A new Turkish-language questionnaire called CARES-TR reliably measures the stress and burden that family caregivers experience when caring for people with swallowing problems. In a study of 193 Turkish caregivers, the tool showed excellent consistency (Cronbach’s α = .91) and strong correlations with other caregiver burden measures (r = .64-.74), making it an accurate screening instrument for identifying caregivers who need support.
Researchers in Turkey created and tested a new questionnaire called CARES-TR to measure the emotional and physical burden that caregivers experience when caring for people with swallowing difficulties. The study involved 193 family caregivers and found that this 10-question tool is reliable, accurate, and easy to use in clinical settings. According to Gram Research analysis, the CARES-TR successfully captures how much stress caregivers feel and correlates well with other measures of swallowing problems and caregiver burden, making it a valuable screening tool for healthcare providers working with Turkish-speaking populations.
Key Statistics
A 2026 cross-sectional study of 193 Turkish caregivers found that the CARES-TR questionnaire demonstrated excellent internal consistency with a Cronbach’s alpha of .91 and test-retest reliability ranging from .89 to .93, indicating highly stable and reproducible results.
According to research reviewed by Gram, the CARES-TR showed strong correlations with the Zarit Caregiver Burden Interview (r = .64-.74) and Penetration-Aspiration Scale (r = .55-.63) in a 2026 validation study of 193 caregivers, confirming its accuracy in measuring swallowing-related caregiver stress.
A 2026 psychometric analysis of the CARES-TR in 193 Turkish caregivers found no floor or ceiling effects and Rasch-model person reliability of .86, demonstrating the tool’s ability to effectively measure caregiver burden across the full spectrum of severity.
The CARES-TR showed moderate-to-strong correlations with the Pedi-EAT-10 (r = .62-.72) in a 2026 study of 193 caregivers, suggesting particular sensitivity to swallowing severity in pediatric populations and dietary modifications.
The Quick Take
- What they studied: Whether a new 10-question survey accurately measures how much stress and burden family caregivers feel when taking care of someone with swallowing problems
- Who participated: 193 family caregivers in Turkey who care for people with swallowing disorders. These were informal caregivers (family members, not paid professionals) of various ages and backgrounds
- Key finding: The CARES-TR questionnaire showed excellent reliability (test-retest scores of .89-.93) and strong connections to other swallowing and caregiver burden measures, with correlations ranging from .52 to .74, indicating it accurately measures caregiver stress
- What it means for you: If you’re a caregiver for someone with swallowing difficulties, this tool could help doctors and therapists understand your stress level and provide better support. However, this study only tested the tool’s accuracy—it doesn’t change how swallowing problems are treated
The Research Details
This was a cross-sectional study, which means researchers collected information from 193 Turkish caregivers at one point in time rather than following them over months or years. The researchers took an existing English-language questionnaire called CARES (Caregiver Analysis of Reported Experiences with Swallowing Disorders) and carefully translated it into Turkish, making sure the questions made sense culturally and linguistically for Turkish speakers.
The team then tested the questionnaire in two main ways. First, they used traditional statistical methods to check if the questions were clear, if people answered consistently, and if the results were stable when people took the test again. Second, they used advanced statistical modeling called Rasch analysis to ensure each question was at the right difficulty level and that the tool measured what it was supposed to measure.
The researchers also compared the CARES-TR scores to five other established measures of swallowing problems and caregiver burden to make sure it was measuring the same things these other tools measured.
Creating a reliable tool in Turkish is important because swallowing disorders affect many people worldwide, and caregivers often experience significant emotional and physical stress. Having a validated questionnaire in a person’s native language ensures accurate measurement of their burden and helps healthcare providers identify caregivers who need extra support. This approach respects cultural differences and ensures the tool works properly across different populations
The study shows strong quality indicators: the internal consistency was very high (Cronbach’s α = .91), meaning the questions measured the same concept reliably. Test-retest reliability was excellent (.89-.93), showing people got similar scores when retested. The tool correlated well with other established measures (.52-.74 range), confirming it measures what it should. The Rasch analysis showed good item fit and no floor or ceiling effects, meaning the tool works well across the full range of caregiver burden levels
What the Results Show
The CARES-TR demonstrated excellent internal consistency with a Cronbach’s alpha of .91, indicating that all 10 questions reliably measure caregiver burden from swallowing disorders. The two subscales (measuring different aspects of caregiver burden) had alpha values of .83 and .88, both considered very good. When caregivers took the test twice, their scores were nearly identical, with intraclass correlation coefficients ranging from .89 to .93—this means the tool produces stable, reproducible results.
When researchers compared CARES-TR scores to other established measures of swallowing problems and caregiver stress, they found strong correlations. Scores correlated with the Eating Assessment Tool-10 (r = .52-.55), the Zarit Caregiver Burden Interview (r = .64-.74), and the Penetration-Aspiration Scale (r = .55-.63). These moderate-to-strong correlations confirm that CARES-TR is measuring caregiver burden accurately and consistently with how other tools measure it.
Rasch analysis revealed that the questionnaire items fit well together (Infit MNSQ = 0.84-1.16; Outfit MNSQ = 0.71-1.19), the tool had good person reliability (.86), and the difficulty of questions matched caregivers’ abilities appropriately. No floor or ceiling effects were observed, meaning the tool effectively discriminates across the full spectrum of caregiver burden—from minimal to severe stress.
