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[测量高血压患者依从性的工具:项目反应理论的贡献]

[Instrument to measure adherence in hypertensive patients: contribution of Item Response Theory].

作者信息

Rodrigues Malvina Thaís Pacheco, Moreira Thereza Maria Magalhaes, Vasconcelos Alexandre Meira de, Andrade Dalton Francisco de, Silva Daniele Braz da, Barbetta Pedro Alberto

出版信息

Rev Saude Publica. 2013 Jun;47(3):523-30. doi: 10.1590/s0034-8910.2013047004439.

Abstract

OBJECTIVE

To analyze, by means of "Item Response Theory", an instrument to measure adherence to t treatment for hypertension.

METHODS

Analytical study with 406 hypertensive patients with associated complications seen in primary care in Fortaleza, CE, Northeastern Brazil, 2011 using "Item Response Theory". The stages were: dimensionality test, calibrating the items, processing data and creating a scale, analyzed using the gradual response model. A study of the dimensionality of the instrument was conducted by analyzing the polychoric correlation matrix and factor analysis of complete information. Multilog software was used to calibrate items and estimate the scores.

RESULTS

Items relating to drug therapy are the most directly related to adherence while those relating to drug-free therapy need to be reworked because they have less psychometric information and low discrimination. The independence of items, the small number of levels in the scale and low explained variance in the adjustment of the models show the main weaknesses of the instrument analyzed. The "Item Response Theory" proved to be a relevant analysis technique because it evaluated respondents for adherence to treatment for hypertension, the level of difficulty of the items and their ability to discriminate between individuals with different levels of adherence, which generates a greater amount of information.

CONCLUSIONS

The instrument analyzed is limited in measuring adherence to hypertension treatment, by analyzing the "Item Response Theory" of the item, and needs adjustment. The proper formulation of the items is important in order to accurately measure the desired latent trait.

摘要

目的

运用“项目反应理论”分析一种用于测量高血压治疗依从性的工具。

方法

2011年在巴西东北部塞阿拉州福塔莱萨的初级保健机构对406例伴有并发症的高血压患者进行分析性研究,采用“项目反应理论”。研究阶段包括:维度检验、项目校准、数据处理和量表编制,使用渐进反应模型进行分析。通过分析多系列相关矩阵和完全信息因子分析对该工具的维度进行研究。使用Multilog软件校准项目并估计分数。

结果

与药物治疗相关的项目与依从性最直接相关,而与非药物治疗相关的项目需要重新修订,因为它们的心理测量信息较少且区分度低。项目的独立性、量表中的水平数量少以及模型调整中解释方差低显示了所分析工具的主要弱点。“项目反应理论”被证明是一种相关的分析技术,因为它评估了受访者对高血压治疗的依从性、项目的难度水平及其区分不同依从性水平个体的能力,从而产生了更多信息。

结论

通过对项目的“项目反应理论”进行分析,所分析的工具在测量高血压治疗依从性方面存在局限性,需要进行调整。为了准确测量所需的潜在特质,项目的恰当制定很重要。

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