2型糖尿病患者胰岛素治疗评估量表（ITAS）的开发与验证
Development and validation of the insulin treatment appraisal scale (ITAS) in patients with type 2 diabetes.
作者信息
Snoek Frank J, Skovlund Søren E, Pouwer Frans
机构信息
Department of Medical Psychology, VU University Medical Center Amsterdam, The Netherlands.
出版信息
Health Qual Life Outcomes. 2007 Dec 20;5:69. doi: 10.1186/1477-7525-5-69.
BACKGROUND
Timely initiation of insulin therapy in type 2 diabetes is important to achieve metabolic control but can be hindered by negative perceptions of patients regarding insulin treatment. To assess the appraisal of insulin therapy of persons with type 2 diabetes, we developed the insulin treatment appraisal scale (ITAS) and tested its reliability and validity in insulin treated type 2 diabetes patients.
METHODS
A sample of 282 patients with type 2 diabetes form the United States (US) completed the ITAS, the WHO-5 Well-being index (WHO-5) and the Problem Areas in Diabetes (PAID) Survey. Exploratory factor analysis (EFA), internal consistency (Cronbach's alpha) and item-total correlations were determined to test the reliability of the instrument. Concurrent validity was examined by calculating Pearson correlation coefficients between the different measures. Discriminant validity was examined by comparing ITAS scores of insulin naive and insulin using patients.
RESULTS
EFA suggested a two-factor structure, separating positively worded and negatively worded items. Cronbach's alpha was 0.90 for the negative appraisal scale and 0.68 for the positive appraisal scale. Yet, Cronbach's alpha of the total 20-item scale was 0.89, suggesting high homogeneity and allowing for calculation of an overall score. Item-total correlations were in the range of 0.46-0.74 for the negative and 0.34 - 0.53 for the positive appraisal scale. The item pertaining to weight gain, as part of the negative appraisal subscale, showed low communality and deserves further testing. Concurrent validity was confirmed with low to moderate correlations in the expected direction between ITAS and WHO-5 and PAID. Discriminant validity was confirmed by the fact that patients using insulin had significantly less negative appraisals than insulin naive patients.
CONCLUSION
The ITAS is a brief, psychometrically sound instrument that can be used in insulin naive and insulin-treated patients to assess positive and negative perceptions regarding insulin treatment and changes therein.
背景
2型糖尿病患者及时开始胰岛素治疗对于实现代谢控制很重要，但患者对胰岛素治疗的负面认知可能会阻碍这一进程。为了评估2型糖尿病患者对胰岛素治疗的评价，我们开发了胰岛素治疗评价量表（ITAS），并在接受胰岛素治疗的2型糖尿病患者中测试了其信效度。
方法
来自美国的282例2型糖尿病患者完成了ITAS、世界卫生组织-5幸福指数（WHO-5）和糖尿病问题领域（PAID）调查。采用探索性因子分析（EFA）、内部一致性（Cronbach's α）和项目-总分相关分析来检验该量表的信度。通过计算不同测量指标之间的Pearson相关系数来检验同时效度。通过比较未使用胰岛素和正在使用胰岛素患者的ITAS得分来检验区分效度。
结果
EFA显示该量表具有两因素结构，将正向表述和负向表述的项目分开。负向评价量表的Cronbach's α为0.90，正向评价量表的Cronbach's α为0.68。然而，20个项目总量表的Cronbach's α为0.89，表明同质性较高，可计算总体得分。负向评价量表的项目-总分相关系数在0.46 - 0.74之间，正向评价量表的项目-总分相关系数在0.34 - 0.53之间。作为负向评价子量表一部分的与体重增加相关的项目，共同度较低，值得进一步测试。ITAS与WHO-5和PAID之间在预期方向上具有低到中度的相关性，证实了同时效度。使用胰岛素的患者比未使用胰岛素的患者负面评价明显更少，证实了区分效度。
结论
ITAS是一种简短的、心理测量学上可靠的工具，可用于未使用胰岛素和正在接受胰岛素治疗的患者，以评估对胰岛素治疗的正负看法及其变化。
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