Validation of a Malay Language Questionnaire Assessing Direct and Indirect Cost Among Caregivers of Individuals with Type 2 Diabetes Mellitus at Public Primary Healthcare

Diabetes is a major global contributor to mortality and disability, with type 2 diabetes mellitus (T2DM) being the most common metabolic disorder. Its increasing prevalence notably decreases life expectancy and creates a significant economic burden for patients and their caregivers. This study validated a culturally relevant Malay-language questionnaire to comprehensively assess direct and indirect costs incurred by caregivers of individuals with T2DM in Malaysian public primary healthcare settings. Employing a cross-sectional design, the validation process involved content validation by an expert panel and face validation with caregivers. The final questionnaire comprised 36 items across four domains: caregiving duration, direct healthcare costs, direct non-healthcare costs and indirect costs. Content validity was measured via the content validity index, achieved a score of 0.89, while the face validity index exceeded 0.8, affirming clarity and relevance. Sociodemographic data revealed that caregivers were predominantly middle-aged, employed, married, with prolonged caregiving responsibilities and limited financial resources. Results highlighted significant direct costs, such as medical expenses and transportation, and indirect costs like productivity losses due to caregiving duties. These findings underscore the multidimensional caregiving burden, amplifying by diabetes-related complications and self-medication practices. This validated questionnaire serves as a robust tool for evaluating economic impacts on caregivers and addressing gaps in health economics research specific to Malaysia’s cultural and healthcare landscape.