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ISSN: 0138-7103 | RNPS: 2030 
_____________________________________________ 
  
  Original   
Psychometric Properties of the Family Assessment Scale 
for Older Adults in Ecuador 
 
Propiedades psicométricas de la escala de evaluación 
familiar para adultos mayores en Ecuador 
 
José Alejandro Valdevila Figueira1,2     
Andrés Ramírez3    
Vanessa Quito-Calle3    
Pedro Andrés Muñoz-Arteaga3    
María Lorena Cañizares-Jarrin3    
Indira Dayana Carvajal Parra2    
 
1 Universidad Tecnológica ECOTEC, Guayaquil. Ecuador 
2 Psychology and Psychiatry Research Group (GIPSI), Ecuador 
3 Carrera de psicología Clínica, Universidad Politécnica Salesiana, Cuenca Ecuador 
 
Recibido: 03/01/2025 
Aceptado: 09/04/2025 
  
 
 

Psychometric Properties of the Family Assessment Scale for Older Adults in Ecuador

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Abstract

Introduction: Family functioning is a key predictor of individual well-being. Aging and its

limitations can disrupt family dynamics, affecting overall functioning.

Objective: Evaluate the psychometric properties of the Family Assessment Scale (APGAR)

in Ecuadorian older adults.

Methodology: The APGAR-family scale was administered to assess internal consistency

and reliability. Confirmatory factor analysis (CFA) using a diagonally weighted least squares

estimator examined the factor structure. Model fit was evaluated through multiple indices,

including chi-square, root mean square error of approximation, standardized root mean

square residual, Tucker-Lewis index, and comparative fit index.

Results: A total of 1,208 participants completed the APGAR. The scale demonstrated

excellent internal consistency and reliability. CFA confirmed a one-dimensional structure

with significant item loadings and adequate fit indices.

Conclusion: The APGAR scale is a reliable and valid tool for assessing family functioning

in Ecuadorian older adults, with potential applications in clinical and social contexts.

Keywords:older adults; APGAR; psychometrics; mental health; family.

Resumen

Introducción: el funcionamiento familiar es un factor clave en el bienestar individual. El

envejecimiento y sus limitaciones pueden alterar la dinámica familiar y afectar su

funcionamiento.

Objetivo: evaluar las propiedades psicométricas de la Escala de Evaluación Familiar

(APGAR) en adultos mayores ecuatorianos.

Metodología: se aplicó la escala APGAR para evaluar su consistencia interna y

confiabilidad. Se realizó un análisis factorial confirmatorio (AFC) con un estimador de

mínimos cuadrados ponderados diagonalmente para examinar su estructura factorial. El

ajuste del modelo se evaluó mediante varios índices, incluidos chi-cuadrado, error cuadrático

medio de aproximación, residuo cuadrático medio estandarizado, índice Tucker-Lewis e

índice de ajuste comparativo.

Resultados: un total de 1,208 participantes completaron la escala. Se demostró una excelente

confiabilidad y consistencia interna. El AFC confirmó una estructura unidimensional con

cargas significativas y adecuados índices de ajuste.

Conclusión: la escala APGAR es una herramienta válida y confiable para evaluar el

funcionamiento familiar en adultos mayores ecuatorianos, con aplicaciones clínicas y

sociales.

Palabras clave: adulto mayor; APGAR; psicometría; salud mental; familia

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Introduction

Family functionality (FF) is a key determinant of well-being and quality of life, particularly

in senior citizens (SC). (1,2) With increasing global life expectancy, (3) understanding family

dynamics is essential to designing effective health interventions for this population. (4)

As SC experience a gradual decline in functional capacities and autonomy, families play a

central role in their care. This dynamic necessitates exploring older adults' (OA) satisfaction

with family support, as differing expectations can lead to conflicts. (5,6) Tools like the Family

Assessment Scale (APGAR) promote understanding of the family environment by fostering

communication and assessing the fulfillment of roles crucial to the health-disease process.

