中文版患者积极度量表的修订及在慢性心力衰竭患者中的应用研究

发布时间：2018-05-11 18:58

本文选题：慢性心力衰竭 + 患者积极度　；参考：《山东大学》2017年硕士论文

【摘要】：目的:修订源自台湾的中文版患者积极度量表(Patient Activation Measure 13,PAM13),将其应用于当地慢性心力衰竭患者中并检验其信度和效度,以制订适合中国大陆人群的简体中文版患者积极度量表,同时研究慢性心力衰竭患者的积极度水平及其影响因素,以制定提高患者积极度水平的策略。方法:采用方便抽样的方法,选择2016年9月至2017年1月于山东省济南市两家三级甲等医院住院治疗的200例慢性心力衰竭患者作为研究对象,采用修订简体中文版患者积极度量表和自编患者基本信息问卷获得数据,进行中文版患者积极度量表的信度、效度检验,评价慢性心力衰竭患者积极度水平,并分析影响患者积极度水平的因素。将调查数据整理后输入SPSS 17.0统计软件进行统计分析,采用Cronbach's α系数、重测信度评价问卷的信度;采用内容效度指数(CVI)、验证性因素分析和探索性因子分析法评价量表的效度;慢性心力衰竭患者积极度水平现状采用描述性统计;慢性心力衰竭患者积极度水平的影响因素采用有序多分类的logistic回归方法对进行分析。结果:1.相关分析法和决断值法对问卷进行项目分析的结果显示,条目与所属模块的相关均达到显著性水平(P0.01),其中除条目2与所属分量表的相关系数为0.25,其余条目相关系数均在0.4以上,13个条目的决断值(CR值)均大于3.0(P0.01);简体中文版PAM13总量表的Cronbach's α系数为0.82,重测信度0.70,显示量表具有良好的信度;效度检验总体CVI是0.87,结构效度探索性因子分析提取出4个特征根值大于1的因子,解释变量总变异的58.20%,共提取4个因子,与原问卷模型基本吻合,验证性因子分析显示各项拟合优度指数均较理想,表明中文版PAM13具有较好的结构效度。2.200例慢性心力衰竭患者积极度得分最小值36.76分,最大值100分,说明在慢性心力衰竭患者中患者积极度水平有很大的个体差异;平均56.58分,患者积极度位于第3水平。3.采用方差分析比较慢性心力衰竭患者积极度水平在一般资料上的差异,结果显示慢性心力衰竭患者积极度水平在受教育程度、生活主要照顾者、心功能分级(NYHA)、是否接受过健康教育、是否主动获取自我管理相关知识方面方面存在差异(均 P0.05)。4.有序多分类logistic回归分析结果显示慢性心力衰竭患者接受教育水平、家庭经济状况、疾病严重程度、家庭照顾支持和是否接受过健康教育是影响患者积极度的主要因素。结论:1.本研究表明修订的简体中文版患者积极度量表具有较好的信度和效度,可以为慢性心力衰竭患者积极度评价提供一个有用的工具。2.慢性心力衰竭患者的积极度水平总体位于第3水平,积极度水平个体差异较大。积极度水平在不同接受教育水平、生活主要照顾者、心功能分级(NYHA)、是否接受过健康教育、是否主动获取自我管理相关知识方面存在差异。3.慢性心力衰竭患者的积极度水平与患者接受教育水平、家庭经济状况、家庭照顾支持、疾病严重程度、是否接受过健康教育等影响因素有关。应根据患者积极度水平制定与患者需求匹配的个性化的支持策略,包括制定与患者积极度水平相匹配的管理目标、干预措施,开展多学科合作的延伸护理体系。
[Abstract]:Objective: to amend the Patient Activation Measure 13 (PAM13) from the Chinese version of the Chinese version of Taiwan, to apply it to the patients with chronic heart failure and to test its reliability and validity in order to formulate a simplified Chinese version of the Chinese version of a Chinese version of the Chinese mainland population, and to study the positive level of the patients with chronic heart failure. And the influencing factors, in order to formulate strategies to improve the level of patients' enthusiasm. Methods: using a convenient sampling method, 200 patients with chronic heart failure hospitalized in three grade A hospitals in Ji'nan, Shandong province from September 2016 to January 2017 were selected as the research object, and the revised simplified Chinese version of the positive measurement table and self compilation were adopted. The patient's basic information questionnaire obtained the data, carried out the reliability of the Chinese version of the positive measurement table, tested the validity of the patients with chronic heart failure, and analyzed the factors affecting the level of the patient's enthusiasm. After the survey data were arranged, the statistical analysis was carried out by the SPSS 17 statistical software, and the Cronbach's alpha coefficient and retest reliability evaluation were used. The reliability of the price questionnaire; the validity of the content validity index (CVI), the confirmatory factor analysis and the exploratory factor analysis; the status of the patients with chronic heart failure was described by descriptive statistics; the influence factors of the positive level of chronic heart failure patients were analyzed by the sequential and multi classification of the logistic regression method. Results: results: the results of 1. correlation analysis and decision analysis showed that the correlation between items and their modules reached significant level (P0.01), in which the correlation coefficient of item 2 and subscale was 0.25, the correlation coefficient of the other items were above 0.4, and the 13 CR values were more than 3 (P0.01); The Cronbach's alpha coefficient of the Chinese version PAM13 is 0.82, the retest reliability is 0.70, the display scale has good reliability; the overall CVI of the validity test is 0.87. The exploratory factor analysis of the structural validity extracts 4 factors which are more than 1 of the root values, and the total variation of the variables is 58.20%, and 4 factors are extracted, which are basically consistent with the original questionnaire model and verifying. The factor analysis showed that all the goodness of fit indices were ideal, indicating that the Chinese version of PAM13 had better structural validity in.2.200 patients with chronic heart failure, the minimum of 36.76 scores and the maximum value of 100 points, indicating that there was a large individual difference in the level of the patient's enthusiasm in the patients with chronic heart failure, with an average of 56.58 points and the patient's positive level. The difference in the general data of chronic heart failure patients was compared by variance analysis at third level by variance analysis. The results showed that the level of enthusiasm in the patients with chronic heart failure was educated, the main caregivers of life, the classification of heart function (NYHA), whether they had received health education, and whether they actively acquired knowledge about self management. The difference (all P0.05).4. ordered multi classification logistic regression analysis showed that the education level of patients with chronic heart failure, family economic status, disease severity, family care support and health education were the main factors affecting the patient's enthusiasm. Conclusion: the 1. study showed the revised simplified Chinese version. The positive measurement table has good reliability and validity, it can provide a useful tool for the evaluation of chronic heart failure patients' enthusiasm. The level of.2. chronic heart failure is generally located at the third level, and the individual differences are large in the level of enthusiasm. The level of enthusiasm is at different level of Education, the main caregivers of life and heart work NYHA, whether to receive health education, or not to take the initiative to acquire self-management knowledge, there are differences in the level of.3. chronic heart failure in patients with chronic heart failure, the level of education, family economic status, family care support, the severity of the disease, the health education and other factors, and should be based on patients. The level of initiative is designed to develop a personalized support strategy that matches the needs of the patient, including the management goals that match the patient's initiative level, the intervention measures, and the extended nursing system of multidisciplinary cooperation.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.54

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