医患沟通质量量表设计及评价

目的：设计适合我国医院使用的医患沟通质量评价指标和评价工具。方法研究采用问卷调查的方法,通过对问卷的定量数据分析来检验量表的信度和效度。结果研究设计了有3个维度22个项目构成的《医患沟通质量评价量表》初稿,以随机抽样的方法选择了5家综合性医院,发放问卷1800份,回收有效问卷1400份,量表部分完整问卷559份,对559份问卷进行了探索性因子分析和验证性因子分析,探索性因子分析并没有验证设想的3个维度,而是将22个项目降维为5个维度：诊断信息、治疗信息、费用沟通、移情性和沟通结果。验证性因子分析 RMSEA、GFI、PGFI、IFI和 CFI 指标分别是0.066、0.895、0.704、0.916、0.915,显示5维度模型有较好的适配度。该量表 Cronbach α信度为0.924,5个维度的 Cronbach α信度和组合信度均在0.7以上,AVE 均接近或者超过0.5,维度间相关系数的平方值均接近或者小于相关维度的 AVE。结论实证分析结果显示量表具有较好的内部一致性、收敛效度和区别效度,模型适配较好。     

中小学生心理健康发育评价量表初步编制及信效度评价

目的 初步编制中小学生心理健康发育评价量表,评价其信效度。方法 问卷中认知发育维度的评价直接利用华文认知能力量表,其余指标的条目均根据理论构思和文献研究自行编写。于2012-2014年12月通过多阶随机抽样,抽取湖北省3个地区共7500名中小学生进行问卷调查,运用项目分析、探索性因素分析筛选条目,通过主成分分析和信效度检验方法验证该问卷理论结构的合理性。结果 确定从认知发育、人格发育、情绪发育、意志发育、自我意识发育5个角度评价中小学生心理健康发育情况。根据条目筛选及因子分析,小学量表由5个维度67个条目组成;中学量表由5个维度65个条目组成。小学全量表的Cronbach's α系数与分半系数分别为0.905、0.850,各分量表的Cronbach's α系数、分半信度分别为0.720~0.757、0.650~0.770;中学全量表的Cronbach's α系数与分半系数分别为0.919、0.812,各分量表的Cronbach's α系数、分半信度分别为0.752~0.837、0.632~0.752,2个量表均有较好的信度;小学量表因子载荷在0.475~0.792之间,中学量表因子载荷在0.515~0.763之间,量表各分量表与总量表的相关在0.699~0.903之间,分量表的相关在0.356~0.670之间,两量表均有一定的效度。结论 初步完成的中小学心理发育特征评价量表具有较好的信效度,达到了编制的要求。     

The SmithKline Beecham ‘quality of life’ scale: a validation and reliability study in patients with affective disorder

The rationale for the development of a Repertory-Grid based quality of life assessment (QOL) is described. The emergent scale, the SmithKline Beecham Quality of Life Scale (SBQOL) utilizes 23 predetermined constructs and three fixed elements: self now, ideal self and sick self. Inclusion of the latter two elements provides a personal frame of reference for the individual and recognizes the highly idiosyncratic and subjective nature of the experience which constitutes quality of life. A study of the validity and reliability of the SBQOL was conducted in 129 patients presenting to their GP with either major depression or generalized anxiety disorder, as defined by DSM III R. Patients were treated at the discretion of their GP and followed over a period of 12 weeks with assessments of treatment efficacy being performed at 6 weeks and 12 weeks in parallel with administration of the SBQOL. The results from co-administration of standard efficacy measures such as the Hamilton Depression Rating Scale (HAMD) and Hamilton Anxiety Scale (HAMA) with the SBQOL, provided good evidence of construct validity. Evidence in support of the concurrent validity of the SBQOL was provided by co-administration of the Sickness Impact Profile and General Health Questionnaire (external criteria) with the SBQOL scale. Test-retest reliability and internal consistency were high. No obvious advantage was conferred by the use of principal components analysis from the Flexigrid software package in contrast to a simple arithmetical procedure for computing interelement distances. It is concluded that the SBQOL provides a valid, reliable and practicable approach to the assessment of quality of life in patients with affective disorder.     

