「兒童健康手冊」發展監測項目之信效度研究

The Reliability and Validity of the Developmental Items of “Child Health Pamphlet”(DICHP)

本研究之目的為探討國民健康局編印之「兒童健康手冊」內發展狀況題目（Developmental Surveillance Items of Child Health Pamphlet, DICHP）之信效度。信度研究設計採方法學研究，效度採病例對照研究。以方便取樣方式，選取1歲至3歲3個年齡層，每個年齡層一般兒童與遲緩兒童人數比例為1-3:1，共395名兒童參與效度研究，其中194名兒童於一週內測試2次，以分析信度。經審視DICHP題目，將2題語意不清楚者略作文字修改，編製DICHP初修版，每個年齡層仍維持6題。請兒童父母或主要照顧者填寫DICHP初修版，據以分析內部一致性與各題目及總分之再測信度、接受者操作特徵（receiver operating characteristic, ROC）曲線下面積、最佳切截點之敏感度與特異度、多層次概率比、已知族群效度（known groups validity）。結果顯示DICHP初修版內部一致性（α=0.74-0.86）與再測信度（斯皮爾曼相關係數＝0.72-1.00; p<0.001）可；由ROC曲線得其篩選正確機率＝0.82-0.86 （p<0.001）；3個年齡層之敏感度範圍為0.69-0.80，特異度為0.76-0.89；綜合各年齡層之多層次概率比，5-6分者（0-1題不通過者），其概率比皆小於1；≦2-4分者（2-4題以上不通過者）其概率比皆為無限大，符合可幫助確定陽性診斷之標準；遲緩兒童之分數顯著低於一般兒童，具已知族群效度。所以，3個年齡層DICHP之信效度在可接受範圍，可當多階段篩選之第一層工具。根據多層次概率比，建議≧2-4題不通過，應轉介診斷測試；1-3題不通過進一步二篩；5-6題通過視為正常。

The developmental surveillance used for the early detection of developmental delay for children has been conducted for many years in Taiwan. However, the information of reliability and validity of the developmental surveillance items in the Child Health Pamphlet (DICHP) edited by the National Health Bureau of the Department of Health were still not very clear. The purpose of this study was to investigate the reliability and validity of the DICHP. The methodology research was used for reliability study, and the case-control study was used for validity study. A convenient sampling method was used to recruit 395 children (developing typically: children with developmental delay =1-3:1) in 3 age groups from 12-to 36-month-of-age, among them 194 children tested 2 times within 1 week for test-retest reliability. Before data collection, the developmental items were inspected by the research group, and a wording revised DICHP (6 items for each age group) was used in this study. The parents or caregivers filled the 6 items according the child’s performance. Then the area under the receiver operating characteristic (ROC) curve, multi-level LRs, and the known-groups validities were analyzed. The results showed that the revised DICHP have acceptable internal consistency (α=0.74-0.86) and test-retest reliabilities (rs=0.72-1.00, p<0.001). The screening accuracy were with area under ROC of 0.82-0.86 (p<0.001). The sensitivities were 0.69-0.80, specificities were 0.76-0.89. The LRs of the DICHP scores of 5-6 were less than 1, of ≦2-4 were infinity, meeting the SpPin rule. It has acceptable known group validity. The authors concluded that for children aged 1-3 years, the DICHP had acceptable reliabilities and validities, and could be used as the first tool for multi-phasic surveillance. From the ROC and multi-level LRs of the DICHP, authors proposed that further diagnosis test was recommended for children with more than 2-4 failure items, second screening test for children with 1-3 failure items, and no intervention for children with 0-1 failure item.