乳腺癌术后淋巴水肿患者自我护理问卷的编制及信度、效度检验

Development of self-care scale for patients with lymphedema after breast cancer surgery and verification of its reliability and validity

目的编制乳腺癌术后淋巴水肿患者自我护理问卷,并进行信度、效度检验,为临床提供一种评估工具。方法2022年7月—2023年4月以知信行理论为指导框架,通过文献研究、半结构式访谈确定问卷条目池,选择全国8个省市临床护理、护理管理、护理教育3个领域的15名专家,采用德尔菲法对该问卷进行2轮专家函询构建了问卷初稿;2023年5月—7月采用便利抽样法,分别选取湖北省和河南省7所三级甲等综合医院的444例乳腺癌术后淋巴水肿患者进行2次问卷调查,测评其信度与效度。结果两轮专家函询的积极性系数分别为93.75%和93.33%,权威程度系数分别为0.86和0.90,Kendall协调系数W分别为0.130和0.379,第1轮函询各条目的重要性均数为4.33~4.93,变异系数为0.05~0.19,满分率为53.33%~93.33%;第2轮函询各条目的重要性均数为2.86~4.93,变异系数为0.05~0.36,满分率为7.14%~92.86%。2次调查421例患者完成研究,问卷总的Cronbachα系数为0.943,折半信度为0.824;问卷总体水平的内容效度指数(scale-level content validity index,S-CVI)为0.912,问卷条目水平的内容效度指数(item-level content validity index,I-CVI)为0.857~1.000;探索性因子分析KMO值为0.919,Bartlett’s球形检验值为4671.724(P<0.001),累计方差贡献率为64.155%;验证性因子分析显示修正后模型适配良好。经信度、效度检验后形成包含知识维度9个条目、态度维度6个条目、行为维度18个条目共33个条目的正式版问卷。结论乳腺癌术后淋巴水肿患者自我护理问卷具有良好信度、效度,适用于评估我国乳腺癌术后淋巴水肿患者的自我护理水平。

Objective To develop a self-care scale for patients with lymphedema after breast cancer surgery and verify its reliability and validity.Methods Based on the model of knowledge,belief and practice,a questionnaire item pool was constructed after literature reviews and qualitative interviews.A questionnaire-based scale was drafted based on the established item pool by carrying out two rounds of consultation with 15 clinical nursing specialists,nursing administrators and nursing educators from 8 provinces or cities in China.Reliability and validity of the scale were tested using convenience sampling,involving 444 patients with breast cancer surgery related lymphedema from 7 general hospitals in Hubei and Henan provinces,China,between May and July 2023.Results The response rates for the two rounds of expert consultation were 93.75%and 93.33%,respectively.The authority coefficients of the two rounds were 0.86 and 0.89,respectively,and the coordination coefficients for the 2 rounds were 0.130 and 0.379,respectively.In the first round,the average importance rating was from 4.33 to 4.93 with the coefficient of variation from 0.05 to 0.19,and the full score ratio from 53.33%to 93.33%.In the second round,the average importance rating ranged from 2.86 to 4.93 with the coefficient of variation from 0.05 to 0.36,and the full score ratios from 7.14%to 92.86%.A total of 421 patients completed the survey.The overall Cronbach’sαcoefficient of the scale was 0.943,the overall split-half reliability was 0.824,the scale-level content validity index(S-CVI)was 0.912,and the item-level content validity index(I-CVI)of the total scale ranged from 0.857 to 1.000.The KMO value of exploratory factor analysis was 0.919,the Bartrett spherical test value was 4671.724(P<0.001),and the cumulative variance contribution rate was 64.155%.Confirmatory factor analysis showed a good model fit.After the reliability and validity tests,the scale was finalised and determined to consist of three dimensions with 33 items:knowledge(9 items),attitude(6 items)and behaviour(18 items).Conclusion The self-care scale for the patients with lymphedema after breast cancer surgery has demonstrated good reliability and validity,and makes it an effective assessment tool for the patients with lymphedema after breast cancer surgery.