中文版家庭照顧者給藥管理困擾量表之信效度檢測

Abstract

研究背景與目的 在長期照顧的範圍中，藥品日常使用及管理工作的確實與否，對於病人的照顧品質有很大的影響。長時間協助被照顧者進行給藥管理所帶來的種種挫折，會使得照顧工作困難度提高，並使照顧者產生心理層面的負荷，進而影響照顧品質。目前國外已發展出適合評估家庭照顧者給藥管理相關照顧負荷之心理測量工具，惟華人地區尚缺乏中文版具信、效度之評量工具。有鑑於藥師在長期照顧領域中肩負著維護民眾用藥安全的責任，在進行療效監測的同時亦須關注給藥管理工作對家庭照顧者所產生之照顧負荷及壓力。本研究選定國外已發展且具良好信、效度之英文量表“Family Caregiver Medication Administration Hassle Scale (FCMAHS)”進行中文版本編製及信、效度檢測，以了解國內家庭照顧者給藥管理困擾現況。 研究方法 本研究採橫斷面研究設計，分三階段進行：第一階段將原始英文量表經雙向翻譯過程完成中文化翻譯，隨後進行專家內容效度檢測以求中文量表之語言及文化對等性，並完成初版量表；第二階段為先驅性試驗，邀請15位本國籍非正式家庭照顧者針對初版中文量表進行試填，並根據受訪者對量表各題項敘述之易讀性所提出之建議進行修訂以完成中文量表之正式施測版本；第三階段進行「中文版家庭照顧者給藥管理困擾量表」之信、效度檢測及給藥管理困擾現況調查，以便利取樣與滾雪球取樣方式於台北市、新北市及部分外縣市地區招募共138名非正式家庭照顧者為研究對象。研究以內在一致性信度、再測信度進行量表信度檢測，並以專家內容效度、建構效度、區辨效度、已知組比較進行量表效度檢測。 研究結果 信度部分，「中文版家庭照顧者給藥管理困擾量表」之內在一致性Cronbach’s α值為.938，個別次量表Cronbach’s α介於.758~.929之間；再測信度方面，以組內相關係數針對30位受試者前後測之得分進行分析，結果顯示整體量表前後測得分之相關係數值為0.78，顯示量表具備良好內在一致性及再測信度。效度部分，「中文版家庭照顧者給藥管理困擾量表」的題項內容效度ICVI、量表內容效度SCVI值皆為1.0，顯示量表具備良好內容效度；使用探索性因素分析進行量表因素萃取，共萃取出四個因素，分別為「資訊取得/資訊分享」、「給藥時間安排」、「安全性議題」、「藥品領取/處方箋管理」，量表共24題，總解釋變異量為65.76%，個別次量表間之相關性呈現低－中度相關，顯示量表具備建構效度；研究亦以被照顧者每日使用藥品種類數(小於或等於10種、大於10種)進行已知組比較，結果發現兩組之量表得分呈現統計顯著差異(p<.05)。 結論 「中文版家庭照顧者給藥管理困擾量表」可應用於國內家庭照顧者族群給藥管理相關工作負荷之評估。本量表具備良好信、效度，建議未來可將此量表應用於雙北以外之縣市及特殊被照顧者族群，以增進該量表的可用性，並可針對國內家庭照顧者給藥管理困擾現況進行衛生教育介入方案之制訂。

Background and Purpose Among long-term caregiving, medication administration is one of the most critical tasks in care recipients’ daily illness management, especially when those medication regimens are complicated to manage various kinds of conditions, which will make the care work more difficult and cause negative impact on the physical and mental health of caregivers and the care quality. At present the instrument to measure family caregiver medication administration related stressors has been developed in United States. However, there is lack of relevant measurement tool to assess how family caregivers routinely handling medication administration tasks and what kinds of difficulties they are dealing with among Chinese societies. The purpose of this study is to develop a good reliability and validity scale named “Family Caregiver Medication Administration Hassle Scale-Chinese (FCMAHS-CH)”, and testing the psychometric properties of FCMAHS-CH when used on Taiwanese family caregivers, a previously unstudied population, to establish the reliability and validity to know the current situation of the stressors related to medication administration among family caregivers in Taiwan. Method A non-experimental, cross-sectional, three-phase study was designed to assess the psychometric properties of the FCMAHS-CH with Taiwanese. First, the original English version of FCMAHS was translated into Chinese via two-way translation process, followed by an expert panel to evaluate the content validity to reach the linguistic and cultural equivalence of the draft Chinese scale. Second, a pilot study was conducted by fifteen Taiwanese informal family caregivers to confirm the readability of the FCMAHS-CH. Final, one hundred and thirty-eight informal Taiwanese family caregivers aged 18 or older living majorly in Taipei and New Taipei City were invited to fill out the FCMAHS-CH to test the internal consistency, test-retest reliability, construct validity, discriminant validity and known group comparison. Results Both item content validity index (ICVI) and scale content validity index (SCVI) were 1.0. Exploratory factor analysis was used to extract four factors which accounted for 65.76% of the variance in total scores – “information seeking/information sharing”, “time scheduling of medication administration”, “safety issues”, and “prescription filling/prescription management”. The internal consistence estimates (Cronbach’s α) for the FCMAHS-CH was .938 and ranged from .758-.929 for four factors. Intra-class Correlation Coefficient (ICC) to assess test-retest reliability across 2 weeks was .78. By testing differential validity, the study divided “The number of kinds of medicine used by the care recipients per day” into two groups (less than or equal to ten species, more than ten species), Mann-Whitney U test showed significant difference (p<.05) between two groups. Conclusion The FCMAHS-CH has good validity and reliability for the assessment of Taiwanese family caregivers’ medication administration related stressors. However, to improve the generalizability of the scale in Taiwan, it is recommended that the scale should be refined in future studies.