Abstract
Background
Perceived social support has been shown to play a crucial role in the well-being of dementia patients, potentially reducing the burden of symptoms and enhancing quality of life. However, there is limited research on perceived social support in dementia populations, particularly in low- and middle-income countries. This study aims to validate the Indonesian version of the Personal Resource Questionnaire (PRQ2000-INA) for measuring perceived social support in people with mild to moderate dementia.
Methods
A cross-sectional study was conducted involving 105 participants diagnosed with mild to moderate dementia at the Memory Clinic of Dr. Sardjito General Hospital in Yogyakarta, Indonesia. The PRQ2000-INA, a 15-item self-administered questionnaire, was translated and culturally adapted following international guidelines. Confirmatory Factor Analysis (CFA) using Structural Equation Modeling (SEM) was conducted to assess the construct validity and reliability.
Results
The age range of the participants was 62 years, with a total of 64 males and 41 females. The PRQ2000-INA demonstrated strong construct validity, with high factor loadings (> 0.7) and and satisfactory fit indices (RMSEA = 0.045, CFI = 0.988, SRMR = 0.029). The reliability was excellent, with composite reliability 0.97 (> 0.7). No significant differences in perceived social support were observed across demographic variables such as age, gender, and educational level.
Conclusion
The PRQ2000-INA is a reliable and valid tool for measuring perceived social support in people with mild to moderate dementia in Indonesia. Further research is recommended to explore the concurrent validity of the PRQ2000-INA and its use in predicting social support in dementia populations.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12877-025-06473-9.
Keywords: Dementia, Perceived social support, Personal resource questionnaire-2000, Validity test, Reliability test, PRQ-2000 indonesia version
Introduction
Approximately 50 million people worldwide suffer from dementia, with almost 60% living in low and middle-income countries (LMIC) [1]. As dementia progresses, individuals experience growing difficulties in performing daily activities, sustaining interpersonal relationships, and engaging with their social environments. These challenges place a significant burden on healthcare systems and social support networks. Consequently, the availability and quality of social support become critical in alleviating the adverse effects of cognitive and functional decline [2, 3]. Despite this demographic shift, much of the literature on dementia remains centered on Western populations, with limited focus on the social dimensions of dementia in LMICs, particularly in Southeast Asia.
In Western countries, research on dementia has been dominated by mainly biomedical aspects, focusing mostly on pathogenesis, diagnosis, and pharmacologic treatments. Meanwhile, psychosocial factors such as social support and quality of life have received considerably less attention [3]. In contrast, studies from Asian countries including China, South Korea, Singapore, and Thailand have begun to explore social aspects including the cultural and familial contexts that shape dementia care [4–7]. In these settings, caregiving is often provided by family members in multigenerational households, guided by strong cultural norms of filial piety. However, despite the presence of close family ties, social support among people with dementia may still be low due to stigma, poor dementia literacy, and limited formal service integration [8].
Social support refers to the emotional, instrumental, and informational assistance provided by family members, friends, caregivers, and healthcare professionals [9, 10]. There are two dimensions of social support: perceived social support and received social support. Received social support refers to the actual receipt of support from others, which includes practical and emotional support provided by family, friends, colleagues, and other networks. This support can be tangible, such as financial assistance or help with daily tasks, or intangible, like providing advice, guidance, or emotional reassurance [10].
Perceived social support, on the other hand, focuses on an individual’s subjective evaluation of the support they believe is available to them if needed. It is related with the perception that one is cared for, loved, esteemed, and part of a supportive social network [11]. Perceived social support does not necessarily align with the actual support received. People might feel well-supported even if they are not actively receiving help, or they might feel isolated despite having a wide support network [10–12].
Studies suggest that perceived social support has a stronger impact on mental health and psychological well-being than actual received support [10, 13]. To date, only one published study has specifically examined perceived social support in dementia, conducted in China. It explored differences in support perception between patients and caregivers during disease progression, using the Interpersonal Support Evaluation List (ISEL), a tool aligned with four domains of health needs and commonly used to identify unmet needs in chronic illness populations [14]. The ISEL focuses more narrowly on the availability of support in hypothetical situations (e.g., problem-solving, tangible aid) [15], which may be less appropriate for people with dementia who rely on routine and familiar interactions rather than hypothetical constructs.
Other study using the Multidimensional Scale of Perceived Social Support (MSPSS) for assessing the perceived social support in family caregivers of people with dementia [16]. Although it also has robust psychometric properties, this scale has never been validated in dementia population. While the MSPSS emphasizes the sources of support, such as family, friends, or significant others, it may not adequately capture the functional dimensions of support that are critical for influencing outcomes in dementia. In particular, it does not assess specific types of support such as reassurance, guidance, or nurturance, which are highly relevant to the needs of individuals with cognitive impairment [16].
