支持美沙冬替代療法量表之信效度評估

Validity and Reliability of a Questionnaire Supporting Methadone Maintenance Treatment

美沙冬替代療法（methadone maintenance treatment, MMT）可降低靜脈藥癮者（injecting drug users, IDUs）個人健康造成損害，愛滋感染問題及犯罪率。2004 年國內愛滋疫情在IDUs 暴增，於2006 年12 月全國實施MMT，目前國內愛滋疫情已減緩。在推動MMT 時，IDUs、衛生醫療人員及檢警獄人員對MMT 的支持態度就顯得相當重要，我們擬定支持美沙冬替代療法量表（Questionnaire Supporting Methadone Maintenance Treatment, QSMMT），並進行信效度的檢定，以利後續研究。量表設計參考相關文獻，整理出三個構面，分別為社會的助益、IDUs 的受惠、及疑慮，共14 題，分數愈高表示支持態度愈正向。本研究邀請10 位專家進行內容效度，平均內容效度指標（content validity index, CVI）為76.6%。對IDUs、衛生醫療人員及檢警獄人員進行信效度評估，共回收有效問卷（不記名）1419 份。已知團體差異的建構效度在IDUs、衛生醫療人員及檢警獄人員在三個構面的平均分數有達統計顯著差異。三個構面的組合信度及Cronbach’s α 值高於0.78，驗證性因素分析得知14 題核心觀察變項可有效建構出符合QSMMT的三個構面，GFI、AGFI、NFI 均>0.9，RMSEA 在0.04~ 0.05 間，顯示模式合適，且各構面皆具有良好的收歛效度及區別效度。本研究量表具良好的專家效度、內在一致性及建構效度，適用於藥癮者、衛生醫療人員及檢警獄人員，期望這份量表能廣泛被採用，成果也能互相比較。

Methadone maintenance treatment (MMT) can reduce the harm to injecting drug users (IDUs), the AIDS/HIV rate and crime rate. After 2004, Taiwan experienced the high rise of AIDS/HIV epidemic among IDUs. Since December 2006, MMT programs were implemented nationwide. Nowadays, HIV incidence in IDUs is under control. How IDUs, healthcare workers, police- procurator-jailer support MMT is important in determining the success of MMT. In this study, we had developed a questionnaire supporting MMT (QSMMT) among these three groups for future study. The QSMMT were based on literature and consisted of 14 items. The higher score of QSMMT represents the positive support of MMT. There are three subscales in QSMMT: advantages to the society, advantages to IDUs, and doubt/worry. The mean content validity index was 76.6% from 10 experts. From October to December 2007, 1419 valid and anonymous questionnaires were returned. The score either for three subscales or for the total reached statistically significance among three study groups, indicating our QSMMT has good known- groups of construct validity. The composite reliability and Cronbach’s α was above 0.78 for the three subscales. Confirmatory factor analysis (CFA) verified an appropriateness of three factors for QSMMT with GFI, AGFI, and NFI > 0.9 and RMSEA between 0.04 and 0.05. Our QSMMT has an acceptable psychometric property, including good expert validity, internal consistence, and construct validity. Our QSMMT can apply to IDUs, healthcare workers and police- procurator-jailer and we welcome other researchers to use QSMMT so that findings can be compared on the same basis.