北京市居民公众应急准备现状评价量表测试结果分析

目的 在北京市居民中对《公众应急准备现状评价量表》的信度和效度进行检验。方法 采用多阶段整群抽样方法,在北京市东城区、朝阳区、门头沟区、延庆区选取1 000名常住人口作为调查对象,使用《公众应急准备现状评价量表》进行问卷调查,使用一致性检验、因子分析等方法对量表信度、效度进行检验。结果 有效调查998人,其中男性472人（47.77%）,女性516人（52.23%）;量表的一致性Cronbach's α系数为0.81,Spearman-Brown 系数为0.68,Guttman split-half系数为0.68,按人群特征分层后,量表的一致性系数和半分系数均在可接受范围,去除条目后的一致性Cronbach's α系数均无明显降低;因子分析结果显示,量表分为5个因子,分别为主动学习、应急风险感知、应急态度、处置自我效能和应急准备认知,累计方差贡献率解释为66.12%,各因子内部相关系数均>0.60,去除条目后的Cronbach's α系数均无明显降低。结论 量表具备较好的信度和结构效度,可以适用于北京居民人群应急准备状况的评价测量。     

Organizational assessment in paediatric primary care: development and initial validation of the primary care organizational questionnaire.

Primary care in the United States is undergoing many changes. Reliable and valid instruments are needed to assess the effects of these changes. The Primary Care Organizational Questionnaire (PCOQ), a 56-item 5-point Likert scale survey that evaluates interactions among members of the clinic/practice and job-related attributes, was administered to clinicians and staff in 36 primary care practices serving paediatric populations in Connecticut. A priori scales were reliable (Cronbach alpha > or = 0.7). Analysis of variance (ANOVA) showed greater heterogeneity across clinics than within clinics for 13 of 15 a priori scales, which were then included in a principal component factor analysis with varimax rotation. Eigenvalue analysis showed nine significant factors, largely similar to the a priori scales, indicating concurrent construct validity. Further research will ascertain the utility of the PCOQ in predicting the effectiveness of primary care practices in implementing disease management programmes.     

Dutch translation and validation of the readiness for interprofessional learning scale (RIPLS) in a primary healthcare context

Background: Interprofessional education and collaborative practice are gradually gaining importance in the context of growing healthcare complexity. The readiness for interprofessional learning scale (RIPLS) is a well-known scale that can identify attitudinal barriers and variance across professions, which may affect educational interventions.

Objectives: This study aims to translate the English RIPLS into Dutch and to test its reliability and validity.

Methods: The scale was translated and back-translated by two pairs of people independently and tested for feasibility and comprehensibility. The translated scale was used with 219 general practitioners, 238 community nurses, and 53 palliative home-care nurses. Exploratory factor analysis was used to assess construct validity. Confirmatory factor analysis was done to generate a fit model. Cronbach’s alpha was computed to evaluate internal consistency. Regression analysis was used to evaluate the effect of the RIPLS score on the level of learning through collaboration and to gauge the influence of the participants’ gender, age, previous palliative care education, type of practice and years in practice.

Results: Confirmatory and exploratory factor analysis confirms the factor structure of the original version. The Dutch version shows good reliability (overall Cronbach’s alpha: 0.88; intraclass correlation coefficient after test-retest: 0.718 (95%CI: 0.499–0.852). The RIPLS score correlates with the amount of workplace learning during collaboration (discriminant validity: P?Conclusion: The Dutch translation of the RIPLS is now ready for comparative studies.     

北京市社区早期儿童发展综合评价标准研究

【目的】编制北京市社区儿童保健医生使用的0~36月儿童发展的综合评价标准,提高群体儿童保健质量,促进早期儿童发展。【方法】依据目前的研究结果,编制综合评价标准,包括体格发育、神经心理、视觉、听觉发育以及疾病情况五个维度;采用横断面、分层随机抽样的方法,选择社区0~36月健康儿童进行信度效度研究;采用纵向追踪的方法在儿童保健门使用考察其应用情况。【结果】综合评价标准采用标准参照研究,评价结果与专家评定R=0.30~0.79;体格发育、视觉、听觉发育以及疾病情况四个维度均有临床可靠的评价和诊断标准,神经心理维度在各年龄组测查的一致百分比为94.22%,同质性信度α=0.43~0.82、具有较好的内容效度及效标关联效度(R=0.40~0.83)。【结论】0~12月儿童发展的综合评价标准适用于综合评价城市社区儿童发展状况,13~36月评价标准有效性有待临床进一步验证。     

