类风湿关节炎病耻感量表的汉化及信效度检验

Reliability and validity test of the Chinese version of rheumatoid arthritis stigma scale

目的对类风湿关节炎病耻感量表(ISMI-RA)进行汉化,并检验其信效度。方法严格遵循Brislin翻译模式对英文版ISMI-RA进行翻译、回译及文化调适,选取20例患者预调查修订部分条目内容,形成中文版ISMI-RA。2020年4月至2021年4月采用方便抽样法对258例RA患者进行调查,评价量表的信效度,运用Pearson相关组内相关系数(ICC)和Cronbach′sα系数评价量表的重测信度和内部一致性;以慢性疾病病耻感量表为标准,计算相关系数验证效标效度;通过验证性因子分析评价量表的结构效度。结果总量表内部一致性Cronbach′sα系数为0.86,各维度的Cronbach′sα系数为0.34~0.93,重测信度Pearson相关分析显示为0.94,抵抗病耻感分量表的Cronbach′sα系数为0.34,过低予以删除后量表Cronbach′sα系数为0.90,重测信度为0.98;其与慢性病病耻感量表效标系数为0.73(P<0.001),各分量表为0.52~0.71;由5个因子组成的ISMI-RA理论因子结构显示出次优的模型拟合[逼近均方根误差(RMSEA)=0.10,塔克-刘易斯指数(TLI)=0.88,比较拟合指数(CFI)=0.89],删除抵抗病耻感维度和3个条目后,模型拟合效果较好(RMSEA=0.09,CFI=0.94,TLI=0.93)。结论中文版ISMI-RA具有良好的信效度,可以作为测量RA病耻感水平的评估工具,为临床制定干预方案、加速康复进程提供依据。

Objective To investigate the Chinese version of rheumatoid arthritis stigma scale(ISMI-RA)and test its reliability and validity.Methods The English version of ISMI-RA was translated into Chinese,translated back and culturally adapted in strictly accordance with the Brislin translation model.A total of 20 patients were selected for preliminary investigation and some items were revised to create the Chinese version of ISMI-RA.From April 2020 to April 2021,258 patients with rheumatoid arthritis were investigated by convenience sampling method,Pearson correlation intraclass correlation coefficient(ICC)coefficient and Cronbach'sαcoefficient were used to evaluate the test-retest reliability and internal consistency of the scale.The stigma scale for chronic illness-8 was used as the standard,and the correlation coefficient was calculated to verify the criterion validity.Confirmatory factor analysis was used to evaluate the construct validity of the scale.Results The internal consistency Cronbach'sαcoefficient was 0.86,the Cronbach'sαcoefficient of each dimension was 0.34-0.93,and Pearson correlation analysis of retest reliability showed that it was 0.94.The Cronbach'sαcoefficient of stigma resistance subscale was as low as 0.34,and the Cronbach'sαcoefficient of stigma resistance subscale was 0.90 after removal.The retest reliability was 0.98.The criterion coefficient between this scale and the stigma scale for chronic illness-8 was 0.73(P<0.001),and the criterion coefficient of the subscales were 0.52-0.71.The theoretical factor structure of ISMI-RA that is composed of five factors showed suboptimal model fitting[root-mean-square error of approximation(RMSEA)=0.10,Tucker-Lewis index(TLI)=0.88,comparative fit index(CFI)=0.89],and the model fitting effect was better after removing the dimension of resistance to stigma and three items(RMSEA=0.09,CFI=0.94,TLI=0.93).Conclusion The Chinese version of ISMI-RA has good reliability and validity,and can be used as an evaluation tool to measure the level of stigma in rheumatoid arthritis patients,and to provide a basis for clinical development of intervention programs to facilitating the rehabilitation process.