In Western settings, the Personal Resource Questionnaire 2000 (PRQ2000) has been widely used to assess perceived social support in individuals with chronic illnesses [17]. The PRQ2000 was developed based on a theoretical model of social support encompassing five core domains—worth, social integration, intimacy, nurturance, and assistance. This broad conceptual coverage allows it to assess multiple aspects of perceived social support, including emotional and instrumental support, without being limited to source-specific subscales as seen in the MSPSS [16]. Unlike the ISEL, which includes negatively worded items that may be confusing for some respondents with cognitive impairment [15], the PRQ2000 consists of positively worded items presented in a straightforward Likert-scale format. This design enhances its cognitive accessibility, particularly for older adults and individuals with mild to moderate cognitive impairment [17].
People with dementia experience cognitive decline that impacts their perception of social support. Their ability to process and respond to questions may differ from other populations, particularly as dementia severity increases, which is associated with increased difficulty in understanding and completing questionnaires [14]. Given this unique challenges, it is essential to validate tools that accurately capture perceived social support in this population. Therefore, the present study aims to validate the PRQ2000 for use in people with mild and moderate dementia in Indonesia, ensuring that the scale adequately captures the perception of social support in this specific population. To our knowledge, this is the first study to use the PRQ2000 in dementia population.
Methods
Study design and participants
A cross-cultural design was used to test the validity and reliability of the PRQ2000-INA. This study was conducted in the Memory Clinic of Dr. Sardjito General Hospital Yogyakarta, Indonesia between January 2020 and April 2021. The Memory Clinic at Dr. Sardjito General Hospital in Yogyakarta was selected for this research due to its role as a major referral center for dementia cases from hospitals across Indonesia. As one of the leading institutions for dementia research and clinical management in the country, the clinic receives a diverse patient population. Therefore, individuals with dementia attending this clinic are considered representative of the hospital-based dementia population in Indonesia.
The inclusion criteria were as follows: [1] had mild or moderate dementia and [2] could communicate in Bahasa Indonesia. The exclusion criteria were: [1] aphasia, and [2] severe dementia. If the patients met the inclusion criteria and did not have any exclusion criteria, the neurologist specializing in dementia at the clinic would notify the research team. The research team would then explain the purpose and methods of the study to the patients and obtain their informed consent.
The diagnosis of dementia was based on the Diagnostic and Statistical Manual of Mental Disorders V [18], which categorizes dementia according to the etiological cause, i.e., Alzheimer’s disease, cerebrovascular disease, mixed-type, or other causes such as traumatic brain injury, space-occupying process (SOP), or epilepsy. Dementia was diagnosed by neurologists specializing in dementia following a series of neurocognitive assessments. These assessments included the Montreal Cognitive Assessment (MoCA), with a cut-off score of < 26 indicating cognitive impairment [19], the Activity of Daily Living (ADL) and Instrumental Activity of Daily Living (IADL) scales to detect functional dependency severe enough to interfere with daily activities (cut-off point ≥ 2/14 for ADL and/or ≥ 4/18 for IADL) [20, 21], and the Clinical Dementia Rating (CDR) scale to measure the severity of dementia (CDR score 0.5 for mild cognitive impairment, 1 for mild dementia, 2 for moderate dementia, and 3 for severe dementia) [22].
The study samples were obtained through a nonprobability sampling technique, specifically convenience sampling. A sample size of 100–200 participants is generally considered acceptable, as this is the required threshold for conducting factor analysis to ensure reasonable statistical power [23]. Our sample size of 105 respondents meets the lower bound of this recommendation.
Data Collection and Measurements
Questionnaire administration
The PRQ2000-INA is a self-administered instrument consists of 15 questions. using a 7-point Likert scale, designed to assess perceived social support. In the previous study involving population with chronic illness, PRQ2000 was found to have 3 distinct factors: (1) Factor 1 consisted of 3 items related to intimacy (questions no. 1,4,11), 1 item related to value (question no. 13), and 1 item related to social integration (question no. 15); (2) Factor 2 consisted of 1 parenting item (question no. 2), 1 social integration item (question no. 3), and 3 value items (questions no. 6, 9, and 12); and (3) Factor 3 included 3 items related to social integration (questions no. 5, 7, and 8) and 2 items related to assistance (questions no. 10 and 14) [24].
