中文版意志量表之信度與效度研究

Abstract

前言：職能治療是使個體在其日常生活中，參與有動機及有意義的職能活動，以增進個體的功能表現。憂鬱症患者常有動機低落的情形，可能造成適應功能的障礙。因此，評估個體動機的狀態，可使治療者確認個體的動機缺陷並設定適當的介入計畫。意志是指個體進行職能的動機表現。意志量表可提供個體具體的動機特徵及確認支持或阻礙動機表現的環境因子。本研究目的是，驗證中文版意志量表應用於臺灣憂鬱症患者的信度與效度。 研究方法：本研究將意志量表進行兩階段中文化翻譯後，收集北台灣三所醫療機構共97位診斷為憂鬱症的個案，男性23位、女性74位。平均年齡為47.14歲，標準差為14.12歲。以個案從事職能活動，評估其意志功能表現，並完成5項效標量表後，驗證本量表的心理計量特性。研究資料以羅序測量模式分析本量表的建構效度與內在一致性，SPSS 11.5版統計軟體進行再測信度、同時效度及描述性統計等分析。 研究結果：中文版意志量表之建構效度除「持續活動直到完成」項目之近合適度為1.41外，其餘各項目皆符合羅序模式假設，具有單一建構效度。再測信度，ICC=.82，各項目之kappa介於.449~.876。內在一致性之項目分離信度係數為1.00。同時效度，本量表與所有效標量表皆呈現低度顯著相關(r = -.201~.335，p=.049~.001)。此外，本研究顯示，49位個案參與早操與圖形排列兩項不同職能形式之環境特徵活動，意志功能表現具顯著差異(t =8.670 , p =.000)。此結果呼應了「人類職能模式」理論，即環境會影響個體的意志表現。 結論：本研究結果證實，中文版意志量表是份可信且有效的評估工具，可提供治療者應用於憂鬱症患者意志功能的臨床評估、介入計畫、療效進展或學術研究的參考依據。

Introduction：Occupational therapy seeks to facilitate the clients’ functional performance through motivated, meaningful participation in life occupations. Clients with depressive disorder commonly experience reduction in motivation and energy. Poor motivation can be an impediment to their adaptive functioning. Hence, Data collected on a person’s motivation enables the therapists to identify motivational barriers to functioning and to plan appropriate intervention. Volition refers to the motivation for occupation. The Volitional Questionnaire can provide individualized and concrete information about the person’s specific motivational characteristics (e.g., personal causation, values, and interests), and identify environmental factors that support or hinder the person’s volition. The purpose of this thesis is to validate the psychometric properties of the Chinese version of the Volitional Questionnaire for clients with depressive disorders in Taiwan. Methods：The Volitional Questionnaire was translated into Mandarin via 2 stage methodology and tested on 97 clients who were diagnosed with depressive disorders and were recruited from one university-affiliated hospital and two psychiatry rehabilitation hospitals in northern Taiwan. The clients were consisted of twenty-three males and seventy-four females. The average age of the clients was 47.14 years old. (SD=14.12). All subjects participated in purposeful activities that were arranged by the researcher or choose by self, then, the volitional status of the clients was assessed by the researcher. Furthermore, the clients had to finish 5 assessments tools in order to examine the psychometric properties of the Chinese version of the Volitional Questionnaire. The data was analyzed by using Rasch measurement model and traditional test theory. Results：Rasch analysis indicated that the Volitional Questionnaire-Chinese version encompasses a unidimensional construct. The results of the study showed that test-retest reliability of the Volitional Questionnaire-Chinese version, ICC= .82. Kappa value of individual item of the Volitional Questionnaire-Chinese version was between .449 and .876. The item separation coefficient is 1.00 showed that the Volitional Questionnaire-Chinese version had ideal internal consistency reliability. Lower correlations between the VQ-C and the criterion-related assessment tools revealed that the concurrent validity of the VQ-C was within acceptable level. Furthermore, The 49 clients took part in two different activities with different occupational forms of environment that indicated significant difference in volitional performance (t = 8.670 ，p =.000). This result did meet the theory of the「Model of Human Occupation」. That is, the volitional function of the clients could be influenced by environmental features. Conclusions：This study confirmed that the VQ-C is a reliable and effective assessment tools, which can provide useful information to therapists about the client’s volitional performance as references in clinical evaluation, intervention program, progression of treatment, or academic research.