(7,9)

The APGAR-family scale, developed by Smilkstein in 1978, (10) measures five dimensions

of FF—adaptability, partnership, growth, affect, and resolve—and has demonstrated

reliability indices ranging from 0.71 to 0.83 across diverse populations. (11-13) Its ease of use

and brevity have made it a popular choice, but its psychometric performance in Ecuadorian

older adults has been underexplored, limiting its adoption by mental health professionals and

students.

While studies in Latin America, including Colombia (14) and Peru, (15) highlight the scale's

strengths, its validation remains limited in Ecuador, where family dynamics profoundly

impact SC's health and satisfaction. Furthermore, existing research has focused primarily on

the instrument's factor structure, overlooking broader aspects of construct validity and its

associations with related measures. (16-18)

This study aims to fill this gap by evaluating the psychometric properties of the APGAR-

family scale in an Ecuadorian sample of SC. The results will provide valuable insights for

future research and contribute to the development of socio-family interventions to enhance

family relationships. This research focuses on Cuenca, Ecuador, a region whose cultural and

socioeconomic context shapes family dynamics and influences FF perception.

Method

Participants

The sample was composed of 1,208 Ecuadorian older adults (OA) from the city of Cuenca,

Ecuador, aged between 65 and 103 years (mean age = 74.1, SD = 8.94). It included 463 male

and 745 female participants. All participants self-reported not having been diagnosed with a

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mental disorder, and no additional inclusion criteria were applied. Participants were recruited

and included in the study between June 1 and August 30, 2024. A non-probability

convenience sampling method was employed, based on the accessibility and willingness of

older adults residing in Cuenca to participate in the study.

Instruments

The APGAR is a 5-item scale that assesses the user's perception of their satisfaction with

family support, analysing basic functions such as adaptation, participation, gradient of

resources, affection and problem-solving capacity, present in all families according to their

structure, development, integration or demographics. The response options of the items of

the scale determine degrees of frequency of certain dynamics, these are: "never", indicating

that the evaluated aspect never occurred in the family; "almost never", indicating that it

happened very rarely; "sometimes", indicating that it happened on some occasion; "almost

always", indicating that it occurred frequently and "always", indicating that the evaluated

aspect always occurred in the family. Each question is scored using a Lickert scale on values

of 0-2, where answers such as "never" and "almost never", receive 0 points; "sometimes"

they receive 1 point; "almost always" and "always" receive 2 points, obtaining a quantitative

index of 0 - 10 at the end. Three cut-off point scales are considered: a) normal function (7-

10 points), b) moderate dysfunction (4-6 points), and c) severe dysfunction (0-3 points).

An ad hoc survey was applied with sociodemographic variables (age, marital status,

educational level, ethnic self-perception, economic income in the last month, way of

obtaining income and socioeconomic level).

Procedure

Researchers visited 1009 homes in Cuenca, providing a brief description of the study

objectives, procedures, confidentiality measures, and the voluntary nature of participation.

Participants signed informed consent to confirm their understanding and willingness to

participate.

The questionnaire was administered at home, allowing participants to complete it at their

convenience. No identifiable information (e.g., names) was collected to ensure privacy.

Responses were securely stored in an encrypted database accessible only to the principal

investigator, adhering to data protection regulations.

Analyses

Psychometric properties of the APGAR-family scale were assessed in three stages. Internal

consistency was evaluated to determine the reliability of the items and the overall scale, with

reliability benchmarks interpreted as follows: ≥.70 acceptable, ≥.80 good, and ≥.90 excellent.

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The factor structure was examined using confirmatory factor analysis (CFA) with the

diagonally weighted least squares (DWLS) estimator, appropriate for ordinal data. Model fit

was evaluated using several indices: chi-square (X²), root mean square error of

approximation (RMSEA), standardized root mean square residual (SRMR), Tucker-Lewis

index (TLI), and comparative fit index (CFI). Additionally, factor loadings and correlations

between latent factors were analyzed to confirm the model's suitability. Items with factor

loadings ≥ 0.50 were retained, indicating strong contributions to their respective factors.

Ethical considerations

This study was conducted in full compliance with the provisions of the Declaration of

Helsinki (1964) and the provisions of the General Health Law on research. It was submitted

to the Research Ethics Committee of the Catholic University of Cuenca, Ecuador and

approved with the code: CEISH-UCACUE-18102022. The confidentiality of the information

was protected with informed consent were used. All authors agree to be mentioned in the

article.

