Polnay Adam, McIntosh Lindsey G, Burnett Aileen, Williams Andrea, Cahill Catherine, Wilkinson Peter, Mohammad Fiona, Patrick Jon
Medical Division The State Hospital Carstairs UK.
Psychotherapy Department Royal Edinburgh Hospital Edinburgh UK.
Health Sci Rep. 2021 Feb 15;4(1):e245. doi: 10.1002/hsr2.245. eCollection 2021 Mar.
Multiple national guidelines stress the importance for clinicians to possess good therapeutic skills for working with patients with significant relational difficulties (who may receive a diagnosis of personality disorder). Training clinicians in mentalization-based treatment skills (MBT-S) is one approach to address this. The main outcome measure used in MBT-S studies is the (KAMQ). However, an absence of research into the properties and validity of the KAMQ has limited the methodological quality of MBT-S evaluations so far. The aim of this study was therefore to investigate the factor structure, internal consistency, reliability, and validity of the KAMQ.
Using an existing multiprofessional sample of 217 clinicians from 2014 to 2016, we undertook exploratory factor analysis to determine the factor structure and internal consistency of the KAMQ. Convergent validity of the measure with the Attitudes to Personality Disorder Questionnaire (APDQ) was assessed in a subset of this dataset where both questionnaires had been administered ( = 92). Additionally, by recruiting a new sample of 70 clinicians, we assessed the measure's test-retest reliability.
Factor analysis found three factors underlying 17 of the 20 KAMQ items, relating to therapeutic skills in mentalizing, beliefs about applying MBT in practice, and specific MBT knowledge. The KAMQ was revised following the factor analysis to form the KAMQ-2 with 17 items. Internal consistency ( = .85, 95% confidence interval [CI] = 0.80-0.89) and test-retest reliability (ICC = 0.84, 95% CI = 0.73-0.91) were good. In correlation analyses, the KAMQ-2 showed convergent validity with the main factor from the APDQ ( = 48; = 0.39, < .01).
The KAMQ-2 provides a short, reliable self-report instrument which probes clinicians' knowledge about mentalizing skills, and beliefs about using these. There was preliminary evidence for validity. The properties of the KAMQ-2 mean that more robust evaluation and development of MBT-S is now possible.
多项国家指南强调临床医生具备良好治疗技能以治疗有严重人际关系困难患者（可能被诊断为患有个性障碍）的重要性。对临床医生进行基于心理化的治疗技能（MBT-S）培训是解决这一问题的一种方法。MBT-S研究中使用的主要结果测量工具是KAMQ。然而，目前尚未对KAMQ的特性和有效性进行研究，这限制了MBT-S评估的方法学质量。因此，本研究旨在调查KAMQ的因子结构、内部一致性、信度和效度。
我们使用2014年至2016年的217名临床医生的现有多专业样本进行探索性因子分析，以确定KAMQ的因子结构和内部一致性。在该数据集的一个子集中评估了该测量工具与《个性障碍态度问卷》（APDQ）的收敛效度，在该子集中同时发放了两份问卷（n = 92）。此外，通过招募70名临床医生的新样本，我们评估了该测量工具的重测信度。
因子分析发现，KAMQ的20个项目中的17个项目有三个潜在因子，分别与心理化治疗技能、在实践中应用MBT的信念以及特定的MBT知识有关。因子分析后对KAMQ进行了修订，形成了包含17个项目的KAMQ-2。内部一致性（α = 0.85，95%置信区间[CI] = 0.80 - 0.89）和重测信度（组内相关系数ICC = 0.84，95% CI = 0.73 - 0.91）良好。在相关性分析中，KAMQ-2与APDQ的主要因子显示出收敛效度（n = 48；r = 0.39，p < 0.01）。
KAMQ-2提供了一种简短、可靠的自我报告工具，可探究临床医生关于心理化技能的知识以及使用这些技能的信念。有初步证据支持其效度。KAMQ-2的特性意味着现在有可能对MBT-S进行更有力的评估和发展。
