Wang Xin, Birch Stephen, Chen Lijin, Huang Yixiang, Valentijn Pim
School of Public Health, Health Development Research Center, Sun Yat-Sen University, Guangzhou 510080, China.
Centre for the Business and Economics of Health, University of Queensland, Australia.
Int J Integr Care. 2021 Apr 19;21(2):5. doi: 10.5334/ijic.5603.
The original Rainbow Model of Integrated Care Measurement Tool (RMIC-MT) is based on the Rainbow Model of Integrated Care (RMIC), which provides a comprehensive theoretical framework for integrated care. The aim of this paper is to modify the original patient version of the RMIC-MT for the Chinese primary care context and validate its psychometric properties.
The translation and adaptation processes were performed in four steps, forward and back-translation, experts review and pre-testing. We conducted a cross-sectional study with 386 patients with diabetes attending one of 20 community health stations in the Nanshan district. We analyzed the distribution of responses to each item to study the psychometric sensitivity. Exploratory factor analysis with principal axis extraction method was used to assess the construct validity. Confirmation factor analysis was used to evaluate model fit of the modified version. Cronbach's alpha was used to ascertain the internal consistency reliability.
During the translation and adaptation process, all 24 items were retained with some detailed modifications. No item was found to have psychometric sensitivity problems. Five factors (person-centeredness, clinical integration, professional integration, team-based coordination, organizational integration) with 15 items were determined by exploratory factor analysis, accounting for 53.51% of the total variance. Good internal consistency was achieved with each item correlated the highest on an assigned subscale and Cronbach's alpha score of 0.890. Moderately positive associations (r≥ 0.4, p<0.01) between the score of the scale and these correlations indicate good construct validity.
The results showed initial satisfactory psychometric properties for the validation of the Chinese RMIC-MT patient version. Its application in China will promote the development of people-centered integrated primary care. However, future studies with diverse samples crossing regions would be needed to test its psychometric properties for the various Chinese primary care contexts.
最初的综合护理测量工具彩虹模型（RMIC-MT）基于综合护理彩虹模型（RMIC），该模型为综合护理提供了一个全面的理论框架。本文的目的是针对中国基层医疗环境对RMIC-MT的原始患者版本进行修改，并验证其心理测量特性。
翻译和改编过程分四个步骤进行，即正向和反向翻译、专家评审和预测试。我们对南山地区20个社区卫生服务站之一的386名糖尿病患者进行了横断面研究。我们分析了每个项目的回答分布，以研究心理测量敏感性。采用主轴提取法进行探索性因素分析，以评估结构效度。采用验证性因素分析来评估修改后版本的模型拟合度。使用Cronbach's alpha系数来确定内部一致性可靠性。
在翻译和改编过程中，所有24个项目都被保留，并进行了一些详细修改。未发现任何项目存在心理测量敏感性问题。探索性因素分析确定了由15个项目组成的五个因素（以患者为中心、临床整合、专业整合、团队协作、组织整合），占总方差的53.51%。每个项目在指定子量表上的相关性最高，Cronbach's alpha系数为0.890，实现了良好的内部一致性。量表得分与这些相关性之间的中度正相关（r≥0.4，p<0.01）表明具有良好的结构效度。
结果显示，中国版RMIC-MT患者版本的心理测量特性初步验证结果令人满意。它在中国的应用将促进以患者为中心的基层综合护理的发展。然而，未来需要进行跨地区的多样化样本研究，以测试其在中国不同基层医疗环境下的心理测量特性。
