中文版癌症兒童主要照顧者正常化量表之信效度研究

Abstract

研究背景： 隨著醫療環境及品質的提升，疾病的存活率及平均餘命增加，導致慢性疾病病患人數逐年遞增。這些長期需要與疾病共處的慢性疾病患者，為了降低疾病或治療所帶來的不良效應，或渴望回歸正常的生活型態，即為「正常化」。國內尚未有以正常化觀點探討慢性疾病病患在因應疾病的過程，因此希望藉由中文版正常化量表的發展，未來可用於檢視台灣慢性疾病病患罹病後的正常化情形。 研究目的： 本研究目的係將O’Neal於2007年發展的正常化量表，經修訂及翻譯成中文之後測試在台灣的適用性並檢測其信效度。具體目標有三：1.發展中文版癌症兒童主要照顧者正常化量表， 2.建立中文版癌症兒童主要照顧者正常化量表的心理計量，及3.瞭解台灣癌症兒童主要照顧者正常化的情形。 研究方法： 本研究中文版癌症兒童主要照顧者正常化量表是經過雙向翻譯及專家內容效度檢定後，以結構式問卷施測於癌症兒童的主要照顧者。研究者於北部某醫學中心兒童癌症病房及門診間採立意取樣的方式進行收案，共收得241位受訪者。經內在一致性信度、專家內容效度、建構效度、效標關聯效度，檢定此量表的心理計量。 研究結果： 本研究量表的內在一致性信度Cronbach’s α值為0.91。效度方面，建構效度經探索式因素分析法，萃取出單一因素。經驗證式因素分析法驗證本量表的假設模型，經模組修飾後其適配指標GFI、AGFI、CFI、IFI、PGFI、PNFI、RMSEA、RMR、χ2/df均可達到閾值，可見本量表模組於統計上具有足夠的解釋力，平均變異萃取量為0.537。中文版癌症兒童主要照顧者正常化量表和「台灣簡明版生活品質量表」、「中文版成人復原力量表」進行相關性分析，其相關係數分別為0.475、0.372，可見本量表具有良好的效標關聯效度。經三位專家進行兩次的專家內容效度檢測，CVI值分別為0.88、0.99。由此可知本研究量表具有良好的信效度。 研究結果發現「治療年距」、「癌童疾病治療階段」、「家庭開銷是否需要他人補助」為影響癌症兒童主要照顧者正常化的主要變項。另外本量表和「台灣簡明版生活品質量表」各範疇均呈中度正相關，相關係數介於0.375-0.436 (p<.01)。和中文版成人復原力量表各範疇呈低至中度正相關，相關係數介於0.253-0.352 (p<.01)。 結論與應用： 本研究所發展的中文版癌症兒童主要照顧者正常化量表具有良好的信效度。建議將此概念運用於臨床護理實務、教育及研究上，從測量的量化結果協助促進慢性疾病病患或其照顧者及早建立正常的生活型態，拓展此概念的發展和應用。

Background: The quality of medical treatment is improving, the survival rate of diseases and average of ages are extended, and many people will coexist with their diseases. The definition of normalization is that these people with chronic disease will want to return to their normal life in order to reduce the distress of life. But in our country, it hasn’t explored the patient who cope with chronic disease used the concept of normalization. This research is conducted to develop the Chinese version of normalization assessment measure to examine the phenomenon of these patient coping chronic diseases in normalization. Objective: The aims of this research have threefold. First, is to translate and revise the “Normalization Assessment Measure” developed by Dr. O’Neal in 2007 into Chinese version. Second, is to establish its reliability and validity. And third, is to understand the phenomenon of normalization of caregivers of cancer children. Methods: The Chinese version of Normalization Measure Assessment in caregiver of cancer children (NAM-CCC) had been double-translated. We survey a sample of 241 the caregivers of cancer children who treated at the medical center in North of Taiwan. Results: The Cronbach’s α coefficient of the NAM-CCC is 0.91. The construct validity is analyzed by exploratory factor analysis, and one factor is extracted. And these items are analyzed by confirmatory factor analysis, all adaptation indexes included GFI、AGFI、CFI、IFI、PGFI、PNFI、RMSEA、RMR、χ2/df, show that the structural model of NAM-CCC has explanatory power on statics. And the Average Variance Extracted of NAM-CCC is 0.537. The Pearson’s correlation with “Taiwan version of WHOQOL-BREF” and ”Chinese version of Resilience Scale for Adult” are 0.475、 0.372(p<0.01). The results show that the NAM-CCC consisted of good criterion-related validity. This research had invited three experts to review NAM-CCC twice. The result of the first content validity is 0.88, and the second is 0.99. The results show that “The years of treatment”、“The stage of treatment for the cancer children” and “Do family need financial support?” are the main variables influenced the normalization on the caregivers of cancer children. NAM-CCC is moderately positive associated with these domains of “Taiwan version of WHOQOL-BREF” (r=.375-.436, p<.01). NAM-CCC is mildly to moderately positive associated with these domains of “Chinese version of Resilience Scale for Adult” (r=.253-.352, p<.01) Discussion and Conclusion: The results indicate that the NAM-CCC consists of good reliability and validity. The instrument can be used for measure normalization in caregivers of cancer children. And it will help us to understand what these people need to enhance them build the normal life.