中文版主观负荷评估法量表和美国国家航空航天任务负荷指数量表评估三级医院内科医生脑力负荷的信效度研究

doi:10.12114/j.issn.1007-9572.2018.00.236

摘要/Abstract

摘要： 目的　检验中文版主观负荷评估法（SWAT）、美国国家航空航天任务负荷指数（NASA-TLX）量表评估三级医院内科医生脑力负荷的信度和效度，并分析不同内科医生之间的脑力负荷差异，为以后评估国内三级医院内科医生的脑力负荷提供一种可行的工具。方法　2014年11月—2015年1月采用方便抽样法选取复旦大学附属中山医院内科临床执业医生107例为调查对象。采用医生一般情况调查表及中文版SWAT、NASA-TLX量表对其进行调查。采用内部一致性信度、分半信度、条目与总分的相关性进行信度评价，采用结构效度、区分效度进行效度评价。采用多个独立样本的非参数检验比较不同科室医生脑力负荷水平的差异。结果　共发放调查问卷107份，回收有效问卷105份（2例拒绝调查），有效回收率为98.1%。中文版SWAT、NASA-TLX量表的Cronbach's α系数分别为0.504、0.516，分半信度系数分别为0.360、0.634，中文版SWAT量表各条目得分与其总分的相关系数均>0.3（P值均<0.05），中文版NASA-TLX量表心智需求、体力需求、时间需求、努力程度、受挫程度条目得分与其总分的相关系数均>0.3（P值均<0.05），由于中文版NASA-TLX量表自我绩效条目得分与其总分的相关系数<0.3，故将此条目删除，形成C-NASA-TLX量表，其Cronbach's α系数为0.645，分半信度系数为0.690，各条目得分与其总分的相关系数均>0.3（P值均<0.05）。中文版SWAT量表的KMO值为0.552，Bartlett's球形检验χ2=24.711，P<0.001，说明适合进行因子分析；共提1个公因子，累积方差贡献率为51.343%，各条目载荷值为0.573~0.817。中文版NASA-TLX量表的KMO值为0.590，Bartlett's球形检验χ2=117.010，P<0.001，说明适合进行因子分析；共提取3个公因子，累积方差贡献率为76.508%，各条目载荷值为0.602~0.827。C-NASA-TLX量表的KMO值为0.607，Bartlett's球形检验χ2=96.658，P<0.001，说明适合进行因子分析；共提取2个公因子，累积方差贡献率为67.037%，各条目载荷值为0.542~0.810。根据中文版SWAT、NASA-TLX量表总分及C-NASA-TLX量表总分，分别采用极端组法将医生分为A高分组、A低分组和B高分组、B低分组及C高分组、C低分组，各28例；A高分组中文版SWAT量表时间负荷、努力负荷、心理紧张负荷条目得分高于A低分组（P<0.05）；B高分组中文版NASA-TLX量表仅心智需求、体力需求、努力程度条目得分高于B低分组（P<0.05）；C高分组C-NASA-TLX量表心智需求、体力需求、时间需求、努力程度、受挫程度条目得分高于C低分组（P<0.05）。不同科室医生中文版SWAT量表总分及其各条目得分比较，差异无统计学意义（P>0.05）。不同科室医生中文版NASA-TLX量表总分及其心智需求、体力需求、时间需求、自我绩效条目得分比较，差异无统计学意义（P>0.05）；不同科室医生中文版NASA-TLX量表努力程度、受挫程度条目得分比较，差异有统计学意义（P<0.05）。结论　中文版SWAT量表虽结构效度及项目区分度较好，但内部一致性信度较差，仍不适合用于评估三级医院内科医生脑力负荷；中文版NASA-TLX量表与中文版SWAT量表信效度相似，但删除自我绩效条目后的C-NASA-TLX量表信效度较好，可以用于三级医院内科医生的脑力负荷研究。三级医院不同科室医生总脑力负荷无差异。