The study found that CARES-TR subscale scores showed particularly strong correlations with the Pedi-EAT-10 (r = .62-.72) and the IDDSI-FDS (r = -.57 to -.68), suggesting the tool is especially sensitive to swallowing severity in pediatric populations and dietary modifications. Item-total correlations ranged from .41 to .64, indicating that each question contributes meaningfully to the overall measurement without redundancy. The absence of floor and ceiling effects is clinically significant because it means the tool can detect changes in caregiver burden across the entire spectrum of severity
This study builds on the original English-language CARES by demonstrating that the tool’s psychometric properties translate well across languages and cultures. Previous validation studies of the CARES in other languages have shown similar patterns of reliability and validity, but this Turkish validation is important because it extends the tool’s applicability to Turkish-speaking populations. The strong correlations with established measures like the Zarit Caregiver Burden Interview confirm that CARES-TR captures the same underlying construct of caregiver stress that other validated instruments measure
The study was cross-sectional, meaning it captured a single moment in time rather than tracking caregivers over time, so researchers couldn’t assess whether the tool detects changes in burden as swallowing problems improve or worsen. The sample of 193 caregivers, while adequate for validation, was limited to Turkish-speaking populations and may not represent all demographic groups equally. The study didn’t include information about caregiver age, gender distribution, or relationship to the person with swallowing problems, which could affect how burden is experienced. Additionally, the study didn’t assess the tool’s sensitivity and specificity for identifying caregivers at risk for depression or other mental health complications
The Bottom Line
Healthcare providers working with Turkish-speaking populations should consider using CARES-TR as a brief, reliable screening tool to assess caregiver burden in patients with swallowing disorders (high confidence). The tool is practical for clinical settings because it’s short and easy to administer. Caregivers who score high on CARES-TR may benefit from additional support services, counseling, or respite care (moderate confidence, as this study doesn’t directly test interventions). The tool should complement, not replace, clinical judgment and comprehensive caregiver assessment
Speech-language pathologists, otolaryngologists, gastroenterologists, and other healthcare providers treating swallowing disorders should use this tool with Turkish-speaking caregivers. Family members caring for people with dysphagia may find this tool helpful for understanding and communicating their stress level to healthcare providers. This tool is specifically validated for Turkish speakers; English speakers should use the original CARES or other validated English-language tools. People without caregiving responsibilities for swallowing disorder patients don’t need this tool
The CARES-TR can be administered in 5-10 minutes during a clinical visit, providing immediate feedback about caregiver burden. Changes in caregiver burden may be detectable with repeated administration every 3-6 months as the patient’s swallowing status changes or as interventions are implemented. Long-term benefits of using this tool depend on whether healthcare providers act on the results by offering support services to high-burden caregivers
Frequently Asked Questions
What is the CARES-TR and how does it help caregivers of people with swallowing problems?
CARES-TR is a 10-question questionnaire that measures how much stress and burden family caregivers experience. A 2026 study of 193 Turkish caregivers found it has excellent reliability (α = .91) and accurately identifies caregivers needing support, helping healthcare providers offer targeted assistance.
How reliable is the CARES-TR for measuring caregiver burden?
The CARES-TR is highly reliable. A 2026 validation study showed test-retest reliability of .89-.93 and internal consistency of .91, meaning caregivers get consistent scores when retested and all questions measure the same concept reliably.
Can the CARES-TR be used to detect changes in caregiver stress over time?
The CARES-TR’s excellent test-retest reliability suggests it can detect meaningful changes in caregiver burden when administered repeatedly. However, the 2026 validation study was cross-sectional, so longitudinal research is needed to confirm its sensitivity to change.
Is the CARES-TR only for Turkish speakers or can English speakers use it?
The CARES-TR is specifically validated for Turkish-speaking populations. English speakers should use the original English-language CARES questionnaire or other validated English-language caregiver burden tools instead.
How long does it take to complete the CARES-TR questionnaire?
The CARES-TR is a brief, 10-question tool that typically takes 5-10 minutes to complete, making it practical for use in clinical settings during routine appointments with healthcare providers.
Want to Apply This Research?
- Users should complete the CARES-TR questionnaire every 4-6 weeks and track their total score over time. Record the date, total score (0-40 scale), and any changes in the care situation (new medications, therapy changes, or patient status changes) to identify patterns in caregiver burden
- After completing the CARES-TR in the app, users scoring in the high-burden range should set a reminder to schedule a conversation with their healthcare provider about support options. The app could suggest specific coping strategies or local caregiver support groups based on the user’s score and responses to individual items
- Create a dashboard showing CARES-TR score trends over 3-6 months with visual alerts when scores increase significantly. Link the questionnaire to caregiver wellness features like stress management resources, respite care information, and mental health support contacts. Allow users to share their scores with healthcare providers directly through the app
This research validates a measurement tool for caregiver burden related to swallowing disorders; it does not provide medical treatment or diagnosis. If you are a caregiver for someone with swallowing difficulties and experiencing significant stress or burden, consult with a healthcare provider, mental health professional, or caregiver support organization for appropriate interventions and support. This tool is designed for use by healthcare professionals in clinical settings and should not replace professional medical or psychological evaluation. The CARES-TR is validated specifically for Turkish-speaking populations; other language versions may have different psychometric properties.
This research translation is published by Gram Research, the science division of Gram, an AI-powered nutrition tracking app.