上海交通大学学报(医学版) ›› 2022, Vol. 42 ›› Issue (12): 1729-1738.doi: 10.3969/j.issn.1674-8115.2022.12.011
• 论著 · 公共卫生 • 上一篇
魏珊(), 纪鸥洋, 陈志豪, 黄泽慧, 李璞, 方均燕, 刘英莉()
收稿日期:
2022-04-19
接受日期:
2022-11-21
出版日期:
2022-12-28
发布日期:
2022-12-28
通讯作者:
刘英莉
E-mail:18252431312@163.com;18616375719@163.com
作者简介:
魏 珊(1994—),女,住院医师,硕士;电子信箱:18252431312@163.com。
基金资助:
WEI Shan(), JI Ouyang, CHEN Zhihao, HUANG Zehui, LI Pu, FANG Junyan, LIU Yingli()
Received:
2022-04-19
Accepted:
2022-11-21
Online:
2022-12-28
Published:
2022-12-28
Contact:
LIU Yingli
E-mail:18252431312@163.com;18616375719@163.com
Supported by:
摘要:
目的·编制慢性肾脏病(chronic kidney disease,CKD)患者安全用药知识-信念-行为(knowledge,attitude,belief and practice,KABP)量表并检验其信度和效度。方法·基于KABP理论,通过系统的文献回顾和半结构化访谈,由科研小组成员综合讨论设计初始条目。采用德尔菲专家咨询法和预调查改进初始条目形成初始量表。纳入上海交通大学医学院附属第九人民医院CKD患者进行问卷调查,使用临界比值法、同质性检验进行条目分析,分别使用探索性因子分析和逻辑分析检验量表的结构效度和内容效度,使用Cronbach′s α系数、折半信度、重测信度检验量表信度。结果·初始量表由3个维度29个条目组成,共发放213份问卷,收集有效问卷209份。条目分析结果显示条目1、2、3、19均有3项以上指标未达标,因此删除这4个条目后进行效度检验。初始量表KMO(Kaiser-Meyer-Olkin)为0.946,Bartlett′s球形检验χ2值为4 554.451(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。使用主成分分析法及直交转轴最大变异法进行因素分析,最终删除条目13;根据各因素内的条目变量特性,提取的3个共同因素分别命名为“安全用药行为”“安全用药知识”“安全用药信念”,3个维度的特征值分别为6.565、6.176、3.863;累积方差贡献率为69.18%。全体一致量表水平内容效度(scale-level-content validity index/universal agreement,S-CVI/UA)和平均量表水平内容效度(S-CVI/average,S-CVI/Ave)分别为0.860和0.987。最终量表由3个维度24个条目组成。信度检验显示总量表的Cronbach′s α系数为0.964,折半信度为0.911,重测信度为0.892。结论·该研究编制的CKD患者安全用药KABP量表具有良好的信度和效度。
中图分类号:
魏珊, 纪鸥洋, 陈志豪, 黄泽慧, 李璞, 方均燕, 刘英莉. 慢性肾脏病患者安全用药知信行量表的编制及信度、效度分析[J]. 上海交通大学学报(医学版), 2022, 42(12): 1729-1738.
WEI Shan, JI Ouyang, CHEN Zhihao, HUANG Zehui, LI Pu, FANG Junyan, LIU Yingli. Development and validation of a knowledge, attitude, belief and practice scale for safe medication in patients with chronic kidney disease[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022, 42(12): 1729-1738.