Participants were instructed to complete the questionnaire by reading each statement and selecting the response that best applied to them by circling the corresponding option of the Likert scale. The 15 questions in the PRQ2000 include [17]: (1) There is someone I feel close to who makes me feel secure; (2) I belong to a group in which I feel important; (3) People let me know that I do well at my work (job, homemaking); (4) I have enough contact with the person who makes me feel special; (5) I spend time with others who have the same interests that I do; (6) Others let me know that they enjoy working with me (job, committees, projects); (7) There are people who are available if I need help over an extended period of time; (8) Among my group of friends, we do favors for each other; (9) I have the opportunity to encourage others to develop their interests and skills; (10) I have relatives or friends that will help me even if I cannot pay them back; 11) When I am upset, there is someone I can be with who lets me be myself; 12) I know that others appreciate me as a person; 13) There is someone who loves and cares about me; 14) I have people to share social events and fun activities with; 15) I have a sense of being needed by another person. The PRQ2000 typically takes approximately 15 min to complete [17].
Responses to those 15 questions above were assessed on a 7-point Likert scale, with 1 indicating ‘strongly disagree’ and 7 indicating ‘strongly agree’. A higher score corresponds to the subject’s perception of a high amount of social support [17].
Translation process
The translation process to Bahasa Indonesia was customized to adhere to international standards [25, 26]. The subsequent stages are advised to be incorporated into the study [27]:
Forward translation
Two translators from the Language Institute of Universitas Gadjah Mada were responsible for translating the original PRQ2000 questionnaire into Bahasa Indonesia. The first translator is a healthcare specialist living in an English-speaking country, with survey-writing expertise and a deep understanding of both the culture and language of the source instrument (English) as well as the target language (Indonesian/Bahasa Indonesia). The second translator, while not having a healthcare background, has lived in English-speaking countries and also has a strong proficiency in both English and Bahasa Indonesia.
Expert panel
The expert panel consisted of two clinicians, both neurologists with a subspecialty in dementia. The contribution of the expert panel is to assess whether the items in the translated version of the scale (Indonesia version) are relevant, understandable, and culturally appropriate for the target population (in this study, people with dementia).
Backwards translation
This procedure included retranslating the PRQ2000 questionnaire from Bahasa Indonesia back into its original language (English). The backwards translation was performed by two translators: one from the region where the instrument was being applied and another independent, sworn translator.
Expert committee
Expert committee discussed and reviewed both translations and compared the backward translations with the original version. The expert committee who consisted of two translators, two pharmacists, and one neurologist produced the final translated version of the instrument, which was semantically, idiomatically, and conceptually considered correct. Any discrepancies in meaning or wording between the forward and backward translations were identified. Consensus was reached with adjustments made to resolve any misunderstandings or ambiguities.
Pretesting (pilot study)
The translated questionnaire was pilot tested with 20 participants. Following this, we conducted interviews with participants to explore how they interpret the questions, ensuring the translated items were understood as intended. We also considered variations in cultural beliefs and tribal interpretations for each item prior to the final validation process.
Review and revision of the translated questionnaire
The feedback and evaluation from the pilot study was then included in the revision of the questionnaire. The expert committee adjusted the language or rephrase items that were misunderstood or not culturally appropriate. Any issues related to question interpretation or participants’ ability to understand the questions were resolved.
The final version of validity and reliability
The final version of the PRQ2000-INA questionnaire was subsequently evaluated for both validity and reliability. Construct validity was assessed in this study, while internal consistency was confirmed through Cronbach’s alpha to ensure the reliability of the scale.
Validity and reliability test
Exploratory factor analysis (EFA)
Exploratory Factor Analysis (EFA) was conducted prior to Confirmatory Factor Analysis (CFA) as part of the validation process. We applied the Kaiser-Meyer-Olkin (KMO) test and Bartlett’s Test of Sphericity to assess sampling adequacy and the appropriateness of factor analysis. The KMO value exceeded the acceptable threshold (>0.6), and Bartlett’s test was significant (p < 0.001), indicating that the data were suitable for factor extraction. Further, the communalities of all items were greater than 0.5, suggesting sufficient shared variance among the items. In the component matrix, all 15 items loaded strongly on a single component, with eigenvalue >1 and no meaningful cross-loading on other dimensions (Supplementary Information).
Orthogonality Test
An orthogonality test between items (Q1–Q15) was necessary to determine whether the adopted items can be applied by researchers and whether they can be broken down into separate components. To assess this, Pearson’s or Spearman’s normality test was conducted. Items were considered orthogonal or independent if the correlation between items is weak (< 0.3) and not statistically significant. If orthogonality is found (i.e., items are uncorrelated), it can guide further steps in the analysis, such as performing factor analysis to break down items into subcomponents or to identify distinct latent constructs [23].