关键词: 工作负荷量, 医师, 内科学, 信度, 效度

Abstract: Objective　To verify the reliability and validity of the Chinese version of the Subjective Load Assessment Method （SWAT） and the National Aeronautics and Space Administration Task Load Index （NASA-TLX） scales for assessing the mental load of physicians in tertiary hospitals，and to analyze the differences in mental loads among physicians.The analysis of the differences provided a feasible tool for assessing the mental workload of physicians in Chinese tertiary hospitals.Methods　From November 2014 to January 2015，107 cases of clinical practitioners in the Zhongshan Hospital Fudan University were selected through a convenient sampling method.A questionnaire assessing doctors' general mental state and the Chinese version of the SWAT as well as NASA-TLX scales were used in this study.Reliability was evaluated through internal consistency reliability，split-half reliability，and the correlation between these items and the total score.The validity of the structure was evaluated through structural validity and discriminant validity.Non-parametric tests using multiple independent samples were used to compare differences in brain load levels among physicians from different departments.Results　A total of 107 questionnaires were distributed，and 105 valid questionnaires were returned （two cases were rejected）．The effective recovery rate was 98.1%.The Cronbach's α coefficients of the Chinese version of SWAT and NASA-TLX scales were 0.504 and 0.516，respectively.The split-half reliability coefficients were 0.360 and 0.634，respectively.The correlation coefficient between the scores of items of the Chinese version of SWAT scale and the total score was >0.3 （all P values <0.05）．The correlations between the scores from the Chinese version of NASA-TLX scale of mental needs，physical needs，time requirements，efforts，degree of frustration and total scores were >0.3 （P<0.05 indicating significant differences）．With the Chinese version of the NASA-TLX，the correlation coefficient between the self-performance item score and its total score was less than 0.3.Consequently，this item was omitted in building the C-NASA-TLX scale.The Cronbach's α coefficient was 0.645，and the split-half reliability coefficient was 0.690.The correlation coefficient between item score of　C-NASA-TLX scale and the total score was >0.3 （P<0.05）．The KMO value of the Chinese SWAT scale was 0.552.The Bartlett's spherical test χ2=24.711，P<0.001，thus indicating that it was suitable for factor analysis.A total of one common factor was proposed，and the cumulative variance contribution rate was 51.343%.The load value of each item was in the range of 0.573-0.817.The Chinese version of the NASA-TLX scale had a KMO value of 0.590，and Bartlett's spherical test χ2=117.010，P<0.001，thus indicating that it was suitable for factor analysis.A total of three common factors were extracted.The cumulative variance contribution rate was 76.508%，and the load value of each item was in the interval of 0.602-0.827.The KMO value of the C-NASA-TLX scale was 0.607.Bartlett's spherical test χ2=96.658，P<0.001，thus indicating that it was suitable for factor analysis.A total of two common factors were extracted，the cumulative variance contribution rate was 67.037%，and the load value of each item was in 0.542-0.810.According to the Chinese version of SWAT and the NASA-TLX scale total score and C-NASA-TLX scale total score，the extreme grouping method was used to divide doctors into the following groups：A-high group，A-low group，B-high group，B-low group，C-high group and C-low group.Each group had 28 cases.The Chinese version of SWAT scale's time load，effort load and psychological stress load item scores of the A-high group were higher than those of the A-low group （P<0.05）．The Chinese version of NASA-TLX scale's mental needs，physical demand，and effort level scores of the B-high group were higher than those of the B-low group （P<0.05）．The C-NASA-TLX scale's mental needs，physical needs，time requirements，effort，and frustration levels of the C-high group were higher than those of the C-low group （P<0.05）．There was no statistically significant difference in the scores of the Chinese version of SWAT scale of the doctors in different departments （P>0.05）．The scores of Chinese version of the NASA-TLX scale in different doctors and their mental needs，physical strength，time requirements and self-performance scores were not significantly different （P>0.05）．The scores of Chinese version of the NASA-TLX scale's effort and frustration were compared for different departments，and the differences were statistically significant （P<0.05）．Conclusion　Although the Chinese version of the SWAT scale had good structural validity and project discrimination，the internal consistency was poor.It was deemed unsuitable to use this criterion for evaluating the mental load of physicians in tertiary hospitals.The Chinese version of the NASA-TLX scale and SWAT volume had equivalent reliability.However，the C-NASA-TLX scale had good reliability and validity after removal of the self-performance item，thus indicating that this scale can be applied for the brain load research of physicians in tertiary hospitals.There were no differences in the total brain load of doctors in different departments of tertiary hospitals.

Key words: Workload, Physicians, Internal medicine, Reliability, Validity

马琳琳,潘志刚. 中文版主观负荷评估法量表和美国国家航空航天任务负荷指数量表评估三级医院内科医生脑力负荷的信效度研究[J]. 中国全科医学, 2018, 21(33): 4127-4133. DOI: 10.12114/j.issn.1007-9572.2018.00.236.
MA Linlin,PAN Zhigang. The Chinese Version of the Subjective Load Assessment Method and the US National Aeronautics and Space Administration Task Load Index Scales for Assessing the Reliability and Validity of Physicians' Mental Loads in Tertiary Hospitals[J]. Chinese General Practice, 2018, 21(33): 4127-4133. DOI: 10.12114/j.issn.1007-9572.2018.00.236.

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