患者预设性不信任情境量表的初步编制

Development of Scale of Patients' Presupposed Distrust

背景部分患者就医前对医生的预设性不信任是导致不良医患关系的重要原因,目前关于评估患者预设性不信任的工具仍较少。目的初步编制患者预设性不信任情境量表,并进行信效度检验。方法将文献查阅、临床实践、研究小组讨论等方法结合,编制患者预设性不信任情境量表。分别于2018年1—2月、2018年2—3月,采用方便抽样法,分别选取医院就诊患者52例和384例进行预调查和正式调查。通过预调查初步优化量表结构,通过正式调查并基于探索性因子分析、相关性分析、效标效度、Cronbach'sα系数等进行量表条目筛选及信效度检验。结果最终确定的患者预设性不信任情境量表共包括22个条目。通过探索性因子分析提取8个公因子,分别为医患沟通、患者个人经验、医生修养、医疗制度、医生医德、其他因素、医生技术、患者判断。探索性因子分析结果显示,8个公因子的累积方差贡献率为58.794%。Pearson相关分析结果显示,量表各条目得分与总分、个条目得分与对应的公因子得分均呈线性正相关(P<0.05)。将维克森林医师信任量表作为患者预设性不信任情境量表的效标,Pearson相关分析结果显示,两个量表总分呈线性负相关(P<0.05)。患者预设性不信任情境量表的Cronbach'sα系数为0.708,分半信度系数为0.729。结论编制的患者预设性不信任情境量表区分度良好,具有较好的效度和信度,可作为我国患者对医生预设性不信任程度测量的适用工具。

Background Some patients'mistrust of doctors before taking medical treatment is an important cause of bad doctor-patient relationship.At present,there are still few tools for assessing patients'presupposed distrust.Objective To compile Patients'Presupposition Distrust Scale and test its reliability and validity.Methods Literature review,clinical practice,research group discussion and other methods were used to develop Patients'Presupposition Distrust Scale.A total of 52 patients and 384 patients were selected by convenient sampling method for pre-investigation and formal investigation from January to February 2018 and February to March 2018.The structure of the scale was optimized preliminarily by pre-investigation,and the items were screened and validated based on exploratory factor analysis,correlation analysis,criterion validity and Cronbach's alpha coefficient.Results The final Patients'Presupposition Distrust Scale consisted of 22 items.Eight common factors were extracted by exploratory factor analysis,including doctor-patient communication,patients'personal experience,doctor's characterization,medical system,doctor's medical ethics,other factors,doctor's skills and patients'judgment.Exploratory factor analysis showed that the cumulative variance contribution rate of the 8 common factors was 58.794%.Pearson correlation analysis showed that the score of each item was positively correlated with the total score,the score of each item and the corresponding common factor score(P<0.05).Wake Forest Physician Trust Scale was used as a criterion for Scale of Patients'Presupposed Distrust.Pearson correlation analysis showed that the total scores of the two scales were negatively correlated(P<0.05).The Cronbach's alpha coefficient of the preset distrust scale was 0.708 and the split half reliability coefficient was 0.729.Conclusion The developed patient presupposition distrust scale has good discrimination,good validity and reliability,and can be used as a suitable tool for measuring the degree of patients'presupposition distrust to doctors in China.