老年慢病共存患者治疗负担量表的研制

Development of a Treatment Burden Scale for Elderly Patients with Coexisting Chronic Diseases

背景 老年慢病共存患者治疗负担重,准确、有效评估患者治疗负担可为个性化干预方案制定、干预效果评价提供至关重要的评估工具,但目前尚无本土化的老年慢病共存患者治疗负担量表。目的 研制老年慢病共存患者治疗负担量表并检验其信效度,为科学评价老年慢病共存患者干预措施的效果提供合适的评估工具。方法 通过文献分析和患者访谈构建量表的条目池,通过专家咨询的方式形成初始量表。通过预测试,对初始量表条目的语义、最佳表达方式等做出修改。于2021年9—11月,采用便利抽样法选取老年慢病共存患者294名,使用项目分析和探索性因子分析对初始量表进行条目筛选,形成测试版量表。于2021年11月至2022年1月,采用便利抽样法选择老年慢病共存患者316名,使用信度、效度、可行性对测试版量表进行科学性考评,最终形成正式版量表。结果正式版老年慢病共存患者治疗负担量表包括33个条目、7个维度,7个维度分别为经济负担、自我管理负担、获得医疗服务负担、药物管理负担、药物不良反应负担、社交负担、心理负担。验证性因子分析结果显示,χ2/df=1.506,比较拟合指数(CFI)=0.933,非规准适配指数(TLI)=0.925,标准化残差均方根(SRMR)=0.054,近似误差均方根(RMSEA)=0.040。总量表的Cronbach’s α系数为0.895,分半信度为0.938,重测信度为0.939(P<0.01)。量表条目水平的内容效度指数(I-CVI)为0.833~1.000,量表水平的内容效度指数(S-CVI/Ave)为0.939,量表条目与各维度之间的相关系数为0.522~0.897(P<0.01)。可行性测试结果显示,量表回收率为95.8%,完成率为100.0%,完成时间为10~15 min。结论 本研究研制的老年慢病共存患者治疗负担量表具有良好的信效度,可用于评估我国老年慢病共存患者的治疗负担。

Background The treatment burden of elderly patients with coexisting chronic diseases is high.Accurate and effective evaluation of the treatment burden provides a crucial assessment tool for the development of individualized intervention protocol and evaluation of intervention effects.However,there is no localized treatment burden scale for elderly patients with coexisting chronic diseases.Objective To develop and test the reliability and validity of the treatment burden scale for elderly patients with coexisting chronic diseases,and provide a suitable assessment tool for scientific evaluation of the effectiveness of interventions for elderly patients with coexisting chronic diseases.Methods The item pool for the scale was constructed through literature analysis and patient interviews,and the initial scale was developed through expert consultation.The semantics and best presentation formats of the initial scale items were modified by pretesting.From September to November in 2021,294 elderly patients with coexisting chronic diseases were selected using convenience sampling method,and items of the initial scale were screened using item analysis and exploratory factor analysis to form a test version of the scale.From November to January in 2022,316 elderly patients with coexisting chronic diseases were selected using convenience sampling method,and the test version of the scale was scientifically evaluated using reliability,validity,and feasibility to finally form the official version of the scale.Results The official version of the treatment burden scale for elderly patients with coexisting chronic diseases included 33 items in 7 dimensions,including economic burden,burden of self-management,burden of access to healthcare,burden of medication management,burden of adverse drug reactions,burden of sociability,and psychological burden.The results of the confirmatory factor analysis showed that χ2/df=1.506,comparative fit index(CFI)=0.933,TuckerLewis index(TLI)=0.925,standardized residual mean root(SRMR)=0.054,and root-mean-square error of approximation(RMSEA)=0.040.The Cronbach’s α coefficient for the total scale was 0.895,the split-half reliability was 0.938,and the retest reliability was 0.939(P<0.01).The item-level content validity index(I-CVI)was 0.833~1.000,the scale-level content validity index(S-CVI/Ave) was 0.939,the correlation coefficient between the scale items and each dimension ranged from 0.522to 0.897(P<0.01).The results of the feasibility test showed that the recovery rate of the scale was 95.8%,the completion rate was 100.0%,and the completion time was 10-15 minutes.Conclusion The treatment burden scale for elderly patients with coexisting chronic diseases developed in this study has good reliability and validity,which is suitable for assessing the treatment burden of elderly patients with coexisting chronic diseases in China.