中文版患者积极度量表的信效度研究

Reliability and validity of the Chinese version of Patient Activation Measure

目的检验中文版患者积极度量表（PAM）的信度和效度，探讨其用于评价腰椎退行性疾病择期行腰椎融合术患者自我健康管理能力的适用性。方法于2017年1—6月，采用便利抽样法，选取精神正常、无沟通障碍且因腰椎退行性疾病于苏州市某三级甲等医院住院拟择期行腰椎融合术的患者作为调查对象，共120例。对研究对象进行问卷调查，问卷内容包括一般资料调查表、中文版PAM和慢性病管理自我效能量表（sEMcDs）。通过项目分析、内部一致性信度、重测信度、内容效度、结构效度、效标关联效度等指标评定中文版PAM的测量学性能。结果共发放问卷120份，收回有效问卷120份，有效回收率为100．0％。中文版PAM包含13个条目，4个水平分级，标准化后总得分为33～100分，平均（50．25±11．33）分。59例（49．2％）得分≤47．0分，积极度处于第一水平，并未意识到自我健康管理的重要性；22例（18．3％）得分为47．1～55．1分，积极度处于第二水平，缺乏参与自我健康管理的知识和信心；31例（25．8％）得分为55．2～67．0分，积极度处于第三水平，开始采取自我健康管理的行动；8例（6．7％）得分≥67．1分，积极度处于第四水平，即使面对压力，也坚持自我健康管理的生活方式。总量表的Cronbach＇sd系数为0．835，Guttman分半信度为0．736，重测信度为0．878，内容效度指数为0．923，各条目的内容效度指数为0．833～1。探索性因子分析共提取了4个公因子，根据腰椎融合术的康复特点，重新命名为自我疾病健康管理的意识、术前疾病相关知识、术后预防相关能力和坚持健康生活行为的信念，累计方差贡献率为63．75％，与慢性病患者自我效能量表效标关联效度的Spearman秩相关系数为0．689。结论中文版PAM信效度良好，可作为我国腰椎退行性疾病住院治疗拟行腰椎融合术患者自我疾病和健康管理积极度的评估工具。临床工作者可根据患者术前积极度初步筛选潜在的可能导致术后康复结局不佳的高危患者，制定个性化的护理措施，合理配置医疗资源，提高患者满意度。

Objective To measure the reliability and validity of the Chinese version of Patient Activation Measure （PAM） and to explore its applicability in assessment of self-health management among lumbar degenerative disease patients scheduled for lumbar spinal fusion. Methods From January to June 2017, we selected 120 lumbar degenerative disease patients who had a right mind, none communication disorders and were treated at a Class I0 Grade A hospital in Suzhou as well as scheduled for lumbar spinal fusion as subjects by convenience sampling. All of the patients were investigated with the questionnaire involving the general information questionnaire, the Chinese version of PAM and Self-Efficacy for Managing Chronic Disease Scale （SEMCDS）. Psychometric characteristics of the Chinese version of PAM were assessed by indexes, such as item analysis, internal consistency reliability, retest reliability, content validity, construct validity and criterionrelated validity. Results A total of 120 questionnaires were sent out and all of them were collected with 100.0% for the effective recovery rate. The Chinese version of PAM included 13 items and 4 levels. Its standardized total score ranged from 33 to 100 and the average score was （50.25 ± 11.33）. There were 59 patients （49.2%） with the score less than or equal to 47.0 belong to the first level of activation which indicated they were not aware the importance of self-health management; 22 patients （18.3%） the score between 47.1 and 55.1 belong to the second level of activation which indicated they lacked knowledge and confidence of self-health management ; 31 patients （25.8%） with the score from 55.2 to 67.0 belong to the third level of activation which indicated they began to take action of self-health management; 8 patients （6.7%）with the score greater than or equal to 67.1 belong to the fourth level of activation which showed they insisted on life style of self-health management even facing pressure. The Cronbach＇s α of the whole scale was 0.835. Guttman split-half reliability and retest reliability was 0.736 and 0.878 respectively. The content validity was 0.923 with it of each item ranging from 0.833 to 1. Exploratory factor analysis extracted four common factors which were renamed as the awareness of self-health management for disease, preoperative disease-related knowledge, postoperative prevention ability and the belief to insist on healthy life style transformation according to the rehabilitative characteristics of lumbar spinal fusion with 63.75% for the cumulative variance contribution rate. Spearman rank correlation coefficient in criterion-related validity was 0.689 between the Chinese version of PAM and the SEMCDS. Conclusions The Chinese version of PAM has good reliability and validity. It could be an assessment instrument of self-disease and health management activation for lumbar degenerative disease inpatients scheduled for lumbar spinal fusion in China. Clinic workers could preliminarily screen potential high-risk patients who may undergo unsatisfactory postoperative rehabilitation based on the level of activation and formulate individualized nursing intervention, reasonably distribute medical resources and improve patients satisfaction.