患者预设性不信任情境量表的初步编制
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摘要
背景部分患者就医前对医生的预设性不信任是导致不良医患关系的重要原因,目前关于评估患者预设性不信任的工具仍较少。目的初步编制患者预设性不信任情境量表,并进行信效度检验。方法将文献查阅、临床实践、研究小组讨论等方法结合,编制患者预设性不信任情境量表。分别于2018年1—2月、2018年2—3月,采用方便抽样法,分别选取医院就诊患者52例和384例进行预调查和正式调查。通过预调查初步优化量表结构,通过正式调查并基于探索性因子分析、相关性分析、效标效度、Cronbach'sα系数等进行量表条目筛选及信效度检验。结果最终确定的患者预设性不信任情境量表共包括22个条目。通过探索性因子分析提取8个公因子,分别为医患沟通、患者个人经验、医生修养、医疗制度、医生医德、其他因素、医生技术、患者判断。探索性因子分析结果显示,8个公因子的累积方差贡献率为58.794%。Pearson相关分析结果显示,量表各条目得分与总分、个条目得分与对应的公因子得分均呈线性正相关(P<0.05)。将维克森林医师信任量表作为患者预设性不信任情境量表的效标,Pearson相关分析结果显示,两个量表总分呈线性负相关(P<0.05)。患者预设性不信任情境量表的Cronbach'sα系数为0.708,分半信度系数为0.729。结论编制的患者预设性不信任情境量表区分度良好,具有较好的效度和信度,可作为我国患者对医生预设性不信任程度测量的适用工具。
Background Some patients' mistrust of doctors before taking medical treatment is an important cause of bad doctor-patient relationship. At present, there are still few tools for assessing patients' presupposed distrust.ObjectiveTo compile Patients' Presupposition Distrust Scale and test its reliability and validity.Methods Literature review,clinical practice,research group discussion and other methods were used to develop Patients' Presupposition Distrust Scale.A total of 52 patients and 384 patients were selected by convenient sampling method for pre-investigation and formal investigation from January to February 2018 and February to March 2018.The structure of the scale was optimized preliminarily by pre-investigation,and the items were screened and validated based on exploratory factor analysis,correlation analysis,criterion validity and Cronbach's alpha coefficient.Results The final Patients' Presupposition Distrust Scale consisted of 22 items.Eight common factors were extracted by exploratory factor analysis,including doctor-patient communication,patients' personal experience,doctor's characterization,medical system,doctor's medical ethics,other factors,doctor's skills and patients' judgment.Exploratory factor analysis showed that the cumulative variance contribution rate of the 8 common factors was 58.794%.Pearson correlation analysis showed that the score of each item was positively correlated with the total score,the score of each item and the corresponding common factor score(P<0.05).Wake Forest Physician Trust Scale was used as a criterion for Scale of Patients' Presupposed Distrust.Pearson correlation analysis showed that the total scores of the two scales were negatively correlated(P<0.05).The Cronbach's alpha coefficient of the preset distrust scale was 0.708 and the split half reliability coefficient was 0.729.Conclusion The developed patient presupposition distrust scale has good discrimination,good validity and reliability,and can be used as a suitable tool for measuring the degree of patients' presupposition distrust to doctors in China.
Background Some patients' mistrust of doctors before taking medical treatment is an important cause of bad doctor-patient relationship. At present, there are still few tools for assessing patients' presupposed distrust.ObjectiveTo compile Patients' Presupposition Distrust Scale and test its reliability and validity.Methods Literature review,clinical practice,research group discussion and other methods were used to develop Patients' Presupposition Distrust Scale.A total of 52 patients and 384 patients were selected by convenient sampling method for pre-investigation and formal investigation from January to February 2018 and February to March 2018.The structure of the scale was optimized preliminarily by pre-investigation,and the items were screened and validated based on exploratory factor analysis,correlation analysis,criterion validity and Cronbach's alpha coefficient.Results The final Patients' Presupposition Distrust Scale consisted of 22 items.Eight common factors were extracted by exploratory factor analysis,including doctor-patient communication,patients' personal experience,doctor's characterization,medical system,doctor's medical ethics,other factors,doctor's skills and patients' judgment.Exploratory factor analysis showed that the cumulative variance contribution rate of the 8 common factors was 58.794%.Pearson correlation analysis showed that the score of each item was positively correlated with the total score,the score of each item and the corresponding common factor score(P<0.05).Wake Forest Physician Trust Scale was used as a criterion for Scale of Patients' Presupposed Distrust.Pearson correlation analysis showed that the total scores of the two scales were negatively correlated(P<0.05).The Cronbach's alpha coefficient of the preset distrust scale was 0.708 and the split half reliability coefficient was 0.729.Conclusion The developed patient presupposition distrust scale has good discrimination,good validity and reliability,and can be used as a suitable tool for measuring the degree of patients' presupposition distrust to doctors in China.