Index | Number of patients/n | Percentage/% |
---|---|---|
Age/year | ||
18‒44 | 26 | 12.44 |
45‒59 | 64 | 30.62 |
60‒74 | 90 | 43.06 |
≥75 | 29 | 13.88 |
Gender | ||
Male | 126 | 60.29 |
Female | 83 | 39.71 |
Education level | ||
Primary education | 36 | 17.22 |
Secondary education | 125 | 59.81 |
Higher education | 48 | 22.97 |
Monthly per capita income/yuan | ||
<3 000 | 49 | 23.44 |
3 000‒6 000 | 85 | 40.67 |
>6 000 | 75 | 35.89 |
Marital status | ||
Unmarried | 12 | 5.74 |
Married | 181 | 86.60 |
Divorced/widowed | 16 | 7.65 |
Residence status | ||
Living with partner | 150 | 71.77 |
Living with kids or parents | 32 | 15.31 |
Living alone | 27 | 12.92 |
Health insurance | ||
Social medical insurance | 192 | 91.87 |
Commercial medical insurance | 6 | 2.87 |
Self-funded | 11 | 5.26 |
CKD stage | ||
Stage 1‒2 | 10 | 4.79 |
Stage 3‒4 | 23 | 11.00 |
Dialysis | 176 | 84.21 |
表1 量表测试对象的人口学特征(n=209)
Tab 1 Demographical characteristics of the test objects (n=209)
Index | Number of patients/n | Percentage/% |
---|---|---|
Age/year | ||
18‒44 | 26 | 12.44 |
45‒59 | 64 | 30.62 |
60‒74 | 90 | 43.06 |
≥75 | 29 | 13.88 |
Gender | ||
Male | 126 | 60.29 |
Female | 83 | 39.71 |
Education level | ||
Primary education | 36 | 17.22 |
Secondary education | 125 | 59.81 |
Higher education | 48 | 22.97 |
Monthly per capita income/yuan | ||
<3 000 | 49 | 23.44 |
3 000‒6 000 | 85 | 40.67 |
>6 000 | 75 | 35.89 |
Marital status | ||
Unmarried | 12 | 5.74 |
Married | 181 | 86.60 |
Divorced/widowed | 16 | 7.65 |
Residence status | ||
Living with partner | 150 | 71.77 |
Living with kids or parents | 32 | 15.31 |
Living alone | 27 | 12.92 |
Health insurance | ||
Social medical insurance | 192 | 91.87 |
Commercial medical insurance | 6 | 2.87 |
Self-funded | 11 | 5.26 |
CKD stage | ||
Stage 1‒2 | 10 | 4.79 |
Stage 3‒4 | 23 | 11.00 |
Dialysis | 176 | 84.21 |
Item No. | CR | Correlation between item score and total score | Homogeneity test | Substandard indicators/n | Outcome | |||
---|---|---|---|---|---|---|---|---|
Correlation (r) | Corrected correlation (r) | Reliability coefficient after item deletion | Commonality | Factor loading | ||||
1 | 6.088 | 0.426 | 0.382 | 0.958 | 0.144 | 0.379 | 4 | Delete |
2 | 2.457 | 0.237 | 0.195 | 0.959 | 0.030 | 0.174 | 6 | Delete |
3 | 2.803 | 0.273 | 0.228 | 0.959 | 0.044 | 0.209 | 6 | Delete |
4 | 19.602 | 0.790 | 0.765 | 0.955 | 0.613 | 0.783 | 0 | Keep |
5 | 16.770 | 0.785 | 0.761 | 0.955 | 0.610 | 0.781 | 0 | Keep |
