中文版记忆障碍感知问卷的修订及其在记忆抱怨主诉人群中的初步应用研究

发布时间：2018-07-10 06:16

本文选题：记忆抱怨主诉 + 记忆障碍感知　；参考：《第三军医大学》2017年硕士论文

【摘要】：【目的】1.通过规范的国际通用问卷翻译修订方法,将英文版记忆障碍感知问卷(Illness Perception Questionnaire,IPQ-M)引进我国,结合我国文化背景进行修订,形成记忆障碍感知问卷中文版。2.采用横断面调查的研究设计,应用中文版的IPQ-M问卷调查记忆抱怨主诉(Subjective Memory Complaints,SMCs)人群的记忆障碍感知特征及其影响因素,以帮助社区医疗工作者及广大老年医学领域的研究者更深入地了解SMCs人群的记忆障碍感知状况,从而更好地为他们提供医疗服务和有针对性的认知干预措施。3.通过分析记忆障碍感知对SMCs人群记忆相关求助行为的影响,为SMCs人群有针对性的健康宣教和干预措施的制定提供理论依据,从而促进SMCs人群及早寻医问诊,以有利于老年痴呆的早期筛查、诊断与防治。【方法】1.通过国际通用的问卷修订流程“翻译-逆向翻译-文化调试-预试验-大样本调查的方法”将英文版IPQ-M问卷引进我国,并通过专家咨询及小样本预测试对条目进行修订,形成初步修订版IPQ-M问卷。2.采用便利性抽样方法,以初步修订版的IPQ-M问卷对重庆市4个社区卫生服务中心建档管理的660位符合纳入标准的SMCs人群进行调查评估。数据录入按奇偶折半法将数据分成2份,一部分样本A(330例),做探索性因素分析;另一部分样本B(330例),运用AMOS20.0软件对问卷进行验证性因素分析,并检测问卷的内部一致性、重测信度、折半信度与效标效度,以形成正式版本的中文版IPQ-M问卷。3.以正式形成的中文版IPQ-M问卷为工具,抽取符合纳入标准的SMCs人群305例进行调查,应用方差分析、spearman相关分析、多元线性回归分析等方法分析社区SMCs人群的记忆障碍感知特征及影响因素。4.结合受试者的听觉词语学习测验量表(AVLT)、简易精神状态评价量表(MMSE)、老年抑郁量表(GDS)的测量结果,应用Logistic回归等方法分析记忆障碍感知对SMCs人群记忆相关求助行为的影响。【结果】1.中文版IPQ-M问卷的信效度评价。正式形成的中文版IPQ-M问卷包含3个部分,11个维度,共计86个条目。第一部分为症状维度,包含19个症状特征,认为与记忆下降相关的症状条目累加计分作为症状感知得分,得分愈高提示感知的症状愈多。第二部分为病情认知,共44个条目,包括病程(急/慢性)、所致后果、进展时间(稳定/下降)、个人控制(责备)、个人控制(无助)、情感表现、治疗控制、疾病关联、社会比较9个维度。第三部分为疾病归因,包含23个SMCs人群认为的可能导致记忆下降的原因。问卷的信效度检验结果如下:(1)内容效度:中文预试版的条目水平内容效度(I-CVI)为0.83~1.0;问卷整体的(S-CVI)为0.913。(2)结构效度:探索性因素分析显示中文版IPQ-M问卷的因子累计方差贡献率为70.757%,且各条目在相应因子上有较满意的因子载荷量(0.4)。验证性因素分析进一步证实了中文版IPQ-M问卷结构的合理性,其分析结果显示,卡方自由度比值(X2/df)为1.865,小于2;RMR为0.027,0.05;RMSEA为0.075,0.08;GFI(0.940)、AGFI(0.910)、NFI(0.903)、CFI(0.939)值均大于0.9,表示数据拟合结果较好。(3)校标效度:以GDS为校标,中文版IPQ-M问卷的维度与GDS呈一定程度的相关,相关系数为-0.242~0.614(p0.05)。(4)内部一致性:中文版IPQ-M问卷各因子的α系数范围为0.770~0.927。(5)重测信度(间隔2周):重测相关系数范围为0.532~0.908(6)折半信度:问卷的Spearman-Brown系数在0.747~0.916之间2.SMCs人群的记忆障碍感知特征及影响因素本研究对象记忆障碍感知主要特征分析:病程(3.57±0.89分)、进展时间(3.71±0.88分)、个人控制(责备)(3.61±0.92分)、疾病关联(3.14±0.64分)、治疗控制(2.78±0.67分)5个维度得分显示为负性感知;后果(2.24±0.77分)、情感表现(2.29±0.70分)、个人控制(无助)(3.31±0.73分)3个维度得分显示为正性感知。社会比较维度得分(2.95±0.78分)显示为中性。记忆下降归因部分的二十三个条目中,得分频率排名前五位的分别是:年龄引起的老化(93.5%)、注意力不集中或没有听清楚(75.4%)、大脑供血不足(61.1%)、不用脑子(58.4%)、脑细胞丢失(55.9%)。另外,有31.1%的人把记忆下降归因于机会或运气不好。多元线性回归显示,中文版IPQ-M问卷第2部分的9个因子分别不同程度受SMCs人群的教育程度、性别、居住状况、婚姻情况、经济水平、痴呆家族史、痴呆知识教育因素的影响。3.SMCs人群的记忆障碍感知对其针对记忆问题相关求助行为的影响本地区的SMCs人群记忆相关求助行为的比率很低,仅为14.4%,其寻求帮助的方式也较单一,其中到社区卫生服务中心进行咨询的占5.6%,询问亲戚朋友的占5.2%,观看养生类节目和书籍的占1.6%,而到大医院记忆诊所看专科医生的仅占2.0%。Logistic回归分析显示:治疗控制(OR=2.456)、情感表现(OR=2.268)、症状感知(OR=1.455)三个维度和脑供血不足(OR=1.115)、不动脑(OR=2.079)、孤独(OR=0.253)、老化(OR=0.450)、机会或运气不好(OR=0.374)五个归因感知,以及是否接受过痴呆知识教育(OR=5.176)是影响SMCs人群记忆相关求助行为的主要因素。治疗控制、情感表现、症状感知三个维度的得分越高,将记忆下降的原因归于脑供血不足和不动脑,以及接受过痴呆知识教育的人求助的可能性更大;将记忆下降的原因归于孤独、老化、机会或运气不好的人求助的几率更小。【结论】1.中文版IPQ-M结构合理,信效度良好,适合于我国文化背景下对中老年SMCs人群进行记忆障碍感知的评估。2.我国SMCs人群记忆障碍感知特征分析显示:SMCs人群对记忆下降的相关知识不够了解,存在较多错误和消极的感知,记忆障碍感知的影响因素复杂。提示在开展认知健康宣教时,应有针对性地制定相关策略,提高记忆抱怨主诉人群对记忆下降和老年痴呆防治知识的了解,培养其积极正确的感知。3.SMCs人群的记忆障碍感知对其针对记忆问题的相关求助行为有一定的预测能力,社区医护人员应重视SMCs人群关于记忆下降的感知,督促其及早就医,以利于痴呆的早期筛查、诊断与防治。
[Abstract]:[Objective] 1. the English version of Illness Perception Questionnaire (IPQ-M) was introduced into China through the standardized international general questionnaire translation revision method. The Chinese version of the Chinese version of the memory barrier perception questionnaire was designed by the Chinese version of the Chinese version of the Chinese version of the English version of the Illness (IPQ-M), and the Chinese version of the Chinese version of the questionnaire was applied. In order to help community medical workers and researchers in the field of geriatric medicine to know more about the perception of memory disorders in the population of Subjective Memory Complaints (SMCs), it is better to provide medical services and pertinence for them. The effect of cognitive intervention on the memory related recourse behavior of the SMCs population by analyzing the perception of memory disorder (.3.) provides a theoretical basis for the formulation of targeted health education and intervention measures for the population of