引文
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[9]杨海洪.9条目病人健康问卷抑郁量表在卒中后抑郁筛查中的应用价值[J].实用临床医药杂志,2016,20(8):28-30.DOI:10.7619/jcmp.201608009.YANG H H.Value of 9 items Patients'Health Questionnaire Depression Scale in screening of post-stroke depression[J].Journal of Clinical Medicine in Practice,2016,20(8):28-30.DOI:10.7619/jcmp.201608009.
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[11]刘德,赵映前,刘建忠.心理干预对艾滋病患者HAART治疗效果的影响[J].湖北中医杂志,2010,32(4):12-13.LIU D,ZHAO Y Q,LIU J Z.Effect of psychological intervention on HAART treatment of AIDS patients[J].Hubei Journal of TCM,2010,32(4):12-13.
[12]戴海崎,张锋,陈雪枫.心理与教育测量[M].广州:暨南大学出版社,2011.DAI H Q,ZHANG F,CHEN X F.Psychological and educational measurement[M].Guangzhou:Jinan University Press,2011.
[13]成丹.基于CBAM的中小学教师信息化教学关注和实施水平研究[D].济南:山东师范大学,2014.CHENG D.The study based on the CBAM about the level of attention and implementation of primary and secondary school teachers in information teaching[D].Jinan:Shandong Normal University,2014.
[14]徐云杰.社会调查设计与数据分析:从立题到发表[M].重庆:重庆大学出版社,2016.XU Y J.Social survey design and data analysis:from topic to publication[M].Chongqing:Chongqing University Press,2016.
[15]程科.健全人格取向大学生心理健康量表的编制[D].重庆:西南大学,2009.CHENG K.Development of the Mental Health Scale with a healthy personality orientation for college students[D].Chongqing:Southwest University,2009.
[16]苏明宏,倪小冬.大学生隐性逃课量表的编制和结构探索[J].中国健康心理学杂志,2015,23(12):1858-1862.DOI:10.13342/j.cnki.cjhp.2015.12.027.SHU M H,NI X D.Development of Recessive Truancy Scale for college students[J].China Journal of Health Psychology,2015,23(12):1858-1862.DOI:10.13342/j.cnki.cjhp.2015.12.027.
[17]谭晖.上海小学生视力保健行为流行特点及干预探索研究[D].上海:复旦大学,2010.TAN H.Prevalence and intervention of vision care behaviors among primary school students in Shanghai[D].Shanghai:Fudan University,2010.
[18]陈蕾.癌症患者心身状态量表的编制及相关研究[D].广州:广东药学院.2014.CHEN L.Establishment of Psychosomatic Status Scale for cancer patients and related research[D].Guangzhou:Guangdong Pharmaceutical University,2014.
[19]木冬冬.基于现代特殊教育理念的特殊教育学校文化评估量表编制与初步应用[D].金华:浙江师范大学,2012.MU D D.Development and preliminary application of Special Education School Culture Assessment Scale based on modern special education concept[D].Jinhua:Zhejiang Normal University,2012.
[2]孙刚,陈雅迪,周梦瑶.居民的就医信任度及影响因素研究[J].中国全科医学,2017,20(16):2003-2006.DOI:10.3969/j.issn.1007-9572.2017.16.020.SUN G,CHEN Y D,ZHOU M Y.Degree of trust in medical care and associated factors in community residents[J].Chinese General Practice,2017,20(16):2003-2006.DOI:10.3969/j.issn.1007-9572.2017.16.020.
[3]孙刚,李慧腾.互害模式下的医患关系研究[J].中国全科医学,2017,20(16):1994-1997.DOI:10.3969/j.issn.1007-9572.2017.16.018.SUN G,LI H T.Doctor-patient relationship under the mutual damage mode based on the analysis of"WEI Ze-xi Event"and"CHENZhong-wei Case"[J].Chinese General Practice,2017,20(16):1994-1997.DOI:10.3969/j.issn.1007-9572.2017.16.018.
[4]许诗琪.预设性不信任在诊疗挫折感和患者攻击之间的中介作用[D].广州:南方医科大学,2017.XU S Q.Mediation effect of presuppose distrust between frustration in treatment and patient aggression[D].Guangzhou:Southern Medical University,2017.
[5]董恩宏,鲍勇.维克森林医师信任量表中文修订版的信效度[J].中国心理卫生杂志,2012,26(3):171-175.DOI:10.3969/j.issn.1000-6729.2012.03.003.DONG E H,BAO Y.Reliability and validity of the Chinese Version of Wake Forest Physician Trust Scale[J].Chinese Mental Health Journal,2012,26(3):171-175.DOI:10.3969/j.issn.1000-6729.2012.03.003.