6 | 16.195 | 0.773 | 0.747 | 0.955 | 0.595 | 0.771 | 0 | Keep |
7 | 14.897 | 0.758 | 0.731 | 0.955 | 0.565 | 0.752 | 0 | Keep |
8 | 11.618 | 0.699 | 0.667 | 0.955 | 0.489 | 0.699 | 0 | Keep |
9 | 9.631 | 0.684 | 0.650 | 0.956 | 0.452 | 0.673 | 0 | Keep |
10 | 13.700 | 0.735 | 0.705 | 0.955 | 0.538 | 0.733 | 0 | Keep |
11 | 15.601 | 0.778 | 0.751 | 0.955 | 0.607 | 0.779 | 0 | Keep |
12 | 19.077 | 0.818 | 0.797 | 0.954 | 0.674 | 0.821 | 0 | Keep |
13 | 8.026 | 0.598 | 0.567 | 0.956 | 0.323 | 0.568 | 0 | Keep |
14 | 12.427 | 0.703 | 0.681 | 0.955 | 0.518 | 0.719 | 0 | Keep |
15 | 12.166 | 0.748 | 0.732 | 0.955 | 0.589 | 0.767 | 0 | Keep |
16 | 7.946 | 0.567 | 0.544 | 0.956 | 0.345 | 0.587 | 0 | Keep |
17 | 10.929 | 0.681 | 0.658 | 0.956 | 0.494 | 0.703 | 0 | Keep |
18 | 11.692 | 0.705 | 0.686 | 0.956 | 0.517 | 0.719 | 0 | Keep |
19 | 3.366 | 0.284 | 0.243 | 0.958 | 0.077 | 0.277 | 5 | Delete |
20 | 14.774 | 0.809 | 0.794 | 0.955 | 0.666 | 0.816 | 0 | Keep |
21 | 12.346 | 0.752 | 0.731 | 0.955 | 0.563 | 0.750 | 0 | Keep |
22 | 15.790 | 0.806 | 0.791 | 0.955 | 0.677 | 0.823 | 0 | Keep |
23 | 16.761 | 0.778 | 0.751 | 0.955 | 0.622 | 0.788 | 0 | Keep |
24 | 16.104 | 0.771 | 0.747 | 0.955 | 0.623 | 0.790 | 0 | Keep |
25 | 16.545 | 0.764 | 0.742 | 0.955 | 0.598 | 0.774 | 0 | Keep |
26 | 15.400 | 0.761 | 0.740 | 0.955 | 0.593 | 0.770 | 0 | Keep |
27 | 13.471 | 0.709 | 0.679 | 0.955 | 0.507 | 0.712 | 0 | Keep |
28 | 15.075 | 0.735 | 0.711 | 0.955 | 0.551 | 0.742 | 0 | Keep |
29 | 13.919 | 0.661 | 0.632 | 0.956 | 0.448 | 0.669 | 0 | Keep |
表2 CKD患者安全用药KABP量表条目分析
Tab 2 Analysis of KABP scale items of safe medication in patients with CKD
Item No. | CR | Correlation between item score and total score | Homogeneity test | Substandard indicators/n | Outcome | |||
---|---|---|---|---|---|---|---|---|
Correlation (r) | Corrected correlation (r) | Reliability coefficient after item deletion | Commonality | Factor loading | ||||
1 | 6.088 | 0.426 | 0.382 | 0.958 | 0.144 | 0.379 | 4 | Delete |
2 | 2.457 | 0.237 | 0.195 | 0.959 | 0.030 | 0.174 | 6 | Delete |
3 | 2.803 | 0.273 | 0.228 | 0.959 | 0.044 | 0.209 | 6 | Delete |
4 | 19.602 | 0.790 | 0.765 | 0.955 | 0.613 | 0.783 | 0 | Keep |
5 | 16.770 | 0.785 | 0.761 | 0.955 | 0.610 | 0.781 | 0 | Keep |
6 | 16.195 | 0.773 | 0.747 | 0.955 | 0.595 | 0.771 | 0 | Keep |
7 | 14.897 | 0.758 | 0.731 | 0.955 | 0.565 | 0.752 | 0 | Keep |
8 | 11.618 | 0.699 | 0.667 | 0.955 | 0.489 | 0.699 | 0 | Keep |
