居家腹膜透析患者自我管理量表的编制及信度、效度分析研究

doi:10.3969/j.issn.1674-8115.2021.07.015

摘要/Abstract

摘要：

目的·完成腹膜透析（腹透）患者居家透析操作过程中自我管理水平量表的编制及信度、效度分析。方法·通过患者访谈、专家咨询、查阅文献等方式，在结合腹透患者管理临床经验的基础上完成对初始量表的编制。采用方便抽样的方式发放问卷，通过临界比值法、同质性检验筛选条目，探索性因子分析评估结构效度，最终确定量表共同因素数目及条目。计算Cronbach’s α系数、折半系数对量表信度进行分析。结果·初始量表由5个维度26个条目组成，共发放136份问卷，收集有效问卷132份。根据项目分析结果，除条目3未达到校正题项与总分相关性、共同性、因素负荷量的筛选条件外，其余条目均满足入选标准。因条目3是考察患者无菌意识的关键步骤，经专家咨询后保留该条目至因素分析。初始量表取样适切性量数（KMO）值为0.880，Bartlett’s球形检验χ²值为2 272.938（P=0.000），提示总体的相关矩阵有共同因素存在，适合进行因素分析。根据量表初始设计条目初衷，限定萃取5个共同因素，采取直交转轴的最大变异法，最终删除条目7、11、16，根据各因素构面包含的条目变量特性，提取的共同因素分别命名为“对腹透并发症和腹透充分性评价的知晓度”“腹透规范化操作能力”“药物管理能力”“饮食管理能力”“腹透效果评估和监测能力”，形成5个维度23个条目的正式量表，各维度的特征值分别为4.604、3.286、3.207、2.817、2.140，累积方差贡献率为66.428%。最终总量表Cronbach’s α系数为0.930，折半系数为0.946。结论·腹透患者自我管理水平量表具有良好的信度和效度，可用于腹透患者自我管理能力测评。

关键词: 腹膜透析, 患者自我管理, 量表, 信度, 效度

Abstract:

Objective·To complete the compilation and reliability and validity analysis of the self-management scale for peritoneal dialysis (PD) patients during home dialysis operations.

Methods·The preparation of the initial scale was based on patient interviews, expert consultation, literature review, and clinical experience in PD patient management. Convenient sampling was used to distribute questionnaires. Critical ratio method and homogeneity test were used to screen items. With the help of exploratory factor analysis to evaluate the validity of the structure, the number of common factors and items of the scale were finally determined, and the reliability of the scale was verified by the Cronbach′s α coefficient and the half coefficient.

Results·The initial scale was composed of 26 items in 5 dimensions, and 136 questionnaires were distributed and 132 valid questionnaires were collected. According to the results of the project analysis, except item 3 that did not meet the criteria for the corrected correlation between the item and the total score, commonality, and factor loading, all the other items met the selection criteria. Since this item was a key step in investigating the patients′ awareness of sterility, this item was retained for factor analysis after expert consultation. The Kaiser-Meyer-Olkin measure of sampling adequacy (KMO) of the initial questionnaire was 0.880, and the χ² value of Bartlett′s spherical test was 2 272.938 (P=0.000). The results suggested that the overall correlation matrix had common factors, which was suitable for factor analysis. According to the original intention of the initial design items of the scale, 5 common factors were limited and extracted, and the maximum variation method of orthogonal rotation axis was adopted, and finally items 7, 11, and 16 were deleted. According to the variable characteristics contained in each factor construct, the extracted common factors were named as “recognition of dialysis complications and adequacy evaluation” “peritoneal standardized operation” “drug management” “dietary management” and “dialysis effect evaluation and monitoring”, respectively, to form a formal questionnaire with 23 items in 5 dimensions. The eigenvalues of each dimension were 4.604, 3.286, 3.207, 2.817, and 2.140, and the cumulative variance contribution rate was 66.428%. The Cronbach′s α coefficient of the total scale was 0.930, and the half coefficient was 0.946.

Conclusion·The self-management scale for PD patients has good reliability and validity, which can be used to evaluate the self-management ability of PD patients.

