Revising the cpra: eliminating method bias to strengthen measurement of caregiver-provider relationships

The National Institute on Aging awarded the University of Texas Health Science Center at Houston $312,000 on September 1, 2026, under the Aging Research program (CFDA 93.866) to revise and validate the Caregiver-Provider Relationship Assessment (CPRA), a measurement tool designed to evaluate interactions between family caregivers of individuals with Alzheimer's disease and related dementias and healthcare providers.

The project will develop a psychometrically validated revision of the CPRA using only positively worded items to eliminate systematic bias introduced by negatively worded items in the original instrument. The recipient will recruit 175 English-speaking family caregivers to complete both the original CPRA and the revised version (CPRAR), then evaluate the revised scale using Bayesian confirmatory factor analysis to compare construct validity, internal consistency, and convergent and discriminant validity. A second aim assesses measurement invariance and differential item functioning of the CPRAR across sex and racial/ethnic subgroups through multi-group confirmatory factor analysis and item response theory modeling.

The award runs through August 31, 2028, with place of performance at Houston, Texas. The project yields a measurement tool intended to improve caregiver-provider relationship assessment in dementia caregiving research and inform intervention design.

Abstract

Family caregivers play a critical role in the care of individuals with alzheimer's disease and related dementias (ADRD), especially in facilitating communication with healthcare providers. However, the quality of these caregiver-provider relationships is often compromised by inconsistent communication and lack of emotional support. Although the caregiver-provider relationship assessment (CPRA) was developed to measure these interactions, IT includes negatively worded items known to introduce systematic bias. This project aims to develop a revised, psychometrically validated version of the CPRA (CPRAR) using only positively worded items. We will recruit 175 english-speaking ADRD family caregivers to complete both the CPRA and CPRAR, and evaluate the revised scale using bayesian confirmatory factor analysis. Our goals are to compare the reliability and validity of CPRAR with the original, and to assess its measurement invariance across racial/ethnic and SEX subgroups through multi-group CFA and differential item functioning analysis. The project has two specific aims. Aim 1 is to evaluate the psychometric properties of the CPRAR using bayesian confirmatory factor analysis, comparing its construct validity, internal consistency, and convergent and discriminant validity to the original CPRA. Aim 2 is to assess measurement invariance and differential item functioning of the CPRAR across SEX and racial/ethnic subgroups, using multi-group confirmatory factor analysis and item response theory modeling. This work will yield a robust tool for evaluating caregiver-provider relationships, improving the quality of intervention design and assessment in dementia caregiving research. This project addresses a critical GAP in dementia caregiving research by producing a psychometrically sound, population-representative tool to evaluate caregiver-provider relationships. The resulting instrument will enable accurate measurement of this modifiable aspect of the care experience, support the design and evaluation of communication-focused interventions, and contribute to improved health outcomes for caregivers and care recipients.