Results

Sociodemographic variables

The results show the dataset of 1208 participants. Most were women (n = 745; 62 %). 51 %

of the subjects were married or in a common-law union (n = 613) and 30 % were widowed

(n = 368). 39 % had attained primary education. Most participants self-identified as mestizos

(97 %, n = 1,167). The income obtained from the last month came from family support (n =

466) or from retirement or pension (n = 452). Finally, 71 % belonged to the middle

socioeconomic stratum (n = 853).

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Table 1. Descriptive of the sociodemographic variables

Sociodemographic variables

Gender

Man

463

Woman

745

Marital status

Single

7.2

Married – Free union

613

Separated – Divorced

140

Widower

368

Education

Primary

469

High school

409

Technical or higher

160

Superior

0.4

None

165

Ethnicity

White

1.5

Mixed

1,167

Indigenous

1.7

African american

0.2

Income on the last month

345

Yes

863

Means of economic income

Retirement / pension

452

Family support

466

Rent / basic income

113

9.4

Subsidies

5.6

Formal employement

3.2

Informal employement

5.8

Socioeconomic level

High

143

Low

212

Medium

853

Source: own elaboration

Internal consistency

The results of the internal consistency analyses (table 2) showed excellent reliability for the

scale-independent items (item F1 M = 3.81 and SD = 0.953 / ω = 0.948 / Correlation with

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the other items 0.841; item F2 M = 3.85 and SD = 0.954 / Correlation with the other items =

0.894 / ω = 0.939; item F3 M = 3.83 and SD = 0.949 / Correlation with the rest of the items

= 0.877 / ω = 0.942; item F4 M = 3.79 and SD = 0.946 / Correlation with the rest of the items

= 0.862 / ω = 0.945; item F5 M = 3.83 and SD = 0.947 / Correlation with the other items =

0.881 / ω = 0.941) M = 3.81 and SD = 0.953. The α Cronbach coefficients obtained were

quite similar to those obtained from ω in all cases (Cronbach's α F1 = 0.948; Cronbach's α

F2 = 0.939; Cronbach's α F3 = 0.942; Cronbach's α F4 = 0.944; Cronbach's α F5 = 0.941).

The total score of the scale also had a mean of 3.82 and a standard deviation of 0.872

(Cronbach's alpha and McDonald's ω 0.954), demonstrating an excellent overall reliability

of the scale. These results indicate that the APGAR-family scale is a highly consistent and

reliable tool to measure family satisfaction in Ecuadorian older adults.

Table 2. Global and item reliability of APGAR in Ecuadorian older adults

Items

Mean

Correlation

of the

elements

with others

F1. I am satisfied with the help I receive from my

family when I have a problem and/or need.

3.81

0.953

0.841

0.948

F2. I am satisfied with how we talk and share our

feelings in my family.

3.85

0.954

0.894

0.939

F3. I am satisfied with how my family accepts and

supports my wishes to start new activities.

3.83

0.949

0.877

0.942

F4. I am satisfied with how my family spends our

time together, the places we share and our money.

3.79

0.946

0.862

0.944

0.945

F5. I am satisfied with how my family expresses

affection and responds to my feelings.

3.83

0.947

0.881

0.941

Score

3.82

0.872

0.954

Source: own elaboration

Note: F1 measures satisfaction with family help, F2 with problem solving, F3 with acceptance of changes, F4

with expression of affection, and F5 with time shared with family.

Factor structure

Figure 1 shows model 1 of the APGAR-family, showing the relationships between the global

construct and its five items. The standardized factor loads were high: F1 (0.87), F2 (0.92),

F3 (0.91), F4 (0.89) and F5 (0.90), indicating strong relationships between the construct and

each independent item. Measurement errors were low, which reinforces the reliability of the

model. Overall, these results suggest that the APGAR-family items are strongly related to

the general construct of family satisfaction in Ecuadorian older adults, confirming the

validity and reliability of the model.

