乡村医生健康管理服务技术培训评价量表的编制与信效度检验

Development,Reliability and Validity of the Health Management Service Skills Training Evaluation Scale for Rural Doctors

背景目前我国针对乡村医生健康管理服务技术培训效果评价的研究相对较少,且缺乏有效的评价工具。目的编制乡村医生健康管理服务技术培训效果评价量表,并对其进行信效度检验。方法基于柯氏模型设计乡村医生健康管理服务技术培训效果评价初始量表,通过专家咨询、课题组讨论等方式形成乡村医生健康管理服务技术培训效果评价试测量表。于2021年5—6月,使用试测量表进行预调查,采用样本1(n=100)进行初测阶段的信度分析和探索性因子分析,形成乡村医生健康管理服务技术培训效果评价正式量表。于2021年7月,对问卷进行正式施测,采用样本2(n=306)进行验证性因子分析和同质信度、组合信度、判别效度及结构效度检验。结果正式量表包括反应层、学习层、行为层及结果层4个维度15个条目。预调查数据抽取合适性度量值(KMO)为0.847,Bartlett球形检验结果显著(χ^(2)=1862.826,P<0.05),探索性因子分析的累积方差贡献率为87.575%。验证性因子分析结果为:χ^(2)/df=3.906,近似误差均方根(RMSEA)=0.098,比较拟合指数(CFI)=0.961,修正的标准拟合指数(IFI)=0.961,标准拟合指数(NFI)=0.948,模型拟合基本良好。最终量表的Cronbach'sα系数为0.967,反应层、学习层、行为层及结果层4个维度的Cronbach'sα系数分别为0.962、0.958、0.971和0.919,各维度的组合信度(CR)值分别为0.963、0.958、0.971和0.919。平均方差抽取量(AVE)的算术平方根大于因子之间的相关系数,各维度之间的相关系数为0.538~0.842,各维度与量表总分之间的相关系数为0.754~0.934。结论本研究编制的乡村医生健康管理服务技术培训效果评价量表信效度较为良好,可作为一种有效的乡村医生健康管理服务技术培训效果评价工具。

Background Few studies have evaluated the effectiveness of health management services sills trainings for rural doctors,and there is a lack of effective evaluation toolsin China.Objective To develop the Health Management Service Skills Training Evaluation Scale for Rural Doctors(HMSSTESRD),and test its reliability and validity.Methods The initial version of HMSSTESRD was developed using the framework of Kirkpatrick model,then was revised using expert consultation and group discussion,and was pretested using a survey with a sample of 100 cases conducted between May to June,2021.The scale was further revised according to the survey,and analyzed using reliability analysis and exploratory factor analysis,then the formal version was determined.In July 2021,the formal scale was retested in a sample(n=306),and was revised according to the test results,and was subjected to confirmatory factor analysis,homogeneous reliability analysis,composite reliability analysis,discriminant validity analysis,and structural validity analysis.Results The formal scale consists of 15 entries in 4 dimensions:reaction,learning,behavior,and results.The KMO index was 0.847,Bartlett's test of sphericity was significant(χ^(2)=1862.826,P<0.05),and the percentage of explained total variance in exploratory factor analysis was 87.575%.The results of the confirmatory factor analysis wereχ^(2)/df=3.906,RMSEA=0.098,CFI=0.961,IFI=0.961,and NFI=0.948,indicating that the model fit was basically good.When it comes to the formal scale,the Cronbach'sαwas 0.967.The Cronbach'sαfor each dimension(reaction,learning,behavior,and results)was 0.962,0.958,0.971,and 0.919,respectively.And the CR values for these dimensions were 0.963,0.958,0.971,and 0.919,respectively.The arithmetic square root of AVE was greater than the correlation coefficient between the factors.Theinter-dimension correlation coefficients were 0.538 to 0.842,and the dimension-scalecorrelation coefficients were 0.754 to 0.934.Conclusion The HMSSTESRD developed by us has been proved to have good reliability and validity,which could be used as an effective tool for assessingtheeffectiveness of health management service skills trainingsfor rural doctors.