Chinese General Practice ›› 2023, Vol. 26 ›› Issue (16): 2047-2054.DOI: 10.12114/j.issn.1007-9572.2022.0388

• Original Research·Focus on Research Tools • Previous Articles    

Development, Reliability and Validity of the Chinese Version of Primary Care Team Dynamics Scale

  

  1. 1Department of Health Management and Policy, School of Public Health, Hangzhou Normal University, Hangzhou 311121, China
    2Shangcheng District Kaixuan Street Community Health Center, Hangzhou 310020, China
  • Received:2022-05-31 Revised:2023-03-11 Published:2023-06-05 Online:2023-03-23
  • Contact: NI Ziling

家庭医生团队动力量表汉化及信效度检验

  

  1. 1311121 浙江省杭州市,杭州师范大学公共卫生学院卫生管理与政策系
    2310020 浙江省杭州市上城区凯旋街道社区卫生服务中心
  • 通讯作者: 倪紫菱
  • 作者简介:
    作者贡献:潘莎莎、崔璐负责论文的构思、设计与撰写;潘莎莎、马程乘、崔璐、李婵姣负责资料的收集、整理;潘莎莎负责论文的修订;倪紫菱对文章整体负责,监督管理。
  • 基金资助:
    浙江省自然科学基金资助项目--基于SELFIE框架的纵向医联体下多重慢病服务整合优化策略研究(LY22G030005)

Abstract:

Background

The family doctor team dynamics mainly refer to inter-member interaction state of the family doctor team in the process of providing services. Improving the team dynamics among family doctors can help promote the enhancement of team effectiveness. The Primary Care Team Dynamics Scale (PCTDS) developed by Sara J. Singer's team at Harvard University, which can be used to comprehensively assess the primary care team dynamics.

Objective

To translate the PCTDS into a Chinese version, and test the reliability and validity of the Chinese version.

Methods

The Brislin's model for translation, back translation and cross-cultural adaptation was utilized to translate the PCTDS into a Chinese version (PCTDS-C) strictly following the principle of scale introduction, and the PCTDS-C was revised in accordance with an email-based expert consultation and a pre-test. Then a total of 569 family doctor team members were selected from 17 cities (including Guangdong's Shenzhen, Hubei's Wuhan, Zhejiang's Hangzhou, and so on) by the convenience sampling method from November 2021 to February 2022 to attend a survey using a self-developed Demographic Questionnaire and the PCTDS-C. The critical ratio (CR) method and item-total correlation were used for item analysis. The content validity of the scale was assessed by the expert consultation. The structural validity of the scale was tested by the KMO test, Bartlett's test of sphericity, exploratory factor analysis, and confirmatory factor analysis. And the reliability of the scale was evaluated by the Cronbach's α.

Results

Three hundred and nine of the 569 cases (54.3%) who returned responsive questionnaires were included for analysis. The absolute CR value for each of the entries was greater than 3.000 (P<0.001), and the average r-value of the correlation between each item score and the total scale score was greater than 0.300 (P<0.001). The I-CVI was 0.692-1.000, and S-CVI was 0.896. A significant KMO value of 0.946 and a significant value of Bartlett's test of sphericity〔χ2=4 488.198 (df= 406, P<0.001) 〕indicated that the scale was suitable for factor analysis. Four common factors with an eigenvalue greater than 1.000 were extracted, including the conditions of team effectiveness (4 items), team shared understanding (6 items), team collaboration process (9 items), and team effectiveness (9 items), explaining 74.2% of the total variance. The load value of each item on the common factor was 0.561-0.802. Confirmatory factor analysis indicated that the performance of fit indices of the initial model was not satisfactory. After the correlations between the error variables e20 and e31, e6 and e7, e19 and e31, e24 and e25, e18 and e23, e4 and e10, e3 and e9 were added according to the indicator prompts, except for χ2/df, IFI and CFI, the performance of the other fit indices of the modified model was still unsatisfactory (χ2/df =2.313, RMSEA=0.091, GFI=0.748, AGFI=0.699, NFI=0.866, IFI=0.919, CFI=0.919). The Cronbach's α for the total scale was 0.978. And the Cronbach's α was 0.826 for the conditions of team effectiveness, 0.945 for team shared understanding, 0.957 for team collaboration process, and 0.956 for team effectiveness.

