肝硬化自我照顧知識及行為：量表設計及信效度評估

KNOWLEDGE AND PRACTICE OF SELF-CARE ON LIVER CIRRHOSIS: QUESTIONNAIRE DESIGN AND ASSESSMENT OF RELIABILITY AND VALIDITY

背景：肝硬化是一慢性不可逆的疾病。當病患對疾病有足夠的自我照顧知識及行為，可減少症狀的出現或預防合併症發生。但尚無量表測量肝硬化自我照顧知識及行為。目的：擬訂量表及評估其信效度。方法：依臨床經驗及參考相關文獻自擬量表。採內容效度、團體差異分析的建構效度、難度及鑑別指數、及內在一致性。樣本採立意取樣選取肝硬化住院病患（n=49） 、山友（n=58） 及醫護人員（n=70）。結果：5 位專家的評分，自我照顧知識的內容效度指標（CVI） 在80%-100% 間、自我照顧行為CVI 為100%。團體差異分析的建構效度：知識單題及總分的答對率及行為的平均得分，均以病患最低、山友次之、醫護人員最高，均達統計顯著意義。病患及山友，自我照顧知識量表的難度指數都在40%-70% 間、鑑別指數達 25% 以上。但醫護人員的難度指數高於70% 、鑑別指數都低於25%。肝硬化自我照顧知識量表的KR-20 在0.68-0.84 間。除遵從醫囑子量表外，肝硬化自我照顧行為量表的Cronbach’sα都 >0.7。結論：本研究的肝硬化自我照顧知識、行為量表具良好內容效度、團體差異分析的建構效度。對肝硬化病患或山友，知識題具鑑別力，但對醫護人員過於簡單，缺乏鑑別力。知識量表具內在一致性；除遵從醫囑子量表外，行為量表具內在一致性。

Background: Liver cirrhosis is an irreversible disease. When patients have enough knowledge and take good care of themselves, episodes of symptoms and complications can be reduced. However, no questionnaire is available to measure the knowledge and practice of self-care on liver cirrhosis. Aims: We designed a questionnaire to measure knowledge and practice of self-care on liver cirrhosis and assess its reliability and validity. Methods: Content validity, known-group differences of construct validity, difficulty index, discrimination index, and internal consistence were used. Hospitalized patients with liver cirrhosis (n=49), climbers (n=58), and medical workers (n=70) were recruited. Results: Five experts rated the content validity index (CVI) at 80-100% for the knowledge section and 100% for the practice section. Known-group differences reached statistical significance. The correct rate of the knowledge section and the mean score of the practice section was the lowest among the patients, followed by climbers, and the highest for medical workers. For patients and climbers, the difficulty indices of the knowledge questionnaire were between 40-70% and the discrimination index was 25% or above. However, the difficulty index of the knowledge questionnaire for medical workers was higher than 70% and the discrimination index was lower than 25%, indicating that the questions about self-care knowledge of liver cirrhosis for medical workers were too easy. The KR-20 of the knowledge part was between 0.68 and 0.84. Except for the compliance subscale, the Cronbach’s α of the practice was greater than 0.7. Conclusion: Our questionnaire to measure knowledge and practice of self-care on liver cirrhosis has acceptable content validity, known-groups difference of construct validity. The knowledge questionnaire has appropriate for patients with liver cirrhosis and climbers, but too easy for medical workers. The knowledge questionnaire has good internal consistence. Except for the compliance subscale of practice questionnaire, the practice questionnaire has good internal consistency.