head of the household illiterate or only capable of reading and writing his own name?	0.712
7. Social network	7	64. Are there friends who live nearby (within walking distance) and who maintain contact?	0.606
		66. Do family members visit at least once a week?	0.513
		67. Do family members visit at least once a month?	0.55
		68. Do family members visit at least once a year?	0.403
		69. Do friends visit at least once a week?	0.568
		70. Do friends visit at least once a month?	0.737
		71. Do friends visit at least once a year?	0.626
Total	50	-	-

*r - factor solution of the matrix, with orthogonal rotation (varimax)

Table 2 - Descriptive statistic of FVI-DD - São Paulo, 2011.

Factors	Cronbach's alpha	Mean (SD)	Median	Min-max
1. Favaroble social conditions	0.86	5.31(3.30)	5	0-11
2. Aging	0.81	2.33 (2.32)	1	0-9
3. Chronic diseases	0.78	3.19 (2.31)	3	0-9
4. Unfavorable social conditions	0.78	1.08 (1.41)	0	0-5
5. Social support	0.85	1.06 (1.72)	0	0-6
6. Illiteracy	0.77	0.34 (0.78)	0	0-3
7. Social network	0.73	2.14 (1.83)	2	0-7
FVI-DD Total	0.82	15.46 (6.60)	15	1-31

Table 3 - Descriptive statistics of indicators of FVI-DD, depending on the presence of dependence on basic activities of daily living (BADL) of the Katz Index and on the instrumental activities of the Lawton Scale - São Paulo, 2011.

Components	Presence of dependency	No one in the family with dependency		At least one person in the family with BADL or IADL dependency		p#
Components	Presence of dependency	Mean	(SD)	Mean	(SD)	p#
1. Favorable social conditions	KATZ	5.27	-3.25	5.7	-3.76	0.59
1. Favorable social conditions	LAWTON	5.12	-3.28	5.96	-3.31	0.09
2. Aging	KATZ	2.12	-2.22	4.48	-2.29	<0.001*
2. Aging	LAWTON	1.7	-1.88	4.55	-2.39	<0.001*
3. Chronic disease	KATZ	3	-2.26	5.3	-1.66	<0.001*
3. Chronic disease	LAWTON	2.55	-2.09	5.44	-1.51	<0.001*
4. Unfavorable social conditions	KATZ	1.13	-1.43	0.65	-1.11	0.14
4. Unfavorable social conditions	LAWTON	1.27	-1.47	0.42	-0.92	<0.001*
5. Social support	KATZ	1.1	-1.74	0.61	-1.5	0.06
5. Social support	LAWTON	1.07	-1.73	1.02	-1.71	0.99
6. Illiteracy	KATZ	0.31	-0.73	0.65	-1.15	0.15
6. Illiteracy	LAWTON	0.29	-0.74	0.53	-0.9	0.01*
7. Social network	KATZ	2.11	-1.81	2.43	-2.04	0.49
7. Social network	LAWTON	2.12	-1.77	2.22	-2.04	0.97
FVI-DD Total	KATZ	15.01	-6.55	19.83	-5.47	<0.01*
FVI-DD Total	LAWTON	14.13	-6.27	20.13	-5.55	<0.01*

# Mann-Whitney test
* statistically significant difference (p<0.05)

Table 4 - Spearman correlation coefficients (rsp) between the indicators of FVI-DD and Katz and Lawton mean family scores - São Paulo, 2011.

Components	Mean Katz score	Mean Lawton score
Components	rsp (p)	rsp (p)
1. Favorable social conditions	0.04 (0.49)	- 0.12 (0.06)
2. Aging	0.30 (<0.001)*	- 0.50 (<0.001)*
3. Chronic diseases	0.29 (<0.001)*	- 0.51 (<0.001)*
4. Unfavorable social conditions	- 0.10 (0.12)	0.27 (<0.001)*
5. Social support	- 0.12 (0.06)	0.02 (0.78)
6. Illiteracy	0.09 (0.15)	- 0.17 (0.01)*
7. Social network	0.05 (0.48)	- 0.02 (0.71)
FVI-DD Total	0.23 (<0.001)*	- 0.40 (<0.001)*

* statistically significant correlation (p<0.05)

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Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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Development and validation of the Family Vulnerability Index to Disability and Dependence (FVI-DD)

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[1] Correspondence: Fernanda Amendola, Escola de Enfermagem da USP - Depto. ENS, Av. Dr. Enéas de Carvalho Aguiar, 419 - Cerqueira César, CEP - 05403-000 - São Paulo - SP, Brazil