Reliability and Construct Validity Test
The reliability and construct validity were assessed using Confirmatory Factor Analysis (CFA) within the framework of Structural Equation Modeling (SEM). Structural Equation Modeling (SEM) using SPSS-AMOS is a parametric multivariate statistical tool, which assumes normality. In SPSS-AMOS, this assumption is met when the Critical Ratio (CR) is less than 2.58. The latest version of SPSS-AMOS also includes a bootstrap test, such as the Bollen-Stine test, which requires a p-value greater than 0.05 to meet the assumption of normality [28].
If the results of the multivariate Critical Ratio (CR) indicate non-normal distribution (>2.58), a bootstrapping test is conducted. Following this, CFA is performed using SEM with IBM SEM AMOS Version 23.
First, we tested the Goodness-of-Fit (GoF) indices, which include:
Absolute Fit Index: Assesses whether the observed covariance matrix fits the model covariance matrix.
Incremental Fit Index: Tests whether the specified model improves fit compared to the null model.
Parsimony Fit Index: Evaluates whether the model is simple or complex.
Once the GoF indices met the required thresholds, item validity was assessed using the estimates, with standardized factor loadings required to be >0.7 and a p-value < 0.05 to indicate good validity. Additionally, the Average Variance Extracted (AVE) needed to be greater than 0.5, and the Composite Reliability (CR) had to exceed 0.7 to be considered reliable [28].
The PRQ2000 has previously been translated into six languages: Japanese, Chinese, Dutch, Spanish, Korean, and Thai. It has been applied in various populations, including women in rural settings, the elderly, and individuals with specific health conditions such as diabetes, inflammatory bowel disease, and cancer [24]. Reliability and validity testing of the PRQ2000 has consistently demonstrated strong internal consistency, with alpha coefficients ranging from 0.87 to 0.93, and has shown good validity in measuring perceived social support in populations with chronic illness [17].
Ethical consideration
All participants were thoroughly informed about the purpose and methods of this study and signed a written informed consent form prior to the study. During the process of obtaining written informed consent, the caregivers were involved to ensure they fully understood the study and could assist in explaining it to the patients if needed. Ethical approval for this study was obtained from The Medical and Health Research Ethics Committee of the Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada Yogyakarta, Indonesia, with the approval number KE/FK/0105/EC/2020.
Results
Baseline characteristics of patients
We recruited 105 patients with mild to dementia—64 males and 41 females. The percentage of participants aged > 65 was 57.1%, while those aged < 65 was 42.9%. The majority of participants (40.0%) had vascular dementia, followed by Alzheimer’s disease (29.5%). Table 1 shows the baseline characteristics of the patients included in this study.
Table 1.
Demographic characteristics of the participants
| Characteristics | n | % |
|---|---|---|
| Sex | ||
| Male | 64 | 61 |
| Female | 41 | 39 |
| Age (mean ± SD) | 64.79 ± 11.23 | |
| ≥ 65 years old | 60 | 57.1 |
| < 65 years old | 45 | 42.9 |
| Level of Education | ||
| Did not attend school | 4 | 3.8 |
| Elementary school | 17 | 16.0 |
| Middle School | 24 | 22.6 |
| High School | 25 | 23.6 |
| University | 35 | 33.0 |
| Dementia type | ||
| Alzheimer's Dementia | 31 | 29.5 |
| Vascular Dementia | 42 | 40.0 |
| Mixed Type Dementia | 17 | 16.2 |
| Other Dementia: | 14.3 | |
| SOP-related dementia | 11 | 10.5 |
| Post TBI-related dementia | 2 | 1.9 |
| HIV-related dementia | 1 | 0.95 |
| Epilepsy-related dementia | 1 | 0.95 |
| PRQ2000 (mean ± SD) | 81.69 ± 12.64 | |
SOP Space-occupying process, TBI Traumatic brain injury, HIV Human immunodeficiency virus
Validity and reliability test
The orthogonality test using Spearman correlation showed that all items (15 questions) in the questionnaire were correlated with each other (Table 2). Therefore, there was no need to break the items into separate factors or components. This indicates that all 15 items should remain integrated and should not be separated.
Table 2.