SMCs, thus promoting the early medical search for the SMCs population to help the early screening, diagnosis and Prevention of Alzheimer's disease. [method] 1. The English version of the IPQ-M questionnaire is introduced to China by the international general revision process, "translation reverse translation, cultural debugging pre test and large sample survey", and revising the items through expert consultation and small sample prediction to form a preliminary revised version of the IPQ-M questionnaire.2. using the convenience sampling method, with a preliminary revision of the IPQ-M question. The volume of 4 community health service centers in Chongqing was investigated and evaluated by the 660 SMCs people in accordance with the standard. Data entry was divided into 2 parts by odd and even half method, one part of the sample A (330 cases), exploratory factor analysis, and another part of B (330 cases), using AMOS20.0 software to carry out confirmatory factor analysis to the questionnaire, The internal consistency, retest reliability, half reliability and validity of the questionnaire were tested to form a formal version of the Chinese version of the IPQ-M questionnaire.3. to formally form the Chinese version of the IPQ-M questionnaire as a tool, to extract 305 cases of SMCs people conforming to the inclusion criteria for investigation, application of variance analysis, Spearman correlation analysis, multiple linear regression analysis and other methods. The perception characteristics and influencing factors of memory disorders in the community SMCs population were analyzed by.4. combined with the subjects' auditory vocabulary learning test scale (AVLT), the simple mental state assessment scale (MMSE), the measurement results of the elderly depression scale (GDS), and the effect of memory impairment perception on the memory related help behavior of SMCs population by using Logistic regression. [results] to evaluate the validity and validity of the Chinese version of the 1. version of IPQ-M. The formal Chinese version of the IPQ-M questionnaire contains 3 parts, 11 dimensions, and a total of 86 items. The first part is the symptom dimension, including 19 symptom features. The cumulative score of the symptom items related to the decline of memory is considered as a symptom perception score, the higher the score is, the higher the symptoms of the symptoms suggest the perceived symptoms. The more. The second part is the cognition of the disease. There are 44 items, including the course (emergency / chronic), the result, the time (stability / decline), the personal control (blame), the personal control (helplessness), the emotional expression, the treatment control, the disease association, the social comparison 9 dimensions. The third part is the disease attribution, including the possibility that the 23 SMCs population may lead to the memory. The results of the reliability and validity of the questionnaire are as follows: (1) content validity: the content validity (I-CVI) of the Chinese pretrial version is 0.83~1.0; the overall (S-CVI) of the questionnaire is 0.913. (2) structure validity: the exploratory factor analysis shows that the cumulative variance contribution rate of the Chinese version of the IPQ-M questionnaire is 70.757%, and the items are compared to the corresponding factors. Satisfactory factor load (0.4). Confirmatory factor analysis further confirmed the rationality of the Chinese version of the IPQ-M questionnaire, which showed that the ratio of chi square's degree of freedom (X2/df) was 1.865, less than 2; RMR was 0.027,0.05; RMSEA was 0.075,0.08; GFI (0.940), AGFI (0.910), NFI (0.903), CFI (0.939) values were more than 0.9, indicating that data fitting results were more than 0.9. (3) calibration validity: with GDS as the standard, the dimension of the Chinese version of IPQ-M questionnaire is related to GDS to a certain extent, the correlation