Pediatrics

Impact on Family Scale 24 (IOF-24): A Full Guide for Researchers and Clinicians

Introduction

The Impact on Family Scale 24 (IOF-24) is a significant instrument which assesses the multifaceted impact of a child’s chronic illness or disability on family life. Developed by Ruth E. K. Stein and Dorothy Jessop and first published in the journal Medical Care in 1980, the IOF-24 has become a key tool for researchers and clinicians. Moreover, with over 700 citations for its key references, its utility in understanding the broader implications of pediatric chronic conditions is well-established.

This article provides a detailed overview of the IOF-24, focusing on its features, applications, and relevance for scientific research and clinical practice.

Key Features of the Impact on Family Scale 24 (IOF-24)

Purpose and Use

The primary purpose of the IOF-24 is to measure the impact of a child’s chronic illness or disability on various dimensions of family life. The questionnaire assesses emotional, social, and financial impacts, making it an essential tool in both clinical assessments to guide family support and in longitudinal research to evaluate the outcomes of interventions aimed at alleviating family burden.

Target Population

The IOF-24’s target population consists of parents or primary caregivers of children and adolescents (0–18 years) who have chronic illnesses or disabilities.

Structure

The scale consists of 24 questions. It should be noted that the original version of the Impact on Family Scale had 27 items; however, it was later refined to this 24-item version (IOF-24), which is now the standard version used. The main domain is Family Impact. This is further broken down into four critical sub-domains:

Financial Impact (4 items): Items related to economic strain.
Social/Familial Impact (9 items): Items assessing changes in social activities and family interactions.
Personal Strain (6 items): Items measuring emotional and psychological stress on the caregiver.
Mastery (5 items): Items evaluating coping mechanisms and perceptions of control.

Completing the IOF-24 typically takes about 10-15 minutes, making it feasible for use in research protocols and clinical settings.

Scoring Method

The IOF-24 utilizes a straightforward scoring method, allowing researchers to quantify the perceived impact on the family.

Each of the 24 items is rated on a 4-point Likert scale:

1 = Strongly Disagree
2 = Disagree
3 = Agree
4 = Strongly Agree

The total score is derived by summing the scores for each item with the total score ranging from 24 to 96. Higher scores on the IOF-24 indicate a greater perceived impact of the child’s chronic illness or disability on the family.

There are no specific cut-off scores for severity categories in the provided documentation, so interpretation relies on the continuous scale and comparison within study groups or against established norms from literature.

Administration Format

Administering the IOF-24 is straightforward, making it a practical choice for busy settings. The formats available of the IOF-24 are:

Paper-based forms
Digitally (online)
In-person interviews
Phone/video call.

There’s no need for special training if the reading level of the respondent is adequate, as it can be self-administered. However, minimal training might be beneficial for administrators in research settings to ensure consistency.

Applications of the Impact on Family Scale 24 (IOF-24)

The IOF-24’s comprehensive assessment of family impact makes it a valuable tool across various pediatric healthcare and research contexts. Indeed, its focus on multiple domains provides a holistic view of the family experience.

Screening: Clinicians can use the IOF-24 to screen families for significant stress or disruption due to a child’s chronic condition, identifying those who may need additional support.
Monitoring: the scale is effective for monitoring changes in family impact over time, or in response to interventions aimed at supporting the child or family.
Treatment Planning: Information from the IOF-24 can help in developing tailored support plans for families and addressing specific areas of concern such as financial burden or social isolation.
Research: The IOF-24 is useful in understanding the burdens faced by families, evaluating the effectiveness of support programs, and exploring factors that mediate or moderate the impact of childhood chronic illness.

Language and availability

To facilitate its use across diverse populations and in international research, the IOF-24 has been translated into several languages including:

English
Spanish
French
German
Portuguese
Italian
Turkish and others

The IOF-24 is under restricted access. To access the scale or seek permission for its use, interested parties should contact Dr. Ruth E. K. Stein at the Department of Pediatrics, Albert Einstein College of Medicine/Children’s Hospital at Montefiore Medical Center via email: ruth.stein@einstein.yu.edu or ruth.stein@einsteinmed.edu.

Reliability and Validity

The IOF-24 scale is highly reliable and valid. Cronbach’s alpha for its subscales typically ranges from 0.87 to 0.93, indicating good to excellent internal consistency.

A key publication revisiting its psychometric data is: Stein, Ruth EK, and Dorothy Jones Jessop. “The impact on family scale revisited: further psychometric data.” Journal of Developmental & Behavioral Pediatrics. Study link

Limitations and Considerations

Despite its strengths, the IOF-24 has a few limitations to consider:

Self-report measure: Responses are based on the caregiver’s perception and thus may be subject to individual biases or interpretations.
Language Barriers: While translated into several languages, proper validation in each specific cultural context is crucial to ensure accuracy, and barriers may still exist for languages not covered.
Narrow Focus: Although comprehensive in its primary area, some researchers might find its focus on specific domains limiting if they wish to explore other nuanced aspects of family functioning or psychological well-being not explicitly covered by the four subscales.

Additional Resources

The Original Development Study. link
The validation study. Link
To obtain the original 24-item Impact on Family Scale (IOF-24) for research or program evaluation purposes, please contact Dr. Ruth E. K. Stein, one of the authors of the questionnaire: Emails: stein@einstein.yu.edu or ruth.stein@einsteinmed.edu.

Frequently Asked Questions (FAQ)

Who completes the IOF-24
Parents or primary caregivers of children (0–18 years) with chronic illnesses or disabilities are the target respondents for the IOF-24.

How long does it take to complete the IOF-24?
It typically takes approximately 10-15 minutes for a caregiver to complete the questionnaire.

How is the IOF-24 administered?
The IOF-24 can be administered using paper-based forms, digital online versions, in-person interviews, or via phone/video calls, offering flexibility for researchers and clinicians.

A word from ResRef about the Impact on Family Scale 24 (IOF-24)

The IOF-24 stands out as a reliable, validated, and internationally adaptable measure for researchers and practitioners interested in evaluating the broader implications of childhood chronic illness on families. Its availability in multiple languages and its established psychometric properties underscore its value in both academic and programmatic contexts.

References

Stein, R. E. K., & Jessop, D. J. (1980). The development of an impact-on-family scale: preliminary findings. Medical Care, 18(4), 465–472. Study link
Stein, R. E. K., & Jessop, D. J. (2003). The impact on family scale revisited: further psychometric data. Journal of Developmental & Behavioral Pediatrics, 24(1), 9–16. Study link