肺结核患者医疗服务体验评价工具的研制及信效度评估

Development, reliability evaluation and validity of a health sevice experience assessment tool for patients with pulmonary tuberculosis

  • 摘要:
    目的 研制适用于我国医疗环境且科学的肺结核患者医疗服务体验评价工具,以系统评估患者就医核心维度,并为优化医疗服务提供量化依据。
    方法 基于医疗保健卫生服务可及性理论及结核病患者诊疗路径,通过文献回顾、德尔菲专家函询法构建肺结核患者医疗服务体验评估量表。采用多阶段整群抽样的方法,以治疗时间≥2个月的普通肺结核患者为研究对象开展问卷调查,了解患者体验评估量表的现场应用场景,评价其信效度,其中信度评价采用Cronbach’s α系数和分半信度,效度评价包括内容效度、结构效度、聚合效度及区分效度。
    结果 研究建立了涵盖知晓度、可及性、可负担性和可接受性4个维度21个评价指标组成的结核病患者医疗服务体验评价量表。总量表的Cronbach’s α系数和分半信度系数分别为0.838和0.859。探索性因子分析共提取6个因子,分别为服务满意度、护士支持、经济可负担性、医患交流、等候时间以及交通成本。拟合度指数(GFI)等指标达到适配标准,负荷矩阵显示量表的结构效度良好,构建的因子模型具有良好的内容效度、区分效度。
    结论 本研究开发的肺结核患者医疗服务体验评估量表具备较好的信效度,可作为评价患者体验的简易工具。

     

    Abstract:
    Objective To develop a scientifically rigorous and contextually appropriate instrument for evaluating the health service experience of pulmonary tuberculosis patients in China, to enable systematic assessment of core medical care dimensions, and to provide quantitative evidence for service improvement.
    Methods Grounded in the theoretical framework of healthcare accessibility and the clinical care pathway for tuberculosis patients, the tool was developed through a systematic literature review and the Delphi expert consultation method. A multi-stage cluster sampling strategy was employed to survey pulmonary tuberculosis patients who had been receiving treatment for more than two months, aimed to explore the scale’s applicability in real-world settings. Reliability was assessed using Cronbach’s α and split-half reliability coefficients. Validity was evaluated through content validity, structural validity, convergent validity, and discriminant validity.
    Results The tool was composed of 21 items across four dimensions: awareness, accessibility, affordability, and acceptability of tuberculosis medical care. It demonstrated a Cronbach’s α coefficient of 0.838 and a split-half reliability coefficient of 0.859. Exploratory factor analyses extracted six factors: satisfaction with healthcare services, supportive role of nurses, affordability of treatment costs, doctor-patient communication, waiting time for medical appointments, and transportation cost. The goodness-of-fit index (GFI) and other indices met the recommended standards, with the loading matrix indicating robust structural validity of the tool. The constructed factor model exhibited satisfactory content validity and discriminant validity.
    Conclusion The scale for assessing patients’ experiences with tuberculosis-related medical care developed in this study demonstrates good reliability and validity and serves as a practical tool for evaluating patient experiences of tuberculosis medical care in China.

     

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