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Figure 1. APGAR global model

Source: own elaboration

Note: standardized factor loads between 0.87 and 0.90

To contrast the hypothesis with the relationship between indicators and latent dimensions,

confirmatory factor analysis was performed. The analysis of the internal structure of the

instrument verified that the APGAR-family evaluates the construct for which it was

designed.

The second model (figure 2) of APGAR-family invariance according to gender, analyzed the

behavior of various adjustment indices. All factor loads were above 0.5. The Comparative

Fit Index (CFI) showed a value greater than 0.95 (0.985), suggesting that the model fits the

sample. The Tucker-Lewis Index (TLI) was 0.970, exceeding the recommended cut-off of

0.90, and the Bentler-Bonett Non-Normalized Fit Index (NNFI) showed excellent value of

0.970. The relative non-centrality index (RNI) and the normalized Bentler-Bonett fit index

(NFI) presented values of 0.985 and 0.984, respectively, which reinforces the adequacy of

the model. The Bollen Relative Fit Index (RFI) had a value of 0.967 and the Bollen

Incremental Fit Index (IFI) showed a value of 0.985, both indicating a strong fit. The

standardized mean square residual (SRMR) was 0.013, indicating minimal discrepancies

between the model and the observed data.

Finally, the large sample size allowed the determination of the mean square error of

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approximation (RMSEA) which had a value of 0.064, which suggests a reasonably good fit

suggesting a good equality between the model observed in the covariance matrix and the

covariance matrix of the implicit model. Taken together, these indices showed that Model 2

of APGAR-familial invariance according to gender was well aligned with the data,

confirming the validity of the model for both genders.

Figure 2. Invariance by sex

Source: own elaboration

Note: Gender factor analysis model for the APGAR scale. (man α and ω₁ (0.948), AVE (0.786) and woman α

and ω₁ (0.957), AVE (0.816).

Discussion

The APGAR-family is one of the most widely used scales to measure the perception of family

functioning due to its easy applicability, easy understanding, limited time of application and

psychometric properties. However, their psychometric performance in Ecuadorian OA has

been undervalued, which limits their preference in mental health professionals.

The present study aimed to evaluate the psychometric properties of APGAR-family in a

sample of Ecuadorian OAs, providing evidence for its use in Spanish-speaking contexts and,

specifically, in Ecuador, where family functioning represents a significant social and public

health problem. The results obtained support the use of the questionnaire in this population,

both in terms of internal consistency and construct validity.

First, the internal consistency analyses showed that the APGAR items, as well as the overall

score, have excellent reliability. This finding is consistent with previous studies conducted

in different languages and cultural contexts, such as American English (α = 0.86), (17) Spanish

in Peru (α = 0,72), (15, 19) and Portuguese in Brazil (α = 0,73-0,78) (20) and Portugal (α = 0.86),

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(21) where only some report results of exploratory factor analysis (EFA) and confirmatory

factor analysis (CFA) to account for construct validity. (22)

A study conducted in Brazil showed acceptable reliability results according to Cronbach's α,

and both the alpha score on the total scale (α = 0.80) and the correlation coefficient were

similar to those of the instrument in its original version. On the other hand, the individual

behavior of the items showed little variation (α from 0.73 to 0.78) in their internal

consistency. (20)

Other researchers found similar results, in different populations and

sociocultural/geographical contexts, for example, Bellon et al., applied the APGAR-family

to 656 people over 60 years of age from a Spanish health center and found intraclass

correlation coefficients of the 5 items greater than 0.55. (17) There were no differences in the

results of the self-assesses (α = 0.86) or with the participation of a companion (α = 0.81). The

item-scale correlation ranged from 0.61 to 0.71. Crombach's α was 0.84 and no item increased

alpha when taken off the scale. Factor analysis separated a single factor.