Key words: peritoneal dialysis (PD), patient self-management, scale, reliability, validity

中图分类号:

R692.5

黄泽慧, 胡春, 李璞, 张春丽, 方均燕, 宋阿会, 魏珊, 纪鸥洋, 佟琰, 邓海, 刘英莉. 居家腹膜透析患者自我管理量表的编制及信度、效度分析研究[J]. 上海交通大学学报(医学版), 2021, 41(7): 942-948.

Ze-hui HUANG, Chun HU, Pu LI, Chun-li ZHANG, Jun-yan FANG, A-hui SONG, Shan WEI, Ou-yang JI, Yan TONG, Hai DENG, Ying-li LIU. Development of self-management scale for peritoneal dialysis at home and its reliability and validity analysis[J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2021, 41(7): 942-948.

图/表 4

参考文献 12

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2	Figueiredo AE, Bernardini J, Bowes E, et al. A syllabus for teaching peritoneal dialysis to patients and caregivers[J]. Perit Dial Int, 2016, 36(6): 592-605.
3	吴婧倩, 刘砚墨, 杨颖昕. 腹膜透析患者用药依从性及相关影响因素分析[J]. 实用药物与临床, 2018, 21(5): 530-532.
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5	郭玲玲, 胡雁, 费锦萍, 等. 居家腹膜透析患者自我护理能力现状及影响因素分析[J]. 中华护理杂志, 2013, 48(5): 436-438.
6	楼翰琦, 杨亚娟, 张平丽, 等. 自我管理教育对提高腹膜透析患者生存质量的影响[J]. 解放军护理杂志, 2009, 26(13): 14-16.
7	刘鹏飞, 王宜芝, 孙玉梅, 等. 腹膜透析患者自我管理行为与自我效能的相关性分析[J]. 中华护理杂志, 2006, 41(7): 615-617.
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11	Karadag E. The effect of a self-management program on hand-washing/mask-wearing behaviours and self-efficacy level in peritoneal dialysis patients: a pilot study[J]. J Ren Care, 2019, 45(2): 93-101.
12	Su CY, Lu XH, Chen W, et al. Promoting self-management improves the health status of patients having peritoneal dialysis[J]. J Adv Nurs, 2009, 65(7): 1381-1389.

Item No.	Content
Peritoneal dialysis standardized operation（腹透规范化操作能力）
1	Can do the fluid replacement by yourself or caregivers who are also trained （能做到您本人或者同样经过培训的亲人、保姆进行腹透液置换操作）
2	Can keep the fluid replacement environment clean， ventilated and dry （能做到保持腹透液置换操作环境干净、通风、干燥）
3	Can wash your hands with soap and wear clean gloves when changing the iodophor cap （能做到在更换碘伏帽时用肥皂和水洗手并戴上干净的手套）
4	Can clean the catheter port and the skin next to it regularly （能做到定期清洗导管口及旁边皮肤）
5	Can change the fluid on time and register each ultrafiltration in the record book （能做到按时更换腹透液，并且在记录本登记每次超滤情况）
6	Can strictly follow the daily dialysis plan provided by your doctor for fluid replacement （能做到按照腹膜透析医生为您制定的每日透析方案进行腹透液置换）
Dialysis effect evaluation and monitoring（腹透效果评估和监测能力）
7	Can record 24-hour urine output at least once a week （能做到至少每周1次记录24小时尿量）
8	Can weigh yourself each morning （能做到每日晨起称体重）
9	Can measure your blood pressure every day （能做到每天测量血压）
10	Can keep regular outpatient follow-up visits to detect biochemical indexes such as blood routine examination， electrolyte， liver and kidney function test （能做到规律门诊随访检测血常规、电解质、肝肾功能等生化指标）
11	Can contact the peritoneal dialysis management nurse in time when there is discomfort （such as abdominal pain， cloudy peritoneal dialysis fluid， poor peritoneal catheter drainage， etc.）［能做到在出现不适时（例如腹痛、腹透液浑浊、腹膜导管引流不畅等）及时与腹透管理护士联系］
Drug management（药物管理能力）
12	Can accurately tell the type of oral drugs you are currently taking （能准确说出目前口服药物种类）
13	Can accurately tell the frequency and time of oral drugs you are taking （能准确说出目前口服药物次数及时间）
14	Can accurately tell the effects of your current oral drugs （能准确说出目前口服药物的作用）
15	Can take your medicine regularly and on time （能做到规律按时、正确使用各种药物）
Dietary management（饮食管理能力）
16	Can control diet such as low salt， low fat， and low phosphorus according to the recommendations of the doctor in charge （能根据主管医生的建议注意控制饮食如低盐、低脂、低磷等）
17	Can take the initiative to understand which symptoms indicate that you currently have calcium and potassium deficiency， hyperphosphatemia or malnutrition， etc. （能主动从主管医生或者网络上了解有哪些症状提示您目前有缺钙、缺钾、高磷或营养不良等）
18	Can reduce your water intake based on ultrafiltration and weight changes （能根据超滤及体重变化情况减少水的摄入）
19	Can take the initiative to understand dietary knowledge suitable for the patients with renal failure （能主动了解适合肾功能不全患者的饮食知识）
20	Can guide your daily diet based on dietary knowledge from medical care or online （能根据从医护处或者网络上了解的饮食知识指导自己每日饮食量）
Recognition of dialysis complications and adequacy evaluation（对腹透并发症和腹透充分性评价的知晓度）
21	What are the adverse effects of unregulated operations （不规范操作有哪些不良影响）
22	What are the symptoms that suggest peritoneal dialysis-related peritonitis （腹膜透析相关性腹膜炎发生时有哪些症状）
23	What conditions indicate that the operation failed （什么情况下提示出现操作失败）
24	What is the significance of monitoring changes in blood pressure and weight （监测血压、体重变化的意义）
25	What indicators should be monitored in each outpatient visit （每次门诊随访应该监测哪些指标）
26	What are the standards of peritoneal dialysis adequacy （腹膜透析充分性达标的标准有哪些）