coefficient is -0.242~0.614 (P0.05). (4) internal consistency: the alpha coefficient of each factor of the Chinese version IPQ-M questionnaire is 0.770~0.927. (5) retest reliability (interval 2 weeks): the range of retest correlation coefficient is 0.532~0.908 (6) half reliability: Questionnaire The Spearman-Brown coefficient of the memory impairment of the 2.SMCs population between 0.747~0.916 and the factors influencing the main characteristics of memory impairment: the course (3.57 + 0.89), the time of progression (3.71 + 0.88), personal control (3.61 + 0.92), disease association (3.14 + 0.64), and treatment control (2.78 + 0.67) 5. The degree score was negative perception; the result (2.24 + 0.77), emotional performance (2.29 + 0.70), personal control (3.31 + 0.73) and 3 dimensions showed positive perception. The score of social comparison dimension (2.95 + 0.78 points) showed neutral. In twenty-three entries of the attribution part of memory decline, the top five in the scoring frequency were respectively: Age induced aging (93.5%), concentration of attention or lack of hearing (75.4%), cerebral blood supply deficiency (61.1%), brain loss (58.4%), brain cell loss (55.9%). In addition, 31.1% of people attributed the decline in memory to opportunity or bad luck. Multiple linear regression showed that the 9 factors of the Chinese version of IPQ-M questionnaire second part were different to S in varying degrees. The education level, gender, living condition, marital status, economic level, dementia family history, dementia knowledge education factors in the MCs population, the impact of memory impairment on the memory related help behavior in.3.SMCs population is low, only 14.4%, which is 14.4%, to seek help. 5.6% of the community health service centers were consulted, 5.2% of relatives and friends, 1.6% of watching health programs and books, while only 2.0%.Logistic regression analysis showed that treatment control (OR =2.456), emotional expression (OR=2.268), symptom perception (OR=1.455) three The dimensions and cerebral blood supply deficiency (OR=1.115), OR=2.079, OR=0.253, aging (OR=0.450), opportunity or bad luck (OR=0.374) five attribution perception, and whether to accept dementia knowledge education (OR=5.176) are the main factors affecting the recourse behavior of the SMCs population. Treatment control, emotional expression, and symptom perception are three dimensions. The higher the score, the decrease in memory is attributed to the lack of brain blood supply and the brain, and the people who have received dementia knowledge education are more likely to seek help. The reasons for the decline of memory are attributed to loneliness, aging, opportunity or bad luck. [Conclusion] 1. Chinese version of IPQ-M is reasonable in structure and good in reliability and validity. The assessment of memory impairment in middle-aged and elderly SMCs population under the cultural background of China.2., the analysis of the cognitive characteristics of memory disorders in the Chinese SMCs population shows that the knowledge of the memory decline in the SMCs population is not enough, there are more errors and negative perceptions, and the influence factors of the memory impairment are complex. At the time, we should formulate relevant strategies to improve the knowledge of memory decline and Alzheimer's prevention and control in memory complaining, and to cultivate their positive and correct perception of the memory barrier of the.3.SMCs population to a certain pretest ability for their related recourse behaviors against memory problems. The community medical staff should attach importance to the SMCs crowd. In the sense of memory decline, urging them to seek medical treatment early is conducive to early screening, diagnosis and prevention of dementia.
【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.74

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