The factor structure may vary, also if the participants have little knowledge about the

construct that evaluates the instrument. (23) In this sense, a population of Colombian

adolescents who are high school students between 13 and 17 years old (mean, 16.0 ± 0.8);

mostly women, 60. 3% had a PCA estimate of the statistics x2 (x2 = 9.11; df = 5; p = 0.105),

RMSEA 0.024 (90 % CI, 0.000-0.048), CFI = 0.998, TLI = 0.996 and SMSR = 0.009 with

favorable results. The internal consistency of the dimension was calculated with Cronbach's

α and McDonald's ω coefficients with results of 0.819 and 0.820 respectively, confirming the

one-dimensional structure of the APGAR-family scale in high school students in Colombia

and the validity and reliability for the measurement of family function in this population

group. (24)

The results of the confirmatory analyses supported the original two-factor correlated model,

despite a poor fit indicated by the chi-square statistic. However, other adjustment indices,

such as RMSEA, SRMR, TFI, and TLI, suggested that the model is adequate. These results

are consistent with previous studies with dental patients where a dataset of 227 Colombian

dental patients between 22 and 94 years of age was analyzed, finding an internal consistency

and construct validity, using exploratory (AFE) and confirmatory (AFC) factor analyses with

acceptable values. The overall mean of the family APGAR was 17.07 ± 3.15 and the

prevalence of family dysfunction was 44.4 % (95 % CI: 38 – 51 %). The internal consistency

was 0.90. The EFA reported a single factor that explained 64.1 % of the total variance. The

TFA showed adjustment indices χ2 = 702.960; df =10, p-value=0.001 RCEMA = 0.155 (90

%CI: 0.107-0.209); AQI = 0.961, ITL= 0.922. (25)

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Studies in the general population (26, 27) and caregivers showed indicators of Cronbach's α >

0.87 and intraclass correlation coefficient > 0.69, which also underscore the validity of the

dimensions of perception of family functioning as related constructs. The high factor loads

of the items reinforce the stability of the model in these populations.

The results of this study are also consistent with the results of this study by Mayorga-Muñoz

et al., in a Chilean multiethnic sample in which a Cronbach's alpha of 0.992 was obtained for

the five-item scale. The confirmatory factor analysis determined a unifactorial model, whose

goodness-of-fit indices were satisfactory (WLS-ANOVA-χ2 = 20.097; p < 0.01), CFI =

0.997, TLI = 0.995 and RMSE = 0.079) with 90 % confidence intervals: 0.049-0.091). (5)

Despite favorable assessments regarding the content validity of the APGAR-family, authors

such as Gómez et al. have concluded that the interpretation of the instrument's scores is not

congruent with the content of the construct it assesses. (18) In addition, Valencia-Vargas, et

al., referred to it in similar terms when listing several negative aspects of the scale. According

to these authors, the range of the values of the items that make up the instrument is low, and

the qualification of the scoring strata cannot be made based on the content of the instrument,

recommending that it be done based on percentiles. (14) Gardner et al., on the other hand,

questioned the psychometric properties of the APGAR-family and found little correlation

between baseline and follow-up scores, as well as discrepancies between test scores and

medical assessments of families. (28)

Conclusions

This study has important practical implications for the prevention of family malfunction in

Ecuador. The validation of APGAR-family in this population allows its application in social

and clinical settings, where it could be used to identify families at risk and design preventive

interventions. In addition, the focus on protective factors highlights the importance of

promoting positive psychological resources as part of prevention efforts. This approach

complements traditional strategies focused solely on risk identification, offering a more

comprehensive perspective to address the complexity of family functioning where seniors

live.

Bibliographic references

1. Díaz-Amador Y, García-Pérez Y, García-Delgado Y, Rodríguez-González M,

González-Rodríguez Y. Evaluación de la funcionalidad y el grado de dependencia de

adultos mayores de una Fundación para la Inclusión Social. Rev Cubana Enferm

[Internet]. 2020 [citado 10 feb 2025];36(3):e3100. Available in:

Psychometric Properties of the Family Assessment Scale for Older Adults in Ecuador

Rev. Hosp. Psiq. Hab. Volumen 22 | Año 2025 |Publicación continua

Este material es publicado según los términos de la Licencia Creative Commons Atribución–NoComercial 4.0. Se permite

el uso, distribución y reproducción no comerciales y sin restricciones en cualquier medio, siempre que sea debidamente

citada la fuente primaria de publicación.

https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=97175

2. Echeverría A, Astorga C, Fernández C, Salgado M, Villalobos Dintrans P.

Funcionalidad y personas mayores: ¿dónde estamos y hacia dónde ir? Rev Panam

Salud Publica [Internet]. 2022 [citado 10 feb 2025];46:e34. Available in:

https://pmc.ncbi.nlm.nih.gov/articles/PMC9004688/

3. Zarebski G. La Organización Mundial de la Salud (OMS): del envejecimiento

saludable a la vejez como enfermedad. Desafíos para la gerontología. Rev IGERMED.