Item No.	Content
Peritoneal dialysis standardized operation（腹透规范化操作能力）
1	Can do the fluid replacement by yourself or caregivers who are also trained （能做到您本人或者同样经过培训的亲人、保姆进行腹透液置换操作）
2	Can keep the fluid replacement environment clean， ventilated and dry （能做到保持腹透液置换操作环境干净、通风、干燥）
3	Can wash your hands with soap and wear clean gloves when changing the iodophor cap （能做到在更换碘伏帽时用肥皂和水洗手并戴上干净的手套）
4	Can clean the catheter port and the skin next to it regularly （能做到定期清洗导管口及旁边皮肤）
5	Can change the fluid on time and register each ultrafiltration in the record book （能做到按时更换腹透液，并且在记录本登记每次超滤情况）
6	Can strictly follow the daily dialysis plan provided by your doctor for fluid replacement （能做到按照腹膜透析医生为您制定的每日透析方案进行腹透液置换）
Dialysis effect evaluation and monitoring（腹透效果评估和监测能力）
7	Can record 24-hour urine output at least once a week （能做到至少每周1次记录24小时尿量）
8	Can weigh yourself each morning （能做到每日晨起称体重）
9	Can measure your blood pressure every day （能做到每天测量血压）
10	Can keep regular outpatient follow-up visits to detect biochemical indexes such as blood routine examination， electrolyte， liver and kidney function test （能做到规律门诊随访检测血常规、电解质、肝肾功能等生化指标）
11	Can contact the peritoneal dialysis management nurse in time when there is discomfort （such as abdominal pain， cloudy peritoneal dialysis fluid， poor peritoneal catheter drainage， etc.）［能做到在出现不适时（例如腹痛、腹透液浑浊、腹膜导管引流不畅等）及时与腹透管理护士联系］
Drug management（药物管理能力）
12	Can accurately tell the type of oral drugs you are currently taking （能准确说出目前口服药物种类）
13	Can accurately tell the frequency and time of oral drugs you are taking （能准确说出目前口服药物次数及时间）
14	Can accurately tell the effects of your current oral drugs （能准确说出目前口服药物的作用）
15	Can take your medicine regularly and on time （能做到规律按时、正确使用各种药物）
Dietary management（饮食管理能力）
16	Can control diet such as low salt， low fat， and low phosphorus according to the recommendations of the doctor in charge （能根据主管医生的建议注意控制饮食如低盐、低脂、低磷等）
17	Can take the initiative to understand which symptoms indicate that you currently have calcium and potassium deficiency， hyperphosphatemia or malnutrition， etc. （能主动从主管医生或者网络上了解有哪些症状提示您目前有缺钙、缺钾、高磷或营养不良等）
18	Can reduce your water intake based on ultrafiltration and weight changes （能根据超滤及体重变化情况减少水的摄入）
19	Can take the initiative to understand dietary knowledge suitable for the patients with renal failure （能主动了解适合肾功能不全患者的饮食知识）
20	Can guide your daily diet based on dietary knowledge from medical care or online （能根据从医护处或者网络上了解的饮食知识指导自己每日饮食量）
Recognition of dialysis complications and adequacy evaluation（对腹透并发症和腹透充分性评价的知晓度）
21	What are the adverse effects of unregulated operations （不规范操作有哪些不良影响）
22	What are the symptoms that suggest peritoneal dialysis-related peritonitis （腹膜透析相关性腹膜炎发生时有哪些症状）
23	What conditions indicate that the operation failed （什么情况下提示出现操作失败）
24	What is the significance of monitoring changes in blood pressure and weight （监测血压、体重变化的意义）
25	What indicators should be monitored in each outpatient visit （每次门诊随访应该监测哪些指标）
26	What are the standards of peritoneal dialysis adequacy （腹膜透析充分性达标的标准有哪些）

