中文版Mishel疾病不确定感量表的重新修订及其在中国恶性肿瘤患者中的信效度检验

摘要

目的 重新翻译、修订中文版Mishel疾病不确定感量表(MUIS),并测试其在中国恶性肿瘤患者中的信效度.方法 将原MUIS汉化并对其进行修订,形成中文版MUIS.采用便利抽样法选取2015年7月—2016年4月在广州中医药大学第一附属医院、中山大学肿瘤防治中心、广东省中医院接受治疗的恶性肿瘤患者550例为调查对象.采用一般资料表、中文版MUIS、焦虑自评量表(SAS)、抑郁自评量表(SDS)、中文版癌症自我管理效能感量表(SUPPH)对其进行调查.2周后,采用EXCEL自带的随机程序从470例患者中选取50例,采用中文版MUIS对其进行重测.对中文版MUIS进行条目分析、信效度分析,并确定其截断值.结果 中文版MUIS包括模糊、缺乏澄清、不可预测3个维度,共20个条目.中文版MUIS各条目的内容效度指数(CVI)为0.73~1.00;KMO值为0.810,Bartlett's球形检验χ2=871.55,P<0.001.3因子模型能在满足各项因子提取标准的前提下最大限度地解释方差(57.23%);模型的拟合指标分别为RMSEA=0.037、CFI=0.905、GFI=0.936、AGFI=0.911、SRMR=0.052.中文版MUIS总分及其各维度得分与SAS得分、SDS得分均呈正相关,与SUPPH总分及其各维度得分均呈负相关(P<0.05).中文版MUIS的Cronbach's α系数为0.825,重测信度系数为0.836;MUIS截断值为60.5分,灵敏度为0.715,特异度为0.759.结论中文版MUIS具有良好的信效度,更适合中国恶性肿瘤患者使用,同时可作为恶性肿瘤患者高危心理的初步筛查工具.%Objective To develop the Revised Chinese Version of Mishel Uncertainty in Illness Scale (RC-MUIS), and test its reliability and validity in a sample of Chinese patients with cancer. Methods The original MUIS was translated into Chinese and revised, then the initial RC-MUIS was developed. Then, the psychometric properties of the initial RC-MUIS were tested in 550 conveniently sampled patients with cancer who received treatment from the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Sun Yat-sen University Cancer Center, Guangdong Provincial Hospital of Chinese Medicine from July 2015 to April 2016. The participants were also surveyed by a self-developed Baseline Characteristics Questionnaire, Chinese version of Zung Self-Rating Anxiety Scale (C-SAS), Chinese version of Zung Self-Rating Depression Scale (C-SDS), and Chinese version of Strategies Used by People to Promote Health (C-SUPPH) for testing the convergent validity of the initial RC-MUIS. Two weeks later, the initial RC-MUIS was re-tested in 50 patients randomly selected from the responsive participants (totaled 470) in the first test by an Excel-based program. After that, we conducted item analysis, reliability and validity assessment of the initial RC-MUIS, then developed the final RC-MUIS, and determined its cutoff value. Results The final RC-MUIS includes three factors (ambiguity, lack of clarity and unpredictability) covering 20 items, which were extracted by factor analysis, explaining 57.23% of the total variance. The CVI of items ranged from 0.73-1.00. KMO=0.810 and Bartlett's χ2=871.55, P<0.001. Confirmatory factor analysis showed root mean square error of approximation (RMSEA)=0.037, comparative fit index (CFI)=0.905, goodness-of-fit index (GFI)=0.936, adjusted goodness-of-fit index (AGFI)= 0.911, standardized root mean square residual (SRMR)=0.052. RC-MUIS and its factors were positively associated with C-SAS and C-SDS and their corresponding factors in terms of score(P<0.05), but were negatively associated with C-SUPPH and its factors (P<0.05). The Cronbach's α and test-retest reliability of RC-MUIS was 0.825 and 0.836, respectively. The cut-off value, sensitivity and specificity of RC-MUIS was 60.5, 0.715 and 0.759, respectively. Conclusion The RC-MUIS, being reliable, valid and easy to use, is suitable to be adapted by clinical settings as a screening tool to recognize Chinese cancer patients with high-risk psychological problems.