2021;1(2). Available in:

https://www.fundacionsidom.org/assets/documentos/investigaciones/0c4ef-graciela-

zarebski-oms..pdf

4. Vera I, Lucchese R, Munari DB, Nakatani AYK. Índex APGAR de Família na

avaliação de relações familiares do idoso: revisão integrativa. Rev Eletrônica Enferm

[Internet]. 2014 [citado 19 sep 2019];16(1):199-210. Available in:

https://www.researchgate.net/publication/272853539_Index_APGAR_de_Familia_

na_avaliacao_de_relacoes_familiares_do_idoso_revisao_integrativa

5. Mayorga-Muñoz C, Gallardo-Peralta L, Galvez-Nieto JL. Propiedades psicométricas

de la escala APGAR-familiar en personas mayores residentes en zonas rurales

multiétnicas chilenas. Rev Med Chil. 2019;147(10):1283-90. Available in:

https://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-

98872019001001283

6. Jiménez-Aguilera B, Baillet-Esquivel LE, Ávalos-Pérez F, Campos-Aragón L.

Dependencia funcional y percepción de apoyo familiar en el adulto mayor. Aten Fam.

2016;23(4):129-33. Available in:

https://www.sciencedirect.com/science/article/pii/S140588711630147X

7. Ochoa-Corral DM, Campos-Valdez G, Gómez-Zarco A, Lima-Quezada A. Scales

and instruments for measuring self-esteem in adolescents and young adults. J Basic

Appl Psychol Res. 2021;3(5):19-24. Available in:

https://repository.uaeh.edu.mx/revistas/index.php/jbapr/article/view/6805

8. Hamilton E, Carr A. Systematic review of self-report family assessment measures.

Fam Process. 2016;55(1):16-30. Available in:

https://onlinelibrary.wiley.com/doi/abs/10.1111/famp.12200

Psychometric Properties of the Family Assessment Scale for Older Adults in Ecuador

Rev. Hosp. Psiq. Hab. Volumen 22 | Año 2025 |Publicación continua

Este material es publicado según los términos de la Licencia Creative Commons Atribución–NoComercial 4.0. Se permite

el uso, distribución y reproducción no comerciales y sin restricciones en cualquier medio, siempre que sea debidamente

citada la fuente primaria de publicación.

9. Terraza AV, Azzolino JM, Neila MJ. Relación entre actividades recreativas

declaradas y capacidades cognitivas y funcionales en adultos mayores. Rev Cubana

Salud Pública. 2020;46(2):1-16. Available in: https://www.medigraphic.com/cgi-

bin/new/resumen.cgi?IDARTICULO=97522

10. Smilkstein G. The Family APGAR: a proposal for family function test and its use by

physicians. J Fam Pract. 1978;6(6):1231-9. Available in:

https://cdn.mdedge.com/files/s3fs-public/jfp-archived-issues/1978-volume_6-

7/JFP_1978-06_v6_i6_the-family-apgar-a-proposal-for-a-family.pdf

11. Jaimes-Grimaldos JA. Confiabilidad y validez del APGAR familiar como

instrumento de evaluación de la funcionalidad familiar en usuarios de atención

primaria en Bucaramanga [Internet]. 2023 [citado 10 feb 2025]. Available in:

https://repositorio.udes.edu.co/server/api/core/bitstreams/bae7e015-236c-42f4-

97de-47a4ae7cdd60/content

12. Andrade JJC, Silva ACO, Frazão IDS, Perrelli JGA, Silva TTM, Cavalcanti AMTS.

Family functionality and burden of family caregivers of users with mental disorders.