Spearman’s correlation test of item-to-item in the PRQ2000-INA
| Q1 | Q2 | Q3 | Q4 | Q5 | Q6 | Q7 | Q8 | Q9 | Q10 | Q11 | Q12 | Q13 | Q14 | Q15 | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Q1 | 1 | ||||||||||||||
| Q2 | 0.674** | 1 | |||||||||||||
| Q3 | 0.693** | 0.661** | 1 | ||||||||||||
| Q4 | 0.650** | 0.675** | 0.714** | 1 | |||||||||||
| Q5 | 0.704** | 0.699** | 0.771** | 0.671** | 1 | ||||||||||
| Q6 | 0.756** | 0.756** | 0.691** | 0.688** | 0.749** | 1 | |||||||||
| Q7 | 0.653** | 0.639** | 0.607** | 0.670** | 0.712** | 0.696** | 1 | ||||||||
| Q8 | 0.713** | 0.637** | 0.723** | 0.675** | 0.758** | 0.726** | 0.691** | 1 | |||||||
| Q9 | 0.553** | 0.621** | 0.669** | 0.749** | 0.661** | 0.652** | 0.581** | 0.593** | 1 | ||||||
| Q10 | 0.651** | 0.648** | 0.808** | 0.733** | 0.707** | 0.658** | 0.647** | 0.719** | 0.613** | 1 | |||||
| Q11 | 0.558** | 0.599** | 0.675** | 0.654** | 0.636** | 0.595** | 0.551** | 0.645** | 0.718** | 0.649** | 1 | ||||
| Q12 | 0.594** | 0.632** | 0.771** | 0.718** | 0.684** | 0.596** | 0.586** | 0.728** | 0.742** | 0.693** | 0.691** | 1 | |||
| Q13 | 0.684** | 0.638** | 0.764** | 0.714** | 0.745** | 0.596** | 0.674** | 0.759** | 0.659** | 0.759** | 0.642** | 0.711** | 1 | ||
| Q14 | 0.628** | 0.583** | 0.765** | 0.731** | 0.694** | 0.658** | 0.670** | 0.731** | 0.665** | 0.702** | 0.663** | 0.722** | 0.755** | 1 | |
| Q15 | 0.678** | 0.648** | 0.744** | 0.714** | 0.707** | 0.699** | 0.662** | 0.666** | 0.695** | 0.715** | 0.628** | 0.730** | 0.730** | 0.692** | 1 |
**p < 0.01
The Goodness of Fit (GoF) showed the model structure with a single latent factor representing all 15 items suggested that these items were measuring a cohesive underlying construct. This validated that the questionnaire was unidimensional, which means it was designed to measure a single concept or construct, supporting its construct validity. Root-mean-square error of approximation (RMSEA) and Standard Root Mean Square Residual (SRMR) values were well within acceptable limits, providing further evidence of a good fit. This supports the model’s construct validity, showing that the hypothesized factor structure aligned well with the observed data (Fig. 1; Table 3).
Fig. 1.
Simplified representations of estimated CFA with a single-factor model
Table 3.
Goodness of fit model for confirmatory factor analysis
| Criteria | Subcriteria | Cut point | Result | Decision |
|---|---|---|---|---|
| Absolute FI | Prob. Cmin | > 0.05 | 0.089 | Fit |
| CMIN/DF | < 2 | 1.210 | Fit | |
| RMSEA | < 0.08 | 0.045 | Fit | |
| Pclose | > 0.05 | 0.871 | Fit | |
| SRMR | < 0.05 | 0.029 | Fit | |
| Incremental FI | TLI | > 0.90 | 0.966 | Fit |
| NFI | > 0.90 | 0.936 | Fit | |
| Parsimony FI | PCFI | > 0.90 | 0.819 | Optional |
| PNFI | > 0.90 | 0.776 | Optional |
The PRQ2000-INA demonstrates strong construct validity and reliability in measuring the perceived social support as indicated by high factor loadings (> 0.7), excellent composite reliability (> 0.7), and sufficient AVE values (> 0.5) which shown in Table 4.
Table 4.
