Johnson William, Cameron Noël, Dickson Peter, Emsley Stuart, Raynor Pauline, Seymour Claire, Wright John
Centre for Human Development and Ageing, Loughborough University, UK.
Int J Nurs Stud. 2009 Mar;46(3):310-6. doi: 10.1016/j.ijnurstu.2008.10.003. Epub 2008 Nov 18.
Reliable data on child growth is a prerequisite for monitoring and improving child health. Despite the extensive resources invested in recording anthropometry, there has been little research into the reliability of these data. If these measurements are unreliable growth may be misreported, and health problems may go undetected.
To assess the reliability of routine infant growth data, following anthropometric training of health workers responsible for collecting these data, in Bradford, UK. To determine whether being observed by an external administrator influenced reliability.
A test-retest design was used.
All health workers (n=192) responsible for growth monitoring in Bradford were included in the study, of which 36.5% (n=70) had complete data.
Following training in basic anthropometry all health workers were asked to complete a test-retest study, using infants aged 0-2 years. Health workers took two recordings of weight, length, head circumference, and abdominal circumferences on five infants. A peer health worker recorded a third set of measurements on each infant. Twenty-two individuals were selected to be observed by an external administrator during data collection. Technical error of measurements (TEMs) were produced to assess intra-observer and inter-observer reliability. Differences between groups were tested to determine whether external observation influences reliability.
None of the TEMs were excessively large, and coefficients of reliability ranged from 0.96 to 1.00. All intra-observer and inter-observer TEMs for the observed group were larger than those for the non-observed group. For example, the observed group's intra-observer TEMs for weight, length, abdominal circumference, and head circumference (46.18 g, 0.60 cm, 0.65 cm, 0.47 cm) were larger than the non-observed group's TEMS (9.14 g, 0.35 cm, 0.34 cm, 0.19 cm). TEMs for weight, abdominal circumference, and head circumference were significantly larger for the observed group, compared to the non-observed group (p<0.001). Inter-observer TEMs for length were also significantly larger for the observed group (p=0.031), whilst intra-observer TEMs for length were not significantly different between the two groups (p=0.137).
Following training in anthropometry health workers in Bradford can, in general, reliably measure child growth. TEMs were comparable to data from other research studies and all coefficients of reliability were indicative of good quality control. Reliability measurement provides a method of quality assurance for routine data monitoring. If commissioners of health services are to be informed by these data then some form of reliability assessment should be considered, and if employed external observation is recommended to improve validity.
可靠的儿童生长数据是监测和改善儿童健康的前提条件。尽管在记录人体测量数据方面投入了大量资源，但对这些数据的可靠性却鲜有研究。如果这些测量不可靠，生长情况可能会被错误报告，健康问题也可能未被发现。
在英国布拉德福德，对负责收集常规婴儿生长数据的卫生工作者进行人体测量培训后，评估这些数据的可靠性。确定外部管理人员的观察是否会影响可靠性。
采用重测设计。
布拉德福德所有负责生长监测的卫生工作者（n = 192）均纳入研究，其中36.5%（n = 70）有完整数据。
在接受基本人体测量培训后，所有卫生工作者被要求对0至2岁的婴儿进行重测研究。卫生工作者对五名婴儿进行了两次体重、身长、头围和腹围测量。一名同行卫生工作者对每名婴儿记录了第三组测量数据。在数据收集期间，挑选了22人由外部管理人员进行观察。计算测量技术误差（TEMs）以评估观察者内和观察者间的可靠性。对组间差异进行检验，以确定外部观察是否会影响可靠性。
所有的TEMs都没有过大，可靠性系数在0.96至1.00之间。观察组的所有观察者内和观察者间TEMs均大于非观察组。例如，观察组体重、身长、腹围和头围的观察者内TEMs（46.18克、0.60厘米、0.65厘米、0.47厘米）大于非观察组的TEMs（9.14克、0.35厘米、0.34厘米、0.19厘米）。与非观察组相比，观察组体重、腹围和头围的TEMs显著更大（p < 0.001）。观察组身长的观察者间TEMs也显著更大（p = 0.031），而两组间身长的观察者内TEMs无显著差异（p = 0.137）。
在接受人体测量培训后，布拉德福德的卫生工作者总体上能够可靠地测量儿童生长情况。TEMs与其他研究数据相当，所有可靠性系数都表明质量控制良好。可靠性测量为常规数据监测提供了一种质量保证方法。如果卫生服务的委托方要依据这些数据，则应考虑某种形式的可靠性评估，并且如果采用的话，建议进行外部观察以提高有效性。