Conclusion

The PCTDS-C has proven to have a good reliability and a fair validity, which can be used as a tool to evaluate the family doctor team dynamics in China. However, there is still much room for the scale improvement. Future research can focus on in-depth exploration of the dimensions and item classification of the scale, and the adding of dimensions in line with the actual situation of family doctor teams in China.

Key words: Family doctor team, Team dynamics, Scale, Translation, Reliability, Validity, Primary health care, Community health services

摘要:

背景

家庭医生团队动力水平是家庭医生团队成员在提供服务过程中互动状态的映射。改善家庭医生团队动力有助于促进团队效能的提升。家庭医生团队动力量表(PCTDS)由美国哈佛大学SINGER所带领的研究团队开发,可用于全面评估家庭医生团队的团队动力。

目的

汉化PCTDS,并对中文版PCTDS进行信效度检验。

方法

严格遵循量表引进原则,采用Brislin模式对PCTDS进行翻译、回译及文化调适,经专家函询及预调查,形成中文版PCTDS。2021年11月至2022年2月,采用方便抽样法,选取来自广东省深圳市、湖北省武汉市、浙江省杭州市等17个城市的569例家庭医生团队成员为调查对象,使用一般资料调查表、中文版PCTDS对其进行调查,采用决断值(CR值)法和条目总分相关法进行项目分析,使用专家咨询法对量表的内容效度进行检验,采用KMO检验、Bartlett's球形检验、探索性因子分析与验证性因子分析评价量表的结构效度,使用Cronbach's α系数评价量表的信度。

结果

共回收问卷569份,其中有效问卷309份,问卷有效回收率为54.3%。所有条目的|CR值|>3.000(P<0.001),各条目得分与量表总分的相关系数>0.300(P<0.001)。条目水平的内容效度指数(I-CVI)为0.692~1.000,量表水平的内容效度指数(S-CVI)为0.896。KMO值为0.946,Bartlett's球形检验结果显示,χ2=4 488.198(df=406)、P<0.001,提示数据适合用于因子分析;按照特征根>1.000的标准可提取4个公因子,分别为团队有效性的条件(4个条目)、团队共识(6个条目)、团队协作过程(9个条目)、团队有效性(9个条目),4个公因子的累积方差贡献率为74.2%,各条目在所属公因子上的载荷值为0.561~0.802。验证性因子分析结果显示,初始模型适配度指标表现不理想,根据指标提示添加误差变量e20和e31、e6和e7、e19和e31、e24和e25、e18和e23、e4和e10、e3和e9间的相关关系后,除χ2/df、增值拟合指数(IFI)、比较拟合指数(CFI)外,修正模型的其余适配度指标表现仍不佳〔χ2/df=2.313,近似误差均方根(RMSEA)为0.091,拟合优度指数(GFI)为0.748,调整后的拟合优度指数(AGFI)为0.699,规范拟合指数(NFI)=0.866,IFI为0.919,CFI为0.919〕。总量表的Cronbach's α系数为0.978,团队有效性的条件、团队共识、团队协作过程、团队有效性维度的Cronbach's α系数分别为0.826、0.945、0.957、0.956。

结论

中文版PCTDS信度良好、效度一般,可用于评估我国家庭医生团队动力,但有待进一步完善。未来,须对量表维度及条目归属进行更加深入的探索,增加更符合我国家庭医生团队发展实际情况的维度。

关键词: 家庭医生团队, 团队动力, 量表, 汉化, 信度, 效度, 初级卫生保健, 社区卫生服务