Results of validity and reliability testing of the PRQ2000-INA
| Items | Estimates (> 0.7) |
Decision | SE | CR | P | AVE (> 0.5) |
CR (> 0.7) |
||
|---|---|---|---|---|---|---|---|---|---|
| Q1 | <--- | F | 0.812 | Valid | 0.101 | 10.000 | < 0.001 | 0.70 | 0.97 |
| Q2 | <--- | F | 0.787 | Valid | 0.101 | 9.432 | < 0.001 | Good | Good |
| Q3 | <--- | F | 0.883 | Valid | 0.100 | 11.204 | < 0.001 | ||
| Q4 | <--- | F | 0.839 | Valid | 0.102 | 10.355 | < 0.001 | ||
| Q5 | <--- | F | 0.876 | Valid | 0.104 | 11.072 | < 0.001 | ||
| Q6 | <--- | F | 0.844 | Valid | 0.082 | 12.375 | < 0.001 | ||
| Q7 | <--- | F | 0.814 | Valid | 0.096 | 9.889 | < 0.001 | ||
| Q8 | <--- | F | 0.821 | Valid | 0.104 | 10.018 | < 0.001 | ||
| Q9 | <--- | F | 0.806 | Valid | 0.107 | 9.749 | < 0.001 | ||
| Q10 | <--- | F | 0.849 | Valid | 0.101 | 10.531 | < 0.001 | ||
| Q11 | <--- | F | 0.770 | Valid | 0.107 | 9.138 | < 0.001 | ||
| Q12 | <--- | F | 0.826 | Valid | 0.107 | 10.121 | < 0.001 | ||
| Q13 | <--- | F | 0.882 | Valid | 0.104 | 11.193 | < 0.001 | ||
| Q14 | <--- | F | 0.836 | Valid | 0.113 | 10.303 | < 0.001 | ||
| Q15 | <--- | F | 0.863 | Valid | 0.102 | 10.815 | < 0.001 |
All 15-items of the PRQ2000-INA questionnaire (Supplementary Table 1) was valid and reliable. In addition, our findings indicate that the mean score on the PRQ2000-INA did not differ significantly across age groups, genders, or levels of educational attainment. However, we observed significant differences in the mean scores of the PRQ2000-INA among various types of dementia. The highest scores (89.53) were recorded in participants with other types of dementia, while the lowest scores (73.82) were noted in those with mixed dementia (Supplementary Table 2).
Discussion
In this study, we established that the PRQ2000-INA is a valid and reliable tool for measuring perceived social support in people with mild to moderate dementia. To the best of our knowledge, this is the first study to validate and assess the reliability of the PRQ2000 specifically within a dementia population. Moreover, it represents the first exploration of perceived social support among dementia patients in Indonesia.
Social support, especially through actual social support group interventions, may offer psychological benefits to dementia patients by reducing depression and enhancing quality of life and self-esteem [29]. However, perceived social support is more strongly linked to both psychosocial well-being and cognitive functioning. Among people with dementia, a decline in psychosocial health is common and often manifests as apathy, depression, and anxiety [10, 30, 31]. Studies have shown that perceived social support encompasses four key domains—informational support, esteem support, social companionship, and instrumental assistance [15, 32]. These dimensions play a critical role in helping individuals manage stress and adapt to the physiological effects of the disease (progressive cognitive decline) [14]. Nevertheless, the availability and perception of social support can vary depending on factors such as the severity of the condition, cultural context, and the individual’s relationships [33]. The complex nature of dementia underscores the importance of assessing and understanding social support as a multidimensional construct, tailored to the needs of those affected by the condition [34].
A previous systematic review study showed that PRQ2000 has been successfully utilized in various populations, including rural women, elderly individuals, patients with chronic diseases like diabetes, heart disease, and cancer, and those with inflammatory bowel disease [24]. Those with high PRQ2000 score had significant correlations with positive health-related behaviors, self-care, self-efficacy, and good health responsibility [24]. Furthermore, an inverse association was discovered between the PRQ2000 scores and stress, depression, sadness, pain, and disability scores [24]. This wide application supports its robustness to assess multiple aspects of perceived social support, including emotional and instrumental support, without being limited to source-specific subscales. This is particularly important in dementia populations, where support networks may include a mix of family, caregivers, and institutional staff [35], which are not always captured explicitly in MSPSS or ISEL. In collectivist societies such as Indonesia, where the boundaries between different types of social support (emotional, practical, affiliative) are less rigid [36], the broad and integrated structure of the PRQ2000 may be more ecologically valid compared to tools like MSPSS that distinctly categorize support sources.
A previous study in China found that individuals with mild dementia reported the lowest levels of perceived social support, with perceptions and predictors varying across different stages of the disease [14]. Although the study using the ISEL, this instrument has not been previously validated in populations with dementia [14]. In addition, the ISEL includes negatively worded items that may be more cognitively demanding to interpret, potentially introducing measurement error in this population.