9 | 9.631 | 0.684 | 0.650 | 0.956 | 0.452 | 0.673 | 0 | Keep |
10 | 13.700 | 0.735 | 0.705 | 0.955 | 0.538 | 0.733 | 0 | Keep |
11 | 15.601 | 0.778 | 0.751 | 0.955 | 0.607 | 0.779 | 0 | Keep |
12 | 19.077 | 0.818 | 0.797 | 0.954 | 0.674 | 0.821 | 0 | Keep |
13 | 8.026 | 0.598 | 0.567 | 0.956 | 0.323 | 0.568 | 0 | Keep |
14 | 12.427 | 0.703 | 0.681 | 0.955 | 0.518 | 0.719 | 0 | Keep |
15 | 12.166 | 0.748 | 0.732 | 0.955 | 0.589 | 0.767 | 0 | Keep |
16 | 7.946 | 0.567 | 0.544 | 0.956 | 0.345 | 0.587 | 0 | Keep |
17 | 10.929 | 0.681 | 0.658 | 0.956 | 0.494 | 0.703 | 0 | Keep |
18 | 11.692 | 0.705 | 0.686 | 0.956 | 0.517 | 0.719 | 0 | Keep |
19 | 3.366 | 0.284 | 0.243 | 0.958 | 0.077 | 0.277 | 5 | Delete |
20 | 14.774 | 0.809 | 0.794 | 0.955 | 0.666 | 0.816 | 0 | Keep |
21 | 12.346 | 0.752 | 0.731 | 0.955 | 0.563 | 0.750 | 0 | Keep |
22 | 15.790 | 0.806 | 0.791 | 0.955 | 0.677 | 0.823 | 0 | Keep |
23 | 16.761 | 0.778 | 0.751 | 0.955 | 0.622 | 0.788 | 0 | Keep |
24 | 16.104 | 0.771 | 0.747 | 0.955 | 0.623 | 0.790 | 0 | Keep |
25 | 16.545 | 0.764 | 0.742 | 0.955 | 0.598 | 0.774 | 0 | Keep |
26 | 15.400 | 0.761 | 0.740 | 0.955 | 0.593 | 0.770 | 0 | Keep |
27 | 13.471 | 0.709 | 0.679 | 0.955 | 0.507 | 0.712 | 0 | Keep |
28 | 15.075 | 0.735 | 0.711 | 0.955 | 0.551 | 0.742 | 0 | Keep |
29 | 13.919 | 0.661 | 0.632 | 0.956 | 0.448 | 0.669 | 0 | Keep |
Item No. | Commonality | Factor loading | ||
---|---|---|---|---|
Factor 1 | Factor 2 | Factor 3 | ||
Factor 1: Practice of safe medication | ||||
22 | 0.814 | 0.815 | 0.307 | 0.236 |
20 | 0.769 | 0.780 | 0.348 | 0.199 |
21 | 0.690 | 0.770 | 0.242 | 0.199 |
23 | 0.736 | 0.753 | 0.291 | 0.292 |
24 | 0.731 | 0.729 | 0.278 | 0.348 |
26 | 0.675 | 0.716 | 0.296 | 0.273 |
25 | 0.679 | 0.710 | 0.364 | 0.207 |
27 | 0.573 | 0.649 | 0.321 | 0.222 |
28 | 0.593 | 0.638 | 0.342 | 0.262 |
29 | 0.483 | 0.576 | 0.335 | 0.198 |
Factor 2: Knowledge about safe medication | ||||
11 | 0.816 | 0.277 | 0.831 | 0.221 |
12 | 0.806 | 0.374 | 0.782 | 0.234 |
5 | 0.739 | 0.300 | 0.759 | 0.269 |
8 | 0.664 | 0.230 | 0.749 | 0.223 |
7 | 0.688 | 0.299 | 0.738 | 0.232 |
6 | 0.682 | 0.349 | 0.702 | 0.261 |
10 | 0.640 | 0.377 | 0.690 | 0.147 |
4 | 0.655 | 0.394 | 0.647 | 0.287 |
9 | 0.511 | 0.297 | 0.611 | 0.222 |
Factor 3: Belief of safe medication | ||||
16 | 0.776 | 0.179 | 0.142 | 0.850 |
15 | 0.797 | 0.376 | 0.300 | 0.752 |
17 | 0.714 | 0.265 | 0.352 | 0.721 |
18 | 0.699 | 0.362 | 0.275 | 0.701 |