Rev Bras Enferm. 2021;74(5):e20201061. Available in:

https://www.scielo.br/j/reben/a/hK4cPr55fCT4Bf73yZ7bc9y/?lang=en

13. Campo-Arias A, Caballero-Domínguez CC. Análisis factorial confirmatorio del

cuestionario de APGAR familiar. Rev Colomb Psiquiatr. 2021;50(4):234-7.

Available in: http://www.scielo.org.co/scielo.php?pid=S0034-

74502021000400234&script=sci_arttext

14. Valencia-Vargas A, López-Palacio GJ, Cardona-Arango D, Segura-Cardona ÁM,

Segura-Cardona A, Muñoz-Rodríguez DI, et al. Análisis Rasch de la escala APGAR-

familiar en adultos mayores de Colombia. Hacia Promoc Salud [Internet].

2021;26(2):102-14. Available in: http://www.scielo.org.co/scielo.php?pid=S0121-

75772021000200102&script=sci_arttext

15. Iparraguirre-Yaurivilca NE, Rosario-Quiroz FJ, Oblea-Durand MO. Análisis

factorial confirmatorio e invarianza factorial de la escala APGAR-familiar en adultos

mayores limeños. Rev Invest Psicol [Internet]. 2022 [citado 10 feb 2025];25(2):73-

87. Available in: http://www.scielo.org.pe/scielo.php?pid=S1609-

74752022000200073&script=sci_arttext&tlng=pt

16. Organización Mundial de la Salud. Década del envejecimiento saludable (2021-2030)

[Internet]. 2021 [citado 10 feb 2025]. Available in:

Psychometric Properties of the Family Assessment Scale for Older Adults in Ecuador

Rev. Hosp. Psiq. Hab. Volumen 22 | Año 2025 |Publicación continua

Este material es publicado según los términos de la Licencia Creative Commons Atribución–NoComercial 4.0. Se permite

el uso, distribución y reproducción no comerciales y sin restricciones en cualquier medio, siempre que sea debidamente

citada la fuente primaria de publicación.

https://www.who.int/es/initiatives/decade-of-healthy-ageing

17. Bellón J, Delgado A, Luna del Castillo J, Lardelli P. Validez y fiabilidad del

cuestionario de función familiar APGAR familiar. Aten Primaria [Internet].

1996;18(6):273-342. Available in: https://www.elsevier.es/es-revista-atencion-

primaria-27-articulo-validez-fiabilidad-cuestionario-funcion-familiar-apgar-

familiar-14357.

18. Martins AP, Vega-Hernández MC, Soares FR, Afonso RM. Perceived Vulnerability

to Disease Scale: Factorial structure, reliability, and validity in times of Portugal's

COVID-19 pandemic lockdown. arXiv preprint arXiv:2402.03108 [Internet]. 2024

[citado 10 feb 2025]. Available in: https://doi.org/10.48550/arXiv.2402.03108

19. Castilla H, Caycho T, Shimabukuro M, Valdivia A. Percepción del funcionamiento

familiar: análisis psicométrico de la escala APGAR-familiar en adolescentes de Lima.

Propósitos Represent. 2014;2(1):49-78. Available in:

https://revistas.usil.edu.pe/index.php/pyr/article/view/53

20. da Silva MJ, Fonseca Victor J, do Nascimento Mota FR, Silva Soares E, Belém Leite

BM, Teixeira Oliveira E. Analysis of psychometric properties of family APGAR with

elderly in northeast Brazil. Es Anna Nery. 2014;18(3). Available in:

https://www.scielo.br/j/ean/a/NBVTbDTftKzLjhyGLGHSNzm/?lang=en

21. Prazeres F, Santiago L. Relationship between health-related quality of life, perceived

family support and unmet health needs in adult patients with multimorbidity attending

primary care in Portugal: a multicentre cross-sectional study. Health Qual Life

Outcomes. 2016;14(1):156. Available in:

https://link.springer.com/article/10.1186/s12955-016-0559-7

22. Torales J, Barrios I, González-Ayala S, Barrios J, Caycho-Rodríguez T, Ortigoza-

Alvez E, et al. Validación de un instrumento de medición de indicadores de gestión

en salud pública. Rev Nac (Itauguá) [Internet]. 2024;16(3):014-029. Available in:

https://revistadelnacional.com.py/index.php/inicio/article/view/193

23. Castilla HA, Caycho TP, Shimabukuro M, Valdivia AA. Percepción del

funcionamiento familiar: análisis psicométrico de la escala APGAR-familiar en

adolescentes de Lima. Propós Represent. 2014;2(1):49-78. Available in:

https://doi.org/10.20511/pyr2014.v2n1.53

24. Cassiani-Miranda CA, Gómez-Alhach J, Cubides-Munévar AM, Hernández-Carrillo

Psychometric Properties of the Family Assessment Scale for Older Adults in Ecuador