The role of the schools of public health in the development of primary health care

Starting with the assumption that the schools of public health can and should be major promoters of primary health care but that they have not fully utilized their potential, the paper reviews the different interpretations of primary health care and their implications for the recruitment policies, educational objectives, teaching methods and research orientation of the schools. Four interpretations (primary health care as a set of activities; as a level of care; as a strategy of organizing health services; and as a philosophy permeating the entire health care system) are identified. It is suggested that most industrialized countries already have a primary medical care system which has to be transformed into primary health care. A blueprint for this transformation is outlined. Many of the changes included in the blueprint are related to the concept of primary health care as a strategy. Schools of public health can play a major role in implementing the necessary strategic changes and in training their implementers. The training of actual primary care providers for leadership; increased emphasis on management in the curricula; and reorientation of research towards primary health care are underlined as particularly important elements in the new role of the schools of public health.     

Process versus outcome indicators in the assessment of quality of health care.

This paper reviews the relative strengths and weaknesses of outcome and process measures as performance indicators in health care. Differences in outcome may be due to case mix, how the data were collected, chance, or quality of care. Health care is only one determinant of health and other factors have important effects on health outcomes, such as nutrition, environment, lifestyle and poverty. The advantages of process measures are that they are more sensitive to differences in the quality of care and they are direct measures of quality. However, outcome measures are of greater intrinsic interest and can reflect all aspects of care, including those that are otherwise difficult to measure such as technical expertise and operator skill. Outcome indicators can be improved if efforts are made to standardize data collection and case mix adjustment systems are developed and validated. It is argued that this is worth doing only where it is likely that variations in health care might lead to significant variations in health outcome and where the occurrence of the outcome is sufficiently common that the outcome indicator will have the power to detect real differences in quality. If these conditions are not met, then alternative strategies such as process measurement and risk management techniques may be more effective at protecting the public from poor quality care.     

中学生心理复原力自评量表的再评价

目的评价中学生心理复原力自评量表在安徽省合肥市长丰县小学四至六年级及初一至初三的在校学生中应用的可行性,为今后开展长丰县中小学生及留守儿童心理健康研究工作提供依据。方法采用整群抽样的方法抽取合肥市长丰县的3所初中和5所小学,对所抽取的全部初中生以及四、五、六年级的小学生共2655名学生进行心理复原力评定及量表的信度、效度分析。心理复原力自评量表包括6个维度,即问题解决、合作与交流、自我效能、目标与渴望、自我意识以及共情。结果心理复原力量表总分的Cronbach’sα系数为0.944,小学四到六年级及初一至初三量表得分的Cronbach’sα系数为0.932～0.947,各因子Cronbach’sα系数为0.772～0.883;量表总分的分半信度为0.874,小学四到六年级及初一至初三量表得分的分半信度为0.848～0.892;量表总分的重测信度为0.894,各因子重测信度为0.753～0.839,所有相关系数均达统计学显著性水平。采用方差最大正交旋转法因子分析产生的6个因子共解释64.532%的总方差;各项目与量表总分间的相关系数为0.434～0.717,与所属因子间的相关系数为0.683～0.876,量表总分与六个因子间的相关系数为0.692～0.846,六个因子间的相关系数为0.401～0.689,所有相关系数均达统计学显著性水平。心理复原力量表总分与抑郁相关系数为-0.493、与焦虑相关系数为-0.290,在0.01水平(双侧)上均显著相关。结论中学生心理复原力自评量表在合肥长丰县小学四到六年级及初一至初三在校学生的应用中具有较好的信度及效度,可作为该人群及其中的留守儿童一个较好的心理复原力评估工具。     

Measuring quality of life: the development and initial validation of the patient-reported erectile function assessment instrument

