基层全科医生糖尿病微血管病变知信行评价量表的信效度检验

Reliability and validity of an assessment scale of knowledge, attitude and practice on diabetic microangiopathy for primary care general practitioners

目的评估“基层全科医生糖尿病微血管病变知信行评价量表”的信度和效度。方法该研究为横断面研究。2023年3—5月,采用“基层全科医生糖尿病微血管病变知信行量表”对上海4个行政区55家社区卫生服务中心的全科医生进行电子问卷调查。4周后,采用随机数字表法抽样选取30名调查对象对量表进行重复调查。以内容效度、结构效度、区分效度检验量表的效度;以内部一致性信度和重测信度检验量表的信度。结果本次调查共回收693份问卷,有效问卷661份,有效回收率95.4%。其中男性191名(28.90%),年龄(39.38±7.99)岁,工作年限(10.15±5.99)年。在内容效度方面,Pearson相关分析显示各分量表与总量表呈正相关,相关系数为0.490~0.876,均P<0.001,且删除态度分量表1个条目后总量表的Cronbach′sα系数有所提高;结构效度方面,第1次探索性因子分析后删除知识分量表1个条目,第2次探索性因子分析累积方差贡献率62.71%,各条目因子负荷均>0.3,量表具有较好的结构效度,验证性因子分析显示修订后的量表卡方自由度比(χ^(²)/df)=2.729、比较拟合指数(CFI)=0.784、近似误差方根(RMSEA)=0.072,模型拟合度好;区分效度方面,高分组与低分组在总量表和分量表得分上的差异均具有统计学意义(t=10.82~44.49,均P<0.001)。信度方面,修订后总量表的Cronbach′sα系数为0.891;重测信度组内相关系数为0.76,重测后各分量表和总量表得分与初测得分的差异均无统计学意义(P>0.05)。结论修订后的“基层全科医生糖尿病微血管病变知信行评价量表”信效度较好,可用作基层全科医生糖尿病微血管病变管理的评价工具。

Objective To evaluate the reliability and validity of an assessment scale of knowledge,attitude and practice on diabetic microangiopathy for primary care general practitioners(GPs).Methods The study was a cross-sectional survey.An electronic questionnaire survey was conducted among primary care GPs in 55 community health service centers of 4 districts in Shanghai using the assessment scale of knowledge,attitude and practice on diabetic microangiopathy from March to May 2023;a repeated survey was conducted among 30 subjects who were selected by random number table method after 4 weeks.The validity of content,structure and discriminant of the scale was tested;the internal consistency reliability and test-retest reliability of the scale were tested.Results A total of 693 questionnaires were distributed,661 valid ones were collected with an effective recovery rate of 95.4%.Among all participants,191(28.90%)were males with an mean age of(39.38±7.99)years and working experience of(10.15±5.99)years.In terms of content validity,Pearson correlation analysis showed that each subscale was positively correlated with the total scale with a correlation coefficients of 0.490 to 0.876(all P<0.001),and the Cronbach′sαcoefficient of the total scale increased after deleting one item from the attitude subscale.In terms of structural validity,one item of the knowledge subscale was deleted after the first exploratory factor analysis,and the cumulative variance contribution rate of the second exploratory factor analysis was 62.71%.Each item had a factor load greater than 0.3,indicating good structural validity of the scale.Confirmatory factor analysis showed that the revised scale had a chi-square degree of freedom ratio(χ^(²)/df)of 2.729,a comparative fit index(CFI)of 0.784,and a root mean square error approximation(RMSEA)of 0.072,indicating good model fit.In terms of discriminant validity,the differences in total and subscale scores between high-and low-score groups were statistically significant(t=10.82 to 44.49,all P<0.001).In terms of reliability,the revised Cronbach′sαcoefficient of the total scale was 0.891;the intra-group correlation coefficient for test-retest reliability was 0.76,and there was no significant difference in the paired t-test between each subscale and total scale score.Conclusions The revised assessment scale of knowledge,attitude and practice on diabetic microangiopathy for primary care GPs can be used as an assessment tool practically.