While our Confirmatory Factor Analysis (CFA) of the PRQ2000-INA demonstrated high inter-item correlations—some exceeding 0.75—these findings do not necessarily indicate item redundancy but rather reflect the high internal consistency of the instrument. We acknowledge that previous studies have supported a three-factor structure of the PRQ-2000 (e.g., perceived belonging, intimacy, and assistance). However, our model yielded a good fit to a unidimensional structure, which may reflect the context-specific nature of perceived social support in individuals with dementia in Indonesia.
Several factors may explain the deviation from the original three-factor solution. First, cognitive decline in people with dementia may lead them to perceive social support as a more global, less differentiated construct. Second, cultural aspects in collectivist societies such as Indonesia may contribute to a holistic perception of support, where family, friends, and caregiving roles are often intertwined and less distinctly categorized [36–38]. In particular, several item pairs—such as Q3 and Q10—showed high correlation coefficients. However, these items are not semantically redundant. Rather, they may reflect causal relationships; for instance, agreeing with Q3 may increase the likelihood of agreeing with Q10, as experiencing emotional support may naturally reinforce the perception of available assistance [39]. Therefore, similar responses to such items are expected and theoretically coherent, rather than indicative of redundancy.
In the present study, we also demonstrated that no significant differences in PRQ2000-INA scores across age groups, gender, or educational levels. This uniformity suggests that the perception of social support, as captured by the PRQ2000-INA, may transcend these demographic variables [17] in dementia patients. It also implies that the instrument is robust across diverse subgroups within the dementia population, which is essential for both clinical assessments and research applications in culturally and demographically varied settings. Conversely, significant differences were noted in the mean scores between different types of dementia, with the lowest scores observed in mixed dementia. This variability could be reflective of the neurobiological and psychosocial impacts of different dementia pathologies on perceived social support. Mixed dementia often involves a combination of Alzheimer’s pathology and vascular injury [40], which may contribute to greater cognitive and functional impairments leading to reduced perception or accessibility of social support [14]. However, the analysis related to the score of PRQ2000-INA among dementia subtypes was descriptive in nature and was not intended to assess the association between dementia subtypes and perceived social support.
While the PRQ2000 has been validated based on psychometric criteria, it is crucial to consider its applicability within the specific cultural context of Indonesia. The PRQ2000-INA captures perceived social support from close relationships [24], which aligns well with the collectivist nature of Indonesian society, where familial and communal support is highly valued [37, 38]. In Indonesia, dementia care is often provided informally by family members, with limited access to formal caregiving institutions [27, 41]. The 15-item PRQ2000 provides a relatively brief yet psychometrically strong measure of perceived social support, providing insight into how caregivers and family members perceive the adequacy of support systems in place [14, 24]. This is critical for identifying gaps in care and for developing interventions that enhance the social support networks surrounding patients with dementia.
Strengths and limitations
The strength of this study is the novel contribution to validating the PRQ2000-INA in a dementia population. Furthermore, this study showed that PRQ2000-INA has excellent psychometric properties, including high factor loadings and internal consistency, align with previous translations of the instrument in other languages and settings, reinforcing the tool’s applicability and reliability in cross-cultural contexts. This broadens the potential for its use in international studies, offering a standardized measure to compare perceived social support across different cultural and healthcare settings.
Additionally, the observed differences in perceived social support scores among various dementia types provide insights into tailored interventions that could address specific needs. For instance, individuals with mixed dementia may benefit from enhanced social support interventions that consider their complex clinical presentations.
Despite its strengths, several limitations should be noted in the present study. First, the exclusion of patients with severe dementia and aphasia might limit the understanding of social support needs across the full spectrum of dementia severity. Individuals with more advanced dementia with more diverse clinical etiology may have unique social support needs and perceptions that are not captured in this study. Given that the PRQ2000-INA is a self-administered instrument designed to assess subjective perceptions of social support, adequate cognitive and language abilities are necessary for meaningful and valid responses. The development or adaptation of proxy-based versions of the PRQ2000, or the use of alternative observational or caregiver-report tools, could offer a promising direction for future studies aiming to assess social support in later stages of dementia or in individuals with communication impairments. Nonetheless, our current study provides a critical first step in validating the PRQ2000-INA for those with sufficient cognitive capacity to self-report. Establishing its reliability and validity in this population is an essential prerequisite before considering adaptations for more cognitively impaired individuals.
Second, the overrepresentation of patients with vascular dementia, possibly due to referral patterns at the memory clinic, which may have attracted patients with cardiovascular risk factors. We did not conduct stratified or matched analysis because we did not intend to draw inferential conclusions about the relationship between dementia type and perceived social support. This could result in findings that are more reflective of the experiences of vascular dementia patients than those with Alzheimer’s or other types of dementia. However, the diversity in dementia types has not impacted the core validity and reliability outcomes of the instrument. The main objective of this study was to validate the Indonesian version of PRQ2000 in individuals with mild-to-moderate dementia, regardless of etiology. The scale demonstrated strong psychometric properties across the sample.
