慢性病病耻感量表的汉化及其在脑卒中患者中的信效度研究

Development of the Chinese Version of Stigma Scale for Chronic Illness and Test of Its Reliability and Validity in Stroke Patients

目的汉化慢性病病耻感量表(SSCI)并检验其在脑卒中患者中的信效度。方法通过翻译、回译、专家小组评定及文化调试,建立SSCI中文版。于2016年3—6月采用方便抽样法在天津市2家社区卫生服务中心选取脑卒中患者204例进行问卷调查,内容包括患者基本情况、SSCI、抑郁自评量表(SDS)、Barthel指数(BI)、12条简明健康状况调查问卷(SF-12)。采用临界比值法、相关性分析对量表进行项目分析,采用内容效度指数(CVI)评价量表内容效度,采用因子分析法评价量表结构效度,根据SSCI得分与SDS、BI、SF-12得分的相关性评价量表构念效度,采用Cronbach'sα系数、重测信度评价量表信度。结果项目分析结果显示:中文版SSCI能够鉴别高分组和低分组(P<0.01);内在病耻感、外在病耻感维度得分与量表总分呈线性正相关(r值分别为0.955、0.900,P<0.01),各条目得分与量表总分均呈线性正相关(r值为0.472~0.806,P<0.01),内在病耻感维度的13个条目得分与该维度得分呈线性正相关(r为0.673~0.807,P<0.01),外在病耻感维度的11个条目得分与该维度得分呈线性正相关(r为0.519~0.845,P<0.01)。各条目CVI为0.800~1.000,总量表CVI为0.932。探索性因子分析共获得3个公因子,累计方差贡献率为65.586%,各条目在其相应维度上的因子载荷为0.463~0.850。SSCI得分与SDS得分呈线性正相关(r=0.609,P<0.01),与BI、SF-12中心理功能(MCS)、生理功能(PCS)得分呈线性负相关(r值分别为-0.486、-0.524、-0.462,P<0.01)。总量表的Cronbach'sα系数为0.951,内在病耻感和外在病耻感维度的Cronbach'sα系数均为0.927;总量表的重测信度为0.881,内在病耻感和外在病耻感维度的重测信度分别为0.927、0.797。结论汉化版的SSCI具有较好的信效度,可在我国神经系统疾病病耻感的相关研究中使用。

Objective To translate the English version of Stigma Scale for Chronic Illness（ SSCI） into Chinese and to test the reliability and validity of the Chinese version of SSCI in patients with stroke. Methods The Chinese version of SSCI was developed by translation,back translation combined with the review and cultural adjustment of panel of experts. From March to June 2016,we conducted a survey in 204 stroke patients recruited from 2 community health service centers by convenience sampling using questionnaires consisting of Demographic Questionnaire,Chinese version of SSCI,Chinese version of Self-rating Depression Scale（ SDS）,Chinese version of Barthel Index（ BI）, Chinese version of 12-item Short Form Health Survey（ SF-12）. Item analysis of the Chinese version of SSCI was performed with critical ratio method and Pearson correlation coefficient. Content validity and structural validity of the Chinese version of SSCI was assessed by content validity index（ CVI）,factor analysis,respectively. Construct validity of the Chinese version of SSCI was tested by correlations of Chinese version of SSCI scores with Chinese version of SDS,BI,SF-12 scores. Cronbach＇ s α was applied to assess the test-retest reliability of the Chinese version of SSCI. Results Item analysis showed that the Chinese version of SSCI could discriminate the high-score group from the low-score group（ P 0. 01）. The Chinese version of SSCI had linear positive correlation with self-stigma dimension（ r = 0. 955,P 0. 01） and enacted stigma dimension（ r = 0. 900,P 0. 01） in scoring. Item-total correlations were linear and positive（ r ranged from 0. 472 to 0. 806,P 0. 01）. Self-stigma dimension was linearly and positively correlated with each of its 13 items in scoring（ r ranged from 0. 673 to 0. 807,P 0. 01）. Likewise,enacted stigma dimension was linearly and positively correlated with each of its 11 items in scoring（ r ranged from 0. 519 to 0. 845,P 0. 01）. The I-CVI ranged from 0. 800 to 1. 000,and the S-CVI was 0. 932. From exploratory factor analysis,3 factors were generated,which explained65. 586% of the total variance. All the items had factor loadings ranged from 0. 463 to 0. 850 in their corresponding dimensions. The Chinese version of SSCI score demonstrated a linear and positive correlation with Chinese version of SDS score（ r= 0. 609,P 0. 01）,whereas it was negatively and linearly correlated with Chinese version of BI score（ r =-0. 486,P 0. 01）,score of mental component summary（ MCS） and physical component summary（ PCS）,in Chinese version of SF-12（ r =-0. 524,-0. 462,respectively,P 0. 01）. Internal consistency of Chinese version of SSCI was confirmed by Cronbach＇s α of 0. 951,and the Cronbach＇s α of self-stigma and enacted stigma were both 0. 927; the test-retest interclass correlation of total scale was 0. 881, and the test-retest interclass correlation of self-stigma and enacted stigma was 0. 927,0. 797 respectively. Conclusion The Chinese version of SSCI showed good reliability and validity,and could be used in the research of stigma of neurological disorders in China.