Item No.	CR	Correlation between items and total score		Homogeneity test			No. substandard indicators	Outcome
Item No.	CR	Correlation （r）	Corrected correlation （r）	Reliability coefficient after item deletion	Commonality	Factor loading	No. substandard indicators	Outcome
1	3.992	0.483	0.450	0.929	0.240	0.490	0	Keep
2	4.805	0.541	0.507	0.928	0.304	0.551	0	Keep
3	4.796	0.407	0.359	0.930	0.159	0.399	3	Observe
4	5.532	0.534	0.496	0.929	0.283	0.532	0	Keep
5	3.745	0.501	0.465	0.929	0.260	0.510	0	Keep
6	4.483	0.491	0.453	0.929	0.248	0.498	0	Keep
7	5.695	0.480	0.428	0.930	0.216	0.465	0	Keep
8	6.399	0.557	0.502	0.929	0.292	0.541	0	Keep
9	4.818	0.535	0.485	0.929	0.283	0.532	0	Keep
10	6.135	0.537	0.487	0.929	0.275	0.524	0	Keep
11	5.281	0.546	0.505	0.928	0.300	0.547	0	Keep
12	11.047	0.742	0.711	0.925	0.583	0.763	0	Keep
13	11.908	0.748	0.720	0.925	0.594	0.771	0	Keep
14	13.463	0.750	0.720	0.925	0.593	0.770	0	Keep
15	11.545	0.727	0.694	0.926	0.557	0.746	0	Keep
16	7.215	0.563	0.521	0.928	0.308	0.555	0	Keep
17	6.624	0.564	0.517	0.928	0.319	0.565	0	Keep
18	11.260	0.654	0.613	0.927	0.424	0.651	0	Keep
19	13.320	0.693	0.658	0.926	0.484	0.696	0	Keep
20	13.382	0.677	0.639	0.926	0.461	0.679	0	Keep
21	14.860	0.702	0.661	0.926	0.488	0.699	0	Keep
22	9.913	0.615	0.565	0.928	0.365	0.604	0	Keep
23	13.434	0.692	0.649	0.926	0.464	0.681	0	Keep
24	9.429	0.643	0.597	0.927	0.400	0.632	0	Keep
25	10.634	0.699	0.660	0.926	0.479	0.692	0	Keep
26	9.406	0.590	0.539	0.928	0.334	0.578	0	Keep