Finally, the study focused solely on perceived social support as measured by the PRQ2000-INA, rather than examining actual social support received. The lack of concurrent validity testing (e.g., with MSPSS or actual support measurements) is a critical gap. Due to logistical constraints and our focus on the initial cultural and linguistic validation of the PRQ2000-INA, such analyses were beyond the scope of the current study. The issue of sensitivity and responsiveness is also well taken. Given that perceived social support can change over time, especially in the context of progressive conditions like dementia and with the implementation of social interventions, it is essential to determine whether PRQ2000-INA can detect such changes. At this stage, our study establishes the baseline psychometric validity of the instrument. Responsiveness analysis (e.g., through intervention trials or repeated measures) remains an important direction for future work and is necessary before recommending the tool for evaluative purposes in clinical or community settings.
Future longitudinal studies incorporating concurrent validity assessments are needed to evaluate the reproducibility of PRQ2000-INA scores over time and to assess the scale’s responsiveness to change, particularly following psychosocial interventions aimed at enhancing social support. Longitudinal designs would allow for the examination of test-retest reliability and the temporal sensitivity of the instrument—critical for determining its utility in both clinical monitoring and intervention studies. Additionally, research involving more diverse or stratified populations should consider including measures of actual received social support alongside perceived support. This would enable a more comprehensive understanding of the multidimensional nature of social support and its role in dementia care across different cultural and demographic contexts.
Conclusions
This study presents the first validation of the Indonesian version of the Personal Resource Questionnaire (PRQ2000-INA) for assessing perceived social support in individuals with mild to moderate dementia. The PRQ2000-INA demonstrated strong psychometric properties, including high construct validity, internal consistency, and a unidimensional factor structure, confirming its reliability and cultural relevance for use in Indonesia. Further longitudinal studies with larger and more diverse sample sizes are warranted to examine the concurrent validity of the PRQ2000-INA score as a predictor of social support and to assess responsiveness to psychosocial interventions in people with dementia.
Supplementary Information
Acknowledgements
This research is part of the “Social Health and Its Relationship with Cognitive Function among People with Dementia in Dr. Sardjito Hospital Yogyakarta, Indonesia”. The authors would like to thank the patients and their families who agreed to participate in this study.
Abbreviations
- PRQ2000
Personal Resource Questionnaire-2000
- PRQ2000-INA
Personal Resource Questionnaire-2000 Indonesia version
- ISEL
Interpersonal Support Evaluation List
- MSPSS
Multidimensional Scale of Perceived Social Support
- EFA
Exploratory Factor Analysis
- CFA
Confirmatory Factor Analysis
- MoCA
Montreal Cognitive Assessment
- CDR
Clinical dementia rating
- SOP
Space-occupying process
- TBI
Traumatic brain injury
- HIV
Human immunodeficiency virus
- SEM
Structural equation modeling
- GoF
Goodness of fit
- RMSEA
Root-mean-square error of approximation
- SRMR
Standard Root Mean Square Residual
Authors’ contributions
Conceptualization, A.N.V., G.F.S.P. and R.N.; methodology, A.N.V., G.F.S.P., R.N., C.E.; software, G.F.S.P., R.N.; validation, A.N.V., C.E. and A.P.; formal analysis, A.N.V., G.F.S.P. and R.N.; investigation, A.N.V., G.F.S.P. and R.N.; resources, A.N.V. and A.P.; data curation, G.F.S.P. and R.N.; visualization, A.N.V.; supervision, A.N.V. and A.P.; project administration, G.F.S.P. and R.N.; writing—original draft preparation, A.N.V.; writing—review and editing, A.N.V., G.F.S.P., R.N., and C.E. All the authors have read and agreed to the published version of the manuscript.
Funding
This study was partly supported by the 2022 Community Grant from the Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada Indonesia. The funding body was not involved in the study design or data analysis.
Data availability
The dataset presented in this study are available at https://zenodo.org/records/13826240.
Declarations
Ethics approval and consent to participate
The study was performed in accordance with the Declaration of Helsinki and was approved by The Medical and Health Research Ethics Committee of the Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada Yogyakarta, Indonesia, with the approval number KE/FK/0105/EC/2020. Informed consent was obtained from all participants and/or their caregivers.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The dataset presented in this study are available at https://zenodo.org/records/13826240.