患者就医体验调查问卷的汉化及信效度评价
发布人：yaot 发布时间：2022/12/16 11:40:58 浏览次数：733次
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】——吴怡雪 童莺歌 陈思亦 韩芷晴 薛子豪 姚兰 宋晓萍?胡凯燕 邱文波
【摘要】目的 汉化患者就医体验调查问卷《我们做得如何（howRwe）》，并检验其信效度和可读性。方法?采用Brislin经典回译模型对howRwe问卷进行直译、回译、等效性评价、文化调适和预测试，形成中文版howRwe问卷（howRwe-C）,便利抽取杭州市两家三甲医院的499名成人住院患者进行问卷信效度检验，邀请研究者评价问卷可读性，便利选取60名住院患者测定问卷作答时间，改编howRwe-C问卷介绍语并选取60名癌痛患者进行试应用。采用SPSS 25.0软件进行统计分析。结果 howRwe-C问卷Cronbach’s α系数为0.940；各条目内容效度和问卷总内容效度均为1.0；探索性因子分析共提取出1个公因子，累计方差贡献率为84.666%；健康素养充足患者howRwe-C问卷得分为（9.28±2.33）分，健康素养不足患者howRwe-C问卷得分为（7.13±2.89）分，两组得分比较差异有统计学意义（Z=-8.006，P＜0.01）。howRwe-C问卷所含常用词29个、非常用词4个，平均作答时间为（54.14±27.74）s。癌痛管理示范化病房患者howRwe-C问卷得分为（10.57±1.65）分，非癌痛管理示范化病房患者howRwe-C问卷得分为（9.60±1.79）分，两者评分比较具有统计学差异（Z=-2.044，P=0.041）。结论 howRwe-C问卷的信效度、可读性良好，所需作答时间短，可用于医院评价住院患者就医体验。
【关键词】住院患者；患者体验；问卷；汉化；信度；效度
中图分类号：R197.323 文献标识码：A
Chinesization of Patient Experience Questionnaire and its Reliability and Validity Evaluation/WU Yixue,TONG Yingge,CHEN Siyi,et al.//Chinese Health Quality Management，2022,29(11):61-66
Abstract Objective To translate the patient experience questionnaire "how are we doing" (howRwe) into Chinese version (howRwe-C), and to test its reliability, validity and readability. Methods The Brislin classic back translation model was used to conduct literal translation, back translation, equivalence evaluation, cultural adaptation and pre-test of the howRwe questionnaire. The Chinese version of howRwe questionnaire (howRwe-C) was formed, and 499 adult inpatients from two tertiary hospitals in Hangzhou were conveniently selected to test the reliability and validity of the questionnaire. Researchers were invited to evaluate the readability of the questionnaire, and 60 inpatients were conveniently selected to measure the response time of the questionnaire. The introduction of howRwe-C questionnaire was adapted and 60 patients with cancer pain were selected for trial application. SPSS 25.0 software was used for statistical analysis.Results The Cronbach's α coefficient of howRwe-C questionnaire was 0.940. Both the content validity index for item and the content validity index for scales were 1.0. Exploratory factor analysis extracted one common factor, and the cumulative variance contribution rate was 84.666%. The howRwe-C score of patients with adequate health literacy was (9.28±2.33). The howRwe-C score of patients with health literacy deficiency was (7.13±2.89), and the difference between the two groups was statistically significant (Z=-8.006, P< 0.01). The howRwe-C questionnaire contained 29 common words and 4 non-common words, and the response time was (54.14±27.74) s. The howRwe-C score of patients in the cancer pain management demonstration ward was (10.57±1.65) , and the howRwe-C score of patients in the non-cancer pain management demonstration ward was (9.60±1.79), and the difference was statistically significant (Z=-2.044, P=0.041). Conclusion The howRwe-C questionnaire has good reliability, validity, readability, short response time, and can be used in hospitals to evaluate inpatients' medical experience.
Key words Inpatient；Patient Experience；Questionnaire；Chinesization；Reliability; Validity
Firstauthor's address School of Nursing, Hangzhou Normal University, Hangzhou, Zhejiang, 311121, China
2018年1月4日，原国家卫生计生委医政医管局发布了《关于印发进一步改善医疗服务行动计划（2018-2020年）的通知》（国卫医发〔2017〕73号），要求医疗机构健全满意度管理制度，动态调查患者就医体验。患者就医体验是指患者及其家属对就医真实经历做出的反馈［1］。国内外医疗机构已使用患者就医体验调查工具替代满意度测评工具或将就医体验作为满意度的补充评价内容［2-4］。检索文献发现，我国已有数项用于评价住院患者就医体验的工具［5-8］，但部分工具存在条目数量多、测量项目不能反映患者就医关注问题等不足。英国学者Benson T等［9］认为，多数患者就医体验测评工具从医院管理人员和医疗服务提供者视角出发进行设计，忽略了患者感受，同时为全面调查而增设过多条目，且部分条目用词晦涩，导致患者无法理解。为此，Benson T等［9］编制了《我们做得如何（how are we doing, howRwe）》问卷，可用于调查各医疗环节（如门诊、术前、住院、康复期等）的患者就医体验［10］。由于howRwe问卷具有患者应答负担轻、计分方式简单、适用场景广等优势，已在英国医疗机构得到广泛应用。本研究将howRwe问卷进行汉化，检验其信效度，并进行试应用，旨在为医院评价住院患者就医体验提供参考。
1研究方法
1.1howRwe问卷介绍
howRwe问卷共有4个条目，前两个条目用于评价患者与医疗机构员工之间的交流，后两个条目用于评价医疗机构医疗服务和健康信息的可及性以及就医环境的友好性。各条目采用Likert 4级评分法，从“做得极好”“做得较好”“基本做到”“做得不够好”依次赋值3分、2分、1分、0分，分别以4种不同脸部表情表示，总分12分，得分越高说明医疗服务质量越高。该问卷在828名骨科预住院患者中进行信效度检验发现，问卷Cronbach’s α系数为0.82，探索性因子分析提取1个公因子，能够解释总变异的67%，信效度良好。
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