Rev. Hosp. Psiq. Hab. Volumen 22 | Año 2025 |Publicación continua

Este material es publicado según los términos de la Licencia Creative Commons Atribución–NoComercial 4.0. Se permite

el uso, distribución y reproducción no comerciales y sin restricciones en cualquier medio, siempre que sea debidamente

citada la fuente primaria de publicación.

M. Prevalencia de bullying y factores relacionados en estudiantes de bachillerato de

una institución educativa de Cali, Colombia, 2011. Rev Salud Publica.

2014;16(1):13-24. Available in: https://www.scielosp.org/pdf/rsap/2014.v16n1/13-

24/es

25. Díaz S, Tirado L, Simancas M. Validez de constructo y confiabilidad de la APGAR

familiar en pacientes odontológicos adultos de Cartagena, Colombia. Rev Univ Ind

Santander Salud [Internet]. 2017 [citado 21 ene 2020];49(4):541-8. Available in:

https://www.redalyc.org/journal/3438/343854585005/

26. Guo N, Ho HCY, Wang MP, Lai AY, Luk TT, Viswanath K, Chan SS, Lam TH.

Factor structure and psychometric properties of the Family Communication Scale in

the Chinese population. Front Psychol [Internet]. 2021;12:736514. Available in:

https://doi.org/10.3389/fpsyg.2021.736514.

27. Good MD, Smilkstein G, Good BJ, Shaffer T, Arons T. The Family APGAR Index:

a study of construct validity. J Fam Pract. 1979;8(3):577-82. Available in:

https://cdn.mdedge.com/files/s3fs-public/jfp-archived-issues/1979-volume_8-

9/JFP_1979-03_v8_i3_the-family-apgar-index-a-study-of-constr.pdf.

28. Gardner W, Nutting PA, Kelleher KJ, Werner JJ, Farley T, Stewart L, et al. Does the

Family APGAR effectively measure family functioning? J Fam Pract.

2001;50(1):19-25. Available in:

https://ohiostate.elsevierpure.com/en/publications/does-the-family-apgar-

effectively-measure-family-functioning

Conflict of interest disclosure

The authors declare no conflict of interest.

Author contributions

José Alejandro Valdevila Figueira: Conceptualization of the study, methodological design,

supervision of the research process, acquisition of funding, critical revision of the

manuscript, and correspondence with the journal during the submission and revision

process.

Andrés Ramírez Coronel: Statistical analysis, interpretation of results, and drafting of the

methods and results sections.

Vanessa Quito-Calle: Literature review, data collection, and initial drafting of the

manuscript.

Pedro Andrés Muñoz-Arteaga: Data processing, preparation of tables and figures, and

Psychometric Properties of the Family Assessment Scale for Older Adults in Ecuador

Rev. Hosp. Psiq. Hab. Volumen 22 | Año 2025 |Publicación continua

Este material es publicado según los términos de la Licencia Creative Commons Atribución–NoComercial 4.0. Se permite

el uso, distribución y reproducción no comerciales y sin restricciones en cualquier medio, siempre que sea debidamente

citada la fuente primaria de publicación.

verification of references.

María Lorena Cañizares-Jarrin: Validation of the questionnaire design, final editing of the

manuscript, and coordination among authors.

Indira Dayana Carvajal Parra: Critical content review, drafting of the discussion section,

and ensuring compliance with the journal's editorial guidelines.

Funding Declaration

This study received no specific grant from any funding agency in the public, commercial, or

not-for-profit sectors.

Data Availability Statement

The datasets generated and analyzed during the current study are available from the

corresponding author upon reasonable request.