Chinesization of Community Client Need Classification System and Testing of Its Reliability and Validity

doi:10.12114/j.issn.1007-9572.2019.00.769

Abstract

Abstract: Background　With the aging of the global population and the increasing burden of medical care，most of the elderly have been suffering from chronic diseases，and the best choice for them was returning the community and family to receive the community medical services. However，the community medical and health services in China are still relatively weak lacking the evaluation tools for comprehensive management of chronic diseases. Objective　To translate the Community Client Need Classification System（CCNCS） into Chinese and evaluate its reliability and validity in patients with chronic diseases，in order to provide a reference for the management of chronic diseases in the community and the formulation of targeted interventions.Methods　The translation of CCNCS was carried out by Brislin model，and the semantic adjustment of its items were carried out through expert consultation and pilot study. From April to June 2018，243 patients with chronic diseases from three community health service centers in Zhengzhou were selected by convenience sampling for questionnaire survey that included general information questionnaire and Chinese version of CCNCS（C-CCNCS），and the reliability and validity of C-CCNCS were tested. A total of 243 questionnaires were distributed，and 240 valid questionnaires were collected with an effective recovery rate of 98.8%. Twenty-eight out of 240 respondents were selected by random number table method and were re-investigated by C-CCNCS after two weeks. SPSS 21.0 software was used for statistical analysis. The validity was evaluated by content validity and predictive validity. The reliability was evaluated by internal consistency reliability，test-retest reliability and inter-rater agreement. Results　C-CCNCS includes seven dimensions：environmental factors，psychosocial needs，physiological care needs，case and care management，nursing assessment，caregiver and family support，health education and health promotion. Pearson correlation analysis showed that the scores of each dimension of C-CCNCS were positively correlated with the total score（r=0.368-0.739，P<0.05）. The C-CCNCS validity test showed that item-level content validity index（I-CVI） was 0.80-1.00，and the average scale-level content validity index（S-CVI/Ave） was 0.97. Predictive validity test：Spearman correlation analysis showed that the direct nursing time（r=0.490） and indirect nursing time（r=0.635） were positively correlated with the need levels（P<0.05），and the differences of the direct nursing time（F=13.500）and indirect nursing time（F=120.984） among all need levels were statistically significant（P<0.05）. Reliability test of C-CCNCS：the coefficient of Cronbach's α of C-CCNCS was 0.763；the test-retest reliability of C-CCNCS was 0.860；and the test-retest reliability of each dimension was between 0.803 and 0.863. The inter-rater agreement for C-CCNCS was 93.75%. Conclusion　The C-CCNCS has good reliability and validity，which could be used for evaluating the levels of health service needs among community patients with chronic diseases.

Key words: Community health services, Chronic disease, Community client need classification system, Reliability, Validity

摘要： 背景　全球人口老龄化加剧，医疗负担不断加重，且大多数老年人罹患慢性病，回归社区和家庭接受社区医疗服务成为最佳选择，但我国社区医疗卫生服务还比较薄弱，缺乏慢性病综合管理的评估工具。目的　汉化社区人群需求分级系统（CCNCS），为我国社区慢性病患者管理和制定针对性的干预措施提供参考。方法　采用Brislin翻译模式对CCNCS工具进行汉化，通过专家咨询和预调查进行语义调整。于2018年4—6月，采用便利抽样法选取郑州市3个社区卫生服务中心243例慢性病患者进行问卷调查，包括一般资料调查表和中文版CCNCS（C-CCNCS），并检验C-CCNCS信效度。共发放243份问卷，回收有效问卷240份，问卷有效回收率为98.8%。采用随机数字表法从240例被调查者中选取28例，间隔2周后采用C-CCNCS再次对其进行调查。采用SPSS 21.0软件进行统计分析，采用内容效度和预测效度评价效度；采用内部一致性信度、重测信度和评定者间一致性评价信度。结果　C-CCNCS包括7个维度：环境因素、心理社会需求、生理照护需求、案例和照护管理、护理评估、照顾者和家庭支持、健康教育和健康促进。各维度得分与总分的Pearson相关性分析结果显示，C-CCNCS各维度得分均与总分呈正相关（r=0.368~0.739，P<0.05）。C-CCNCS效度检验：条目内容效度（I-CVI）为0.80~1.00，平均内容效度指数（S-CVI/Ave）为0.97。预测效度：Spearman秩相关分析显示社区慢性病患者直接护理时间（rs=0.490）、间接护理时间（rs=0.635）与需求水平分级呈正相关（P<0.05），且各需求水平分级之间的直接护理时间（F=13.500）、间接护理时间（F=120.984）比较，差异有统计学意义（P<0.05）。C-CCNCS信度检验：C-CCNCS的Cronbach's α系数为0.763；C-CCNCS的重测信度为0.860，各维度的重测信度为0.803~0.863；C-CCNCS的评定者间一致性为93.75%。结论　C-CCNCS具有良好的信效度，可用于社区慢性病患者卫生服务需求水平的评估。

关键词: 社区卫生服务, 慢性病, 社区人群需求分级系统, 信度, 效度

FENG Rongfang，WANG Yu，WANG Peng，ZHANG Zhenxiang，SI Dayan，LI Mengmeng，JIAO Jiawei. Chinesization of Community Client Need Classification System and Testing of Its Reliability and Validity　[J]. Chinese General Practice, 2020, 23(34): 4326-4331.

冯荣芳，王宇，王鹏，张振香，司妲艳3李萌萌，焦佳伟. 社区人群需求分级系统的汉化及信效度检验[J]. 中国全科医学, 2020, 23(34): 4326-4331.

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