14 | 0.675 | 0.310 | 0.365 | 0.668 |
Eigenvalue | ‒ | 6.565 | 6.176 | 3.863 |
Variance explained/% | ‒ | 27.352 | 53.085 | 69.180 |
表3 CKD患者安全用药KABP量表各条目的共同性及因素负荷量矩阵
Tab 3 Factor loading matrix and commonality of KABP scale items of safe medication in patients with CKD
Item No. | Commonality | Factor loading | ||
---|---|---|---|---|
Factor 1 | Factor 2 | Factor 3 | ||
Factor 1: Practice of safe medication | ||||
22 | 0.814 | 0.815 | 0.307 | 0.236 |
20 | 0.769 | 0.780 | 0.348 | 0.199 |
21 | 0.690 | 0.770 | 0.242 | 0.199 |
23 | 0.736 | 0.753 | 0.291 | 0.292 |
24 | 0.731 | 0.729 | 0.278 | 0.348 |
26 | 0.675 | 0.716 | 0.296 | 0.273 |
25 | 0.679 | 0.710 | 0.364 | 0.207 |
27 | 0.573 | 0.649 | 0.321 | 0.222 |
28 | 0.593 | 0.638 | 0.342 | 0.262 |
29 | 0.483 | 0.576 | 0.335 | 0.198 |
Factor 2: Knowledge about safe medication | ||||
11 | 0.816 | 0.277 | 0.831 | 0.221 |
12 | 0.806 | 0.374 | 0.782 | 0.234 |
5 | 0.739 | 0.300 | 0.759 | 0.269 |
8 | 0.664 | 0.230 | 0.749 | 0.223 |
7 | 0.688 | 0.299 | 0.738 | 0.232 |
6 | 0.682 | 0.349 | 0.702 | 0.261 |
10 | 0.640 | 0.377 | 0.690 | 0.147 |
4 | 0.655 | 0.394 | 0.647 | 0.287 |
9 | 0.511 | 0.297 | 0.611 | 0.222 |
Factor 3: Belief of safe medication | ||||
16 | 0.776 | 0.179 | 0.142 | 0.850 |
15 | 0.797 | 0.376 | 0.300 | 0.752 |
17 | 0.714 | 0.265 | 0.352 | 0.721 |
18 | 0.699 | 0.362 | 0.275 | 0.701 |
14 | 0.675 | 0.310 | 0.365 | 0.668 |
Eigenvalue | ‒ | 6.565 | 6.176 | 3.863 |
Variance explained/% | ‒ | 27.352 | 53.085 | 69.180 |
Dimension | Item/n | Cronbach′s α | Spearman-Brown split-half coefficient | Test-retest reliability (P value) |
---|---|---|---|---|
Knowledge about safe medication | 9 | 0.942 | 0.915 | 0.896 (0.000) |
Belief of safe medication | 5 | 0.899 | 0.900 | 0.744 (0.000) |
Practice of safe medication | 10 | 0.942 | 0.949 | 0.791 (0.000) |
Total scale | 24 | 0.964 | 0.911 | 0.892 (0.000) |
表4 CKD患者安全用药KABP量表各维度及总量表信度分析
Tab 4 Reliability analysis of each dimension and KABP scale of safe medication in patients with CKD
Dimension | Item/n | Cronbach′s α | Spearman-Brown split-half coefficient | Test-retest reliability (P value) |
---|---|---|---|---|
Knowledge about safe medication | 9 | 0.942 | 0.915 | 0.896 (0.000) |
Belief of safe medication | 5 | 0.899 | 0.900 | 0.744 (0.000) |
Practice of safe medication | 10 | 0.942 | 0.949 | 0.791 (0.000) |
Total scale | 24 | 0.964 | 0.911 | 0.892 (0.000) |
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