类风湿关节炎西班牙语患者赋权量表的心理测量学验证。
Psychometric validation of an empowerment scale for Spanish-speaking patients with rheumatoid arthritis.
机构信息
Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Colonia Belisario Domínguez Sección XVI, México City, Mexico.
External collaborator, Mexico City, Mexico.
出版信息
Arthritis Res Ther. 2018 Oct 30;20(1):244. doi: 10.1186/s13075-018-1741-6.
BACKGROUND
Rheumatoid arthritis (RA) knowledge has been constructed with studies performed in Caucasians patients; Latin American patients present unique characteristics. Empowerment is a social multidimensional construct that has been associated to better health-related quality of life in RA. There is no validated instrument for use with Spanish-speaking patients. The objective of the study was to adapt the Spanish version of the Health Empowerment Scale (S-HES), which was selected for its psychometric properties and suitability for low-literacy populations, for RA Hispanic patients (RAEH), and to perform its psychometric validation.
METHODS
RAEH adaptation, pilot testing, and psychometric validation were performed. Three convenience samples of RA outpatients from a national tertiary care level center were used. For RAEH adaptation, the word "health" was substituted with "RA" in the original S-HES, integrated by 8 items. Pilot testing (in 50 patients) assessed feasibility. Psychometric validation included content validity (nine experts rated item convenience, clarity, and cultural semantic accuracy), internal consistency (in 200 patients, Cronbach's alpha) and test-retest (in a subsample of 50 patients, ICC and 95% CI), construct validity (factor analysis), and face validity (in 20 patients, % of agreement). Patients gave written informed consent.
RESULTS
Patients were primarily middle-aged females and had typical long-standing disease, although early disease was represented. In the psychometric validation sample, the majority of the outpatients had autoantibodies; meanwhile, half of them had no evidence of disease activity, with acute reactants phase determinations within normal range. Patients with comorbidities and joint replacement were also included. Experts agreed upon the attributes of content validity: 83-100% considered the item was essential, 100% agreed on the item's clarity and 80-100% on the cultural semantic accuracy. In the pilot sample, ≥ 80% of the patients agreed with the item's clarity and format. In the psychometric validation sample, mean RAEH was 34 (maximum possible score: 40 = highest score). RAEH had a good internal consistency, Cronbach's α = 0.86, and moderately good reliability (ICC [95% CI] test-retest: 0.79 [0.62-0.88]). Factor analysis for construct validity showed a single factor explaining 52% of the variance. Patients agreed with each item content validity (85-100%) and clarity (75-100%).
CONCLUSIONS
RAEH was valid and reliable to evaluate empowerment in Spanish-speaking RA patients.
背景
类风湿关节炎（RA）知识是在白种人患者中进行的研究构建的；拉丁美洲患者具有独特的特征。赋权是一个社会多维结构，与 RA 患者的健康相关生活质量更好相关。目前还没有针对讲西班牙语患者的经过验证的工具。本研究的目的是改编西班牙版健康赋权量表（S-HES），该量表因其心理测量特性和适合低识字人群而被选中，用于评估西班牙裔 RA 患者（RAEH），并对其进行心理测量验证。
方法
对 RAEH 进行适应性调整、试点测试和心理测量验证。使用全国三级保健中心的三个 RA 门诊患者的便利样本。为了对 RAEH 进行适应性调整，在原始 S-HES 中用“RA”代替了“健康”一词，该量表由 8 个项目组成。试点测试（在 50 名患者中）评估了可行性。心理测量验证包括内容效度（9 位专家评估项目的便利性、清晰度和文化语义准确性）、内部一致性（在 200 名患者中，克朗巴赫α）和测试-重测（在 50 名患者的亚样本中，ICC 和 95%CI）、结构效度（因子分析）和表面效度（在 20 名患者中，一致性百分比）。患者签署了书面知情同意书。
结果
患者主要是中年女性，患有典型的长期疾病，尽管也有早期疾病的代表。在心理测量验证样本中，大多数门诊患者都有自身抗体；与此同时，他们中有一半人的疾病活动没有证据，急性反应物阶段测定值在正常范围内。也包括有合并症和关节置换的患者。专家对内容效度的属性达成一致：83-100%的专家认为该项目是必不可少的，100%的专家同意项目的清晰度，80-100%的专家同意文化语义准确性。在试点样本中，≥80%的患者对项目的清晰度和格式表示满意。在心理测量验证样本中，RAEH 的平均值为 34（最高可能得分为 40=最高得分）。RAEH 具有良好的内部一致性，克朗巴赫α=0.86，可靠性中等良好（测试-重测 ICC [95%CI]：0.79 [0.62-0.88]）。结构效度的因子分析显示，一个因素解释了 52%的方差。患者对每个项目的内容效度（85-100%）和清晰度（75-100%）表示一致。
结论
RAEH 是一种有效的、可靠的评估西班牙语 RA 患者赋权的工具。
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