SF-12量表评价上海市社区老年人生命质量的信效度研究

Reliability and Validity of the 12-item Short-Form Health Survey Questionnaire among the Elderly in Shanghai

背景目前我国有超过200种不同用途的生命质量测评量表。国内大多数量表是在国外人群的研究基础上不断修正、改良得到的,但由于语言、文化、生活习惯的差异,如果将量表直接应用到我国人群中,其信效度可能会受到影响。目的分析SF-12量表评价上海市社区老年人生命质量的信效度。方法 2014年8—10月,采用整群随机抽样法抽取上海市徐汇区徐家汇街道社区卫生服务中心、上海市浦东新区花木社区卫生服务中心、上海市嘉定工业区社区卫生服务中心健康档案登记在册的60岁以上老年人4 714例,其中上海市徐汇区徐家汇街道社区卫生服务中心1 493例,上海市浦东新区花木社区卫生服务中心1 489例,上海市嘉定工业区社区卫生服务中心1 732例。根据纳入与排除标准,共选取4 395例老年人为调查对象。采用一般资料调查表和SF-12量表对其进行调查,同时采用随机数字表法从调查对象中抽取300例老年人填写SF-36量表。采用内部一致性信度和折半信度评价SF-12量表的信度,采用结构效度、集合效度、区分效度、效标效度评价SF-12量表的效度。结果 SF-12量表各维度校正的项总计相关系数为0.485～0.637(P<0.05);SF-12量表的Cronbach'sα系数为0.828,删除相应维度后的Cronbach'sα系数也均>0.700。SF-12量表的Spearman-Brown系数为0.797。SF-12量表的KMO=0.847,Bartlett's球形检验的χ~2=10 405.294,P<0.001,表明可以进行探索性因子分析。采用最大方差正交旋转法共提取2个特征根>1.000的公因子,分别命名为生理总评分(PCS)和心理总评分(MCS),其贡献率分别为32.3%和24.8%,累积贡献率为57.1%;除情感职能(RE)维度外,其余维度均与理论模型结果一致。验证性因子分析的规范拟合指数(NFI)=0.967,比较拟合指数(CFI)=0.944,拟合优度指数(GFI)=0.957,近似误差均方根(RMSEA)=0.038。SF-12量表集合效度相关系数为0.703～1.000(P<0.05),区分效度相关系数为0.217～0.637(P<0.05);集合、区分效度定标试验成功率均为100.0%。SF-36量表的PCS、MCS与SF-12量表的PCS、MCS的相关系数分别为0.851、0.802(P值均<0.001)。结论 SF-12量表评价上海市社区老年人生命质量的信效度良好,可以将其用于评估基层老年人的生命质量,并在国内初级卫生保健系统中推广应用。

Background There are more than 200 different quality of life scales in China.Most of them are revised and improved on the basis of studies on foreign populations.However,due to the differences in language,culture and living habits,their reliability and validity may different from original edition when we directly applied them to the Chinese population.Objective To assess the reliability and validity of SF-12 scale in measuring quality of life among the elderly in Shanghai.Methods The data of 4 714 elderly people over the age of 60 years registered in the archives in Xujiahui Community Center in Xuhui District(1 493 samples),Huamu Community Center in Pudong District(1 489 samples)and Jiading Industrial District Community Center in Jiading District(1 732 samples)were randomly collected from August to October 2014.According to inclusion and exclusion criteria,a total of 4 395 elderly people were selected as respondents.The general data questionnaire and the SF-12 scale were used to investigate the collected data.Meanwhile the data of 300 elderly were randomly selected from the participants to complete the SF-36 scale through random number table method.The reliability of the SF-12 scale was assessed by internal consistency reliability and half-fold reliability.The validity of the SF-12 scale was assessed by structural validity,set validity,discriminate validity and criterion validity.Results The correlation coefficient between each dimension in SF-12 scale was 0.485 to 0.637(P<0.05).The Cronbach’sαcoefficient of the SF-12 scale was 0.828,and the Cronbach’sαcoefficient after deleting the corresponding dimension was also>0.700.The Spearman-Brown coefficient of the SF-12 scale was 0.797.KMO=0.847 for the SF-12 scale andχ~2 of Bartlett’s spherical test was 10 405.294,P<0.001 indicating that exploratory factor analysis can be performed.Two common factors(eigenvectors>1.000)were extracted through the maximum variance orthogonal rotation method and named as PCS and MCS.The contribution rates of the two factors were 32.3%and 24.8%,respectively,and the cumulative contribution rate was 57.1%.Except the RE dimension,the rest dimensions are consistent with the theoretical model results.Confirmatory factor analysis showed that NFI=0.967,CFI=0.944,GFI=0.957,and RMSEA=0.038.The correlation coefficient of SF-12 scale set validity was 0.703 to 1.000(P<0.05),and correlation coefficient of discriminate validity was 0.217 to 0.637(P<0.05).The achievement ratio of aggregation tests and discrimination tests were both 100%.The correlation coefficient of PCS and MCS in the SF-36 scale and the SF-12 scale were 0.851 and 0.802,respectively(P<0.001).Conclusion The SF-12 scale has showed a good reliability and validity in measuring health status of the elderly in Shanghai.It is applicable for assessment of the health-related quality of life among elderly population in communities of Shanghai and can be promoted in the primary health care system in China.