门诊导医评价工具的汉化及信效度研究
发布人：yaot 发布时间：2023/8/15 9:18:16 浏览次数：567次
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】——陈宣成 赖善缘?吴怡雪 童莺歌 陈羊毅 汪书蓓 徐淑娟 叶怡欣 薛子豪
【摘要】目的 汉化健康素养支持性环境评价工具的门诊导医问卷（HLE2-Navigation），并检验其信效度。 方法 基于Brislin翻译模型对HLE2-Navigation问卷进行直译、回译和文化调适，形成中文版HLE2-Navigation（HLE2-Navigation-C）问卷，并选取5名专家和浙江省不同级别医疗机构门诊就诊者进行信效度检验，选取浙江省12家医院的444名门诊就诊者进行应用。采用SPSS 20.0软件进行数据统计分析。结果 HLE2-Navigation-C问卷包括“抵达”（10个条目）和“寻路”（20个条目）两个维度共30个条目。HLE2-Navigation-C问卷内在一致性信度即Cronbach's α系数为0.886，重测信度为0.874（P＜0.05）；条目内容效度指数在0.8～1.0之间，总内容效度指数为0.980。三级医院和基层医疗卫生机构均以条目6得分最高，二级医院以条目2得分最高；三级医院、二级医院和基层医疗卫生机构均以条目8得分最低。结论 HLE2-Navigation-C问卷具有良好的信效度，可用于评价我国医疗机构门诊导医环境和服务建设情况。
【关键词】门诊；导医；健康素养支持性环境；评价工具；汉化；信度；效度；服务质量
中图分类号：R197.323 文献标识码：A
Chinesization of Evaluation Tool for Outpatient Navigation and Its Reliability and Validity Rearsch/CHEN Xuancheng,LAI Shanyuan,WU Yixue,et al.//Chinese Health Quality Management，2023,30(7):52-57
Abstract Objective To translate Second Edition of the Health Literacy Environment of Hospitals and Health Centers-Navigation（HLE2-Navigation）into Chinese version, and to test its reliability and validity.Methods Based on the Brislin translation model, HLE2-Navigation was translated, back translated and culturally adapted. The Chinese version of HLE2-Navigation questionnaire (HLE2-Navigation-C) was formed and 5 experts and outpatients from different levels of medical institutions in Zhejiang Province were selected to conduct the reliability and validity test. A total of 444 outpatient patients from 12 hospitals in Zhejiang Province were selected for the application. SPSS 20.0 software was used for statistical analysis. Results The HLE2-Navigation-C questionnaire included two dimensions of "arrival" (10 items) and "wayfinding" (20 items) with a total of 30 items. The Cronbach's α coefficient of questionnaire was 0.886 and the retest reliability was 0.874 (P<0.05). The item level and the content validity of the total questionnaire were 0.8~1.0 and 0.980, respectively. Tertiary hospitals and primary medical institutions had the highest score with item 6. Secondary hospitals had the highest score with item 2. Tertiary hospitals, secondary hospitals and primary medical institutions all had the lowest scores in item 8.Conclusion The HLE2-Navigation-C has good reliability and validity, which can provide a reference tool for the evaluation of outpatient department navigation environment and service in China's medical institutions.
Key words Outpatient; Medicare Navigation; Health Literacy Environment; Evaluation Tool; Chinesization; Reliability; Validity; Service Quality
Firstauthor's address School of Nursing, Hangzhou Normal University, Hangzhou, Zhejiang, 311121, China
健康素养支持性环境（Health Literacy Environment，HLE）是指通过降低医疗机构医疗系统的复杂程度，使公众更容易搜寻、理解和利用健康信息的医疗环境。HLE建设可促进就诊者与就医场所之间的互动，减轻医疗环境带给就诊者候诊的不利影响。导医具备的“引导功能”是HLE建设的重点［1］。导医是指医疗机构通过使用导医标识、配置导医设备及提供导医服务帮助不同健康素养水平的患者找到目标位置［2］。研究［3-5］表明，具备HLE条件的医疗机构可通过设置导医标识、问询处等方法，降低门诊系统的复杂性，避免医患知识鸿沟等问题给患者就医造成困扰，从而提供适应不同健康素养水平就诊者的友好型导医服务。我国卫生行政部门日益重视门诊导医环境与服务建设。2022年6月，国家卫生健康委办公厅发布《关于印发医疗机构门诊质量管理暂行规定的通知》，规定医疗机构门诊应当按照不少于日均门诊量0.2%的比例配备导医人员或智能引导设备数量［6］。但我国导医主要强调导医人员与问询处等人工服务，而国外导医的含义较广泛，除人工服务外，还考虑导医标识、导医设备等物理环境。此外，我国尚无专门的门诊导医环境与服务评价工具。美国学者Rudd RE等［1］于2006年开发了健康素养支持性环境评价工具（Health Literacy Environment of Hospitals and Health Centers, HLEHHC），并于2019年修订形成《第二版健康素养支持性环境评价工具》中的门诊导医问卷（Second Edition of the HLEHHC-Navigation, HLE2-Navigation）［7］，用于评价医疗机构门诊导医环境与服务建设情况。本研究通过对HLE2-Navigation问卷进行汉化及信效度检验，并进行试应用，旨在为评价我国医疗机构门诊导医环境和服务提供参考。
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