[6]董照伦,陈长香.医师信任患者量表中文版的效度和信度初步研究[J].中国心理卫生杂志,2016,30(7)481-485.DOI:10.3969/j.issn.1000-6729.2016.07.001.DONG Z L,CHEN C X.A preliminary study of validity and reliability of the Chinese Version of the Physician Trust in the Patient Scale[J].Chinese Mental Health Journal,2016,30(7):481-485.DOI:10.3969/j.issn.1000-6729.2016.07.001.
[7]张艳.艾滋病患者医患信任量表的编译及应用研究[D].长沙:中南大学,2012.ZHANG Y.The Healthcare Relationship Trust Scale in HIV/AIDSpatients:translation,compilation and utilization[D].Changsha:Central south university,2012.
[8]徐喆玥,谢莹.医患信任现状及影响因素分析[J].中国卫生质量管理,2016,23(2):49-52.DOI:10.13912/j.cnki.chqm.2016.23.2.17.XU Z Y,XIE Y.Status quo and influence factors of doctor-patient trust[J].Chinese Health Quality Management,2016,23(2):49-52.DOI:10.13912/j.cnki.chqm.2016.23.2.17.
[9]杨海洪.9条目病人健康问卷抑郁量表在卒中后抑郁筛查中的应用价值[J].实用临床医药杂志,2016,20(8):28-30.DOI:10.7619/jcmp.201608009.YANG H H.Value of 9 items Patients'Health Questionnaire Depression Scale in screening of post-stroke depression[J].Journal of Clinical Medicine in Practice,2016,20(8):28-30.DOI:10.7619/jcmp.201608009.
[10]周常春,徐雪.近年来国内外医患信任研究综述[J].昆明理工大学学报(社会科学版),2015,15(1):8-14.DOI:10.16112/j.cnki.53-1160/c.2015.01.002.ZHOU C C,XU X.Review on the studies of doctor-patient trust in both China and overseas countries[J].Journal of Kunming University of Science and Technology(Social Sciences Edition),2015,15(1):8-14.DOI:10.16112/j.cnki.53-1160/c.2015.01.002.
[11]刘德,赵映前,刘建忠.心理干预对艾滋病患者HAART治疗效果的影响[J].湖北中医杂志,2010,32(4):12-13.LIU D,ZHAO Y Q,LIU J Z.Effect of psychological intervention on HAART treatment of AIDS patients[J].Hubei Journal of TCM,2010,32(4):12-13.
[12]戴海崎,张锋,陈雪枫.心理与教育测量[M].广州:暨南大学出版社,2011.DAI H Q,ZHANG F,CHEN X F.Psychological and educational measurement[M].Guangzhou:Jinan University Press,2011.
[13]成丹.基于CBAM的中小学教师信息化教学关注和实施水平研究[D].济南:山东师范大学,2014.CHENG D.The study based on the CBAM about the level of attention and implementation of primary and secondary school teachers in information teaching[D].Jinan:Shandong Normal University,2014.
[14]徐云杰.社会调查设计与数据分析:从立题到发表[M].重庆:重庆大学出版社,2016.XU Y J.Social survey design and data analysis:from topic to publication[M].Chongqing:Chongqing University Press,2016.
[15]程科.健全人格取向大学生心理健康量表的编制[D].重庆:西南大学,2009.CHENG K.Development of the Mental Health Scale with a healthy personality orientation for college students[D].Chongqing:Southwest University,2009.
[16]苏明宏,倪小冬.大学生隐性逃课量表的编制和结构探索[J].中国健康心理学杂志,2015,23(12):1858-1862.DOI:10.13342/j.cnki.cjhp.2015.12.027.SHU M H,NI X D.Development of Recessive Truancy Scale for college students[J].China Journal of Health Psychology,2015,23(12):1858-1862.DOI:10.13342/j.cnki.cjhp.2015.12.027.
[17]谭晖.上海小学生视力保健行为流行特点及干预探索研究[D].上海:复旦大学,2010.TAN H.Prevalence and intervention of vision care behaviors among primary school students in Shanghai[D].Shanghai:Fudan University,2010.
[18]陈蕾.癌症患者心身状态量表的编制及相关研究[D].广州:广东药学院.2014.CHEN L.Establishment of Psychosomatic Status Scale for cancer patients and related research[D].Guangzhou:Guangdong Pharmaceutical University,2014.
[19]木冬冬.基于现代特殊教育理念的特殊教育学校文化评估量表编制与初步应用[D].金华:浙江师范大学,2012.MU D D.Development and preliminary application of Special Education School Culture Assessment Scale based on modern special education concept[D].Jinhua:Zhejiang Normal University,2012.