Item No.	CR	Correlation between items and total score		Homogeneity test			No. substandard indicators	Outcome
Item No.	CR	Correlation （r）	Corrected correlation （r）	Reliability coefficient after item deletion	Commonality	Factor loading	No. substandard indicators	Outcome
1	3.992	0.483	0.450	0.929	0.240	0.490	0	Keep
2	4.805	0.541	0.507	0.928	0.304	0.551	0	Keep
3	4.796	0.407	0.359	0.930	0.159	0.399	3	Observe
4	5.532	0.534	0.496	0.929	0.283	0.532	0	Keep
5	3.745	0.501	0.465	0.929	0.260	0.510	0	Keep
6	4.483	0.491	0.453	0.929	0.248	0.498	0	Keep
7	5.695	0.480	0.428	0.930	0.216	0.465	0	Keep
8	6.399	0.557	0.502	0.929	0.292	0.541	0	Keep
9	4.818	0.535	0.485	0.929	0.283	0.532	0	Keep
10	6.135	0.537	0.487	0.929	0.275	0.524	0	Keep
11	5.281	0.546	0.505	0.928	0.300	0.547	0	Keep
12	11.047	0.742	0.711	0.925	0.583	0.763	0	Keep
13	11.908	0.748	0.720	0.925	0.594	0.771	0	Keep
14	13.463	0.750	0.720	0.925	0.593	0.770	0	Keep
15	11.545	0.727	0.694	0.926	0.557	0.746	0	Keep
16	7.215	0.563	0.521	0.928	0.308	0.555	0	Keep
17	6.624	0.564	0.517	0.928	0.319	0.565	0	Keep
18	11.260	0.654	0.613	0.927	0.424	0.651	0	Keep
19	13.320	0.693	0.658	0.926	0.484	0.696	0	Keep
20	13.382	0.677	0.639	0.926	0.461	0.679	0	Keep
21	14.860	0.702	0.661	0.926	0.488	0.699	0	Keep
22	9.913	0.615	0.565	0.928	0.365	0.604	0	Keep
23	13.434	0.692	0.649	0.926	0.464	0.681	0	Keep
24	9.429	0.643	0.597	0.927	0.400	0.632	0	Keep
25	10.634	0.699	0.660	0.926	0.479	0.692	0	Keep
26	9.406	0.590	0.539	0.928	0.334	0.578	0	Keep

Item No.	Commonality	Factor 1	Factor 2	Factor 3	Factor 4	Factor 5
Factor 1： Recognition of dialysis complications and adequacy evaluation
23	0.777	0.843	0.116	0.140	0.175	0.049
24	0.734	0.809	0.027	0.227	0.071	0.149
22	0.716	0.799	0.114	0.076	0.236	-0.062
26	0.697	0.788	-0.086	0.208	0.140	0.082
21	0.724	0.752	0.132	0.315	0.205	-0.001
25	0.693	0.745	0.090	0.184	0.231	0.205
Factor 2： Peritoneal dialysis standardized operation
2	0.683	0.074	0.772	0.222	0.036	0.174
5	0.743	-0.037	0.752	0.198	-0.025	0.370
3	0.484	-0.023	0.658	0.023	0.217	0.049
1	0.511	0.164	0.625	0.145	0.214	-0.161
6	0.515	0.043	0.609	0.266	0.014	0.267
4	0.583	0.200	0.572	-0.037	0.107	0.451
Factor 3： Drug management
14	0.893	0.265	0.152	0.824	0.326	0.117
15	0.850	0.293	0.159	0.820	0.234	0.105
12	0.813	0.348	0.228	0.767	0.125	0.194
13	0.776	0.377	0.275	0.719	0.139	0.151
Factor 4： Dietary management
19	0.839	0.260	0.126	0.180	0.817	0.233
17	0.736	0.206	0.164	0.149	0.799	-0.074
20	0.768	0.222	0.198	0.200	0.782	0.165
18	0.574	0.387	0.039	0.221	0.568	0.225
Factor 5： Dialysis effect evaluation and monitoring
8	0.731	0.198	0.152	0.170	0.101	0.793
9	0.663	-0.053	0.238	0.378	0.157	0.661
10	0.553	0.116	0.452	-0.004	0.176	0.552
Eigenvalue	?	4.604	3.286	3.207	2.817	2.140
Variance explained/%	?	20.016	14.288	13.941	12.248	9.306