慢性腎臟病人自我照顧行為量表之發展與信效度檢定

Construction and Validation of a Chronic Kidney Disease Self-Care Scale

背景：隨著慢性腎臟病盛行率之增加，了解慢性腎臟病人的自我照顧行為是一個重要的議題。目的：發展及驗證慢性腎臟病人自我照顧行為量表之信度與效度。方法：採橫斷性研究，先依文獻查證及臨床經驗擬定量表的題項，再透過項目分析、探索性因素分析及驗證性因素分析，來檢測及建構量表之信、效度。結果：本量表經驗證性因素分析將此六因素進行三次模式配適度分析，最後結果共萃取五個因素，分別為：規律服藥、飲食控制、規律運動、吸菸習慣及監測血壓共16題，其為本量表最佳解釋模式（GFI= .91, AGFI = .88, CFI = .92），解釋總變異量為74.96%。因素負荷量介於 .72~.94，總量表及五個次量表的內在一致性Cronbach's α分別為 .83、.83、.83、.94、.81及. 87，皆達可接受範圍。結論／實務應用：慢性腎臟病衛教人員需應用適當的工具，得以有效評估病人的自我照顧行為。本研究建構經驗證後具信、效度的慢性腎臟病自我照顧行為量表，可以協助臨床專業人員進行簡單而快速的評估，以提供符合病人個別化的慢性腎臟病照護計畫。

Background: As the prevalence of chronic kidney disease (CKD) increases, it is important to understand the selfcare behavior of CKD patients. Objectives: To construct a CKD self-care scale and evaluate its metric properties. Methods: Through literature review and clinical experience, question items were constructed and validated using item analysis. Factors analysis was used to validate the reliability and validity of the resultant questionnaire in a cross-sectional study. Results: Six subscales containing a total of 20 items were extracted from the original CKD self-care scale using item and exploratory factor analysis. After performing three-time model goodness of fit, only five subscales including regular medication (5 items), diet control (4 items), regular exercise (3 items), smoking habits (2 items), and blood pressure management (2 items) were included in the final scale. The total explained variance of the final subscales was 74.96%. The reliability of the scale was examined and found to be satisfactory. Each absolute factor loading value fell between .72 and .94. The Cronbach's alpha for the overall scale was .83 and those for the five subscales were .83, .83, .94, .81, and .87, respectively. Conclusions / Implications for Practice: Appropriate assessment tools that allow CKD health educators to evaluate the self-care behaviors of patients effectively are needed. The valid and reliable CKD self-care scale that was developed in the present study is able to assist CKD health educators to quickly evaluate the self-care behavior of patients and to make appropriate health plans.