OBJECTIVES: Erectile dysfunction (ED) is a complex condition, which is variously influenced by physical, emotional, societal, and relationship factors. ED has serious implications for the quality of life (QoL) enjoyed by an affected male and his partner. It is very important, therefore, to understand the impact of ED on the QoL of those affected by it. Our objective was to determine if the eight-question Patient Reported Erectile Function Assessment (PREFA) could act as an independent, comprehensive disease-specific instrument in the assessment of QoL as it is impacted by ED. METHODS: During the development and validation of the Erectile Function-Visual Analog Scale (EF-VAS) (14), a new ED-specific preference-based instrument, a series of questions were included at the beginning of the assessment that would act as a way to encourage respondents to focus on their own experience with ED. Upon analysis of the EF-VAS data, it became apparent that the eight-question "warm up" section might act as a stand-alone assessment. Accordingly, the eight questions were named PREFA, and a validation analysis was undertaken to determine their consistency, feasibility, reliability, validity, and responsiveness. RESULTS: The PREFA questionnaire was found to be feasible and simple to complete, reliable, and valid, with excellent responsiveness. Overall, the PREFA has demonstrated that it can perform as a stand alone, validated assessment of the impact of ED on QoL, assessing areas of QoL not previously captured in existing instruments. CONCLUSIONS: The PREFA is suitable for use in clinical and research settings as a disease-specific QoL assessment tool.     

The measure of processes of care (MPOC): validation of the Dutch translation

AIM: The objective was to validate the Dutch translation of the Canadian measure of processes of care (MPOC) questionnaire for use in children's rehabilitation centres in the Netherlands. MPOC consists of 56 items (assessing five domains) and was designed to find out what parents of children with chronic health problems think of the services they and their child receive and to measure the extent to which these services are family-centred. METHODS: The Canadian validation procedures were followed, consisting of construct and concurrent validation and reliability analyses. Participants were parents of 427 children aged 1-18 years recruited through nine children's rehabilitation centres in the Netherlands. RESULTS: The construct validity of the Dutch version of MPOC (MPOC-NL) was examined with confirmative analyses of the scale structure. These analyses all supported the construct validity of MPOC-NL. MPOC-NL showed adequate internal consistency, with Cronbach's alpha ranging from 0.80 to 0.95. The intraclass correlation coefficients (ICCs) ranged from 0.79 to 0.94, which demonstrated good stability of MPOC-NL. The Spearman correlations between MPOC-NL scores and satisfaction questions ranged from 0.39 to 0.73, and thus supported the construct validity of MPOC-NL. Correlations between MPOC-NL scores and a question about parents' stress in relation to services received were moderately negative (r(s) = -0.28 to -0.39). CONCLUSION: The construct and concurrent validity of MPOC-NL was shown by confirmative analyses of the original Canadian scale structure, and by modest Spearman correlations between MPOC-NL scores and satisfaction and stress variables. MPOC-NL is internally consistent and reliable.     

Measuring quality of care: considering measurement frameworks and needs assessment to guide quality indicator development

ObjectiveIn this article, we describe one approach for evaluating the value of developing quality indicators (QIs).Study Design and SettingWe focus on describing how to develop a conceptual measurement framework and how to evaluate the need to develop QIs. A recent process to develop QIs for injury care is used for illustration.ResultsKey steps to perform before developing QIs include creating a conceptual measurement framework, determining stakeholder perspectives, and performing a QI needs assessment. QI development is likely to be most beneficial for medical problems for which quality measures have not been previously developed or are inadequate and that have a large burden of illness to justify quality measurement and improvement efforts, are characterized by variable or substandard care such that opportunities for improvement exist, and have evidence that improving quality of care will improve patient health.ConclusionBy developing a conceptual measurement framework and performing a QI needs assessment, developers and users of QIs can target their efforts.     

Measuring health related quality of life (HRQoL) in community and facility-based care settings with the interRAI assessment instruments: development of a crosswalk to HUI3

Background

Health-related quality of life (HRQoL) measures are of interest because they can be used to describe health of populations and represent a broader health outcome for population health analyses than mortality rates or life expectancy. The most widely used measure of HRQoL for deriving estimates of health-adjusted life expectancy is the Health Utilities Index Mark 3 (HUI3). The HUI3 is available in most national surveys administered by Statistics Canada, and has been used as part of a microsimulation model to examine the impact of neurological conditions over the life course. Persons receiving home care and nursing home services are often not well-represented in these surveys; however, interRAI assessment instruments are now used as part of normal clinical practice in these settings for nine Canadian provinces/territories. Building on previous research that developed a HUI2 crosswalk for the interRAI assessments, the present study examined a new interRAI HRQoL index crosswalked to the HUI3.

