基于ICF的长期照护保险失能评估量表的编制与验证

Construction and verification of disability assessment scale for long-term care insurance based on ICF

目的基于ICF理论框架,对长期照护保险(简称长照险)失能评估量表进行优化和改良,并对其进行信效度验证。方法采用方便取样法,对国内长照险某试点地区共2391例老年人进行失能评估,采用项目分析、探索性和验证性因子分析、校标关联效度、Cronbach'sα系数和折半信度进行数据分析。结果项目分析中,所有条目的临界比均>3.000,条目与总分的相关性为0.460~0.899,因素负荷均>0.450,共同性除视力外均>0.200,除意识状态、视力和听力外,条目删除后α值均小于量表总Cronbach'sα系数。探索性因子分析将20个条目划分为3个维度,包括自理能力12个条目、认知能力5个条目、感官能力3个条目,累计解释变异量为76.148%。同时建立了二阶结构方程模型,模型拟合良好,条目因素负荷为0.633~0.949,各维度的收敛效度为0.509~0.809、判别效度为0.713~0.899。条目和Barthel指数总分的r值为-0.348~-0.932(P<0.001)。总量表Cronbach’sα系数和折半信度分别为0.970、0.883。结论基于ICF的新版长照险失能评估工具共包含3个维度20个条目,信效度良好,可用于评定长照险保障对象和判断其失能程度。

Objective To verify the reliability and validity of the revised disability assessment scale for long-term care insurance based on ICF theoretical framework,and to ensure the reliability and effectiveness of the tool.Methods By convenient sampling method,2391 elderly in a pilot area of long-term care insurance were evaluated.Project analysis,exploratory and confirmatory factor analysis,calibration relevance validity,Cronbach’sαcoefficient and half reliability were used to analyze the data.Results In the project analysis,the critical ratio of all items was>3.000,the correlation between items and total score was 0.460-0.899,and the factor loads were>0.450.The commonality of items were>0.200 except for vision.Except for consciousness,vision and hearing,the items’deletedαvalues were less than Cronbach’sαcoefficient of the scale.Exploratory factor analysis divided 20 items into three dimensions,including 12 items of self-care ability,5 items of cognitive ability and 3 items of sensory ability,and the cumulative explanatory variation was76.148%.At the same time,the second-order structural equation model was established.The model fitted well,the item factor loads were 0.633-0.949,the convergence validity of dimensions were 0.509-0.809,and the discrimination validity were 0.713-0.899.The r value of items and Barthel Index were from-0.348 to-0.932(P<0.001).The total scale’s Cronbach’sαcoefficient and half reliability were 0.970 and 0.883.Conclusion The scale based on ICF contains 3 dimensions and 20 entries,which has good reliability and validity,and can be used to evaluate the objects of long-term care insurance and judge the degree of disability.