Methods

interRAI and survey data were used to examine the distributional properties of global and domain-specific interRAI HRQoL and HUI3 index scores, respectively. Three populations were considered: well-elderly persons not receiving home care, home care clients and nursing home residents.

Results

The mean HUI3 and interRAI HRQoL index global scores declined from independent healthy older persons to home care clients, followed by nursing home residents. For the home care and nursing home populations, the interRAI HRQoL global estimates tended to be lower than HUI3 global scores obtained from survey respondents. While there were some statistically significant age, sex and diagnostic group differences in global scores and within attributes, the most notable differences were between populations from different care settings.

Discussion

The present study provides strong evidence for the validity of the interRAI HRQoL based on comparisons of distributional properties with those obtained with survey data based on the HUI3. The results demonstrate the importance of admission criteria for home care and nursing home settings, where function plays a more important role than demographic or diagnostic criteria. The interRAI HRQoL has a distinct advantage because it is gathered as part of normal clinical practice in care settings where interRAI instruments are mandatory and are used to assess all eligible persons in those sectors. In particular, those with severe cognitive and functional impairments (who tend to be under-represented in survey data) will be evaluated using the interRAI tools. Future research should build on this work by providing direct, person-level comparisons of interRAI HRQoL index and HUI3 scores, as well as longitudinal analyses to examine responsiveness to change.

     

The development of a scale to measure medical students' attitudes towards communication skills learning: the Communication Skills Attitude Scale (CSAS)

INTRODUCTION: There is little research identifying medical students' attitudes towards communication skills learning. This pilot study outlines the development of a new scale to measure attitudes towards communication skills learning. METHODS: First- and second-year medical students (n = 490) completed the 26-item Communication Skills Attitude Scale (CSAS) and 39 students completed the CSAS on a second occasion. Factor analysis was conducted to determine the factors underpinning the scale. The internal consistency of the subscales was determined using alpha coefficients. The test-retest reliability of the individual scale items were determined using weighted kappa coefficients and the test-retest reliability of the subscales were established using intraclass correlation coefficients. RESULTS: Maximum likelihood extraction with direct oblimin rotation resulted in a 2-factor scale with 13 items on each subscale. Factor I represented positive attitudes towards communication skills learning and factor II represented negative attitudes. Subscale I had an internal consistency of alpha=0.873 and an intraclass correlation of 0.646 (P < 0.001). Subscale II had an internal consistency of alpha=0.805 and an intraclass correlation of 0.771 (P < 0.001). The majority of items on the positive (n=9, 69.2%) and the negative attitude subscales (n=8, 61.5%) possessed moderate test-retest reliability. DISCUSSION: The development of a new and reliable scale to identify medical students' attitudes towards communication skills learning will enable researchers to explore the relationships between medical students' attitudes and their demographic and education-related characteristics. Further work is needed to validate this scale among a broader population of medical students.     

The development and initial validation of the Hawaiian Youth Drug Offers Survey (HYDOS)

Objective. This study describes the development and preliminary validation of a survey focused on the most salient situations where drugs and/or alcohol are offered to Native Hawaiian youth in rural communities.

Design. The study used a five-phase approach to test development and validation. In Phase 1 (item generation), survey items were created from a series of focus groups with middle school aged youth (n=47). In Phase 2 (item refinement and selection), items were edited and reduced to 62 drug-offer situations that were selected for inclusion in the survey. In Phase 3 (item reduction), items were administered to 249 youth from seven middle or intermediate schools in Hawai‘i.

Results. Exploratory factor analysis of the Native Hawaiian subsample (n=194) indicated the presence of three factors accounting for 63% of the variance: peer pressure (23%); family offers and context (21%); and unanticipated drug offers (19%). The survey items differentiated between Hawaiian and non-Hawaiian youth respondents, supporting the validity of the questionnaire. The hypothesized relationship between cultural connectedness and drug offer exposure was not confirmed. Internal consistency of the measure was high.

Conclusions. The survey helps to fill the gap in information related to drug use of Native Hawaiian youth and has implications for the development and assessment of culturally-specific drug prevention programs for these youth.