如何在初级保健中筛查社交退缩：使用项目反应理论对警报苦恼婴儿量表的评估。
How to screen for social withdrawal in primary care: An evaluation of the alarm distress baby scale using item response theory.
作者信息
Egmose Ida, Smith-Nielsen Johanne, Lange Theis, Stougaard Maria, Stuart Anne C, Guedeney Antoine, Væver Mette Skovgaard
机构信息
Center for Early Intervention and Family Studies, Department of Psychology, University of Copenhagen, Copenhagen, Denmark.
Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
出版信息
Int J Nurs Stud Adv. 2021 Jul 15;3:100038. doi: 10.1016/j.ijnsa.2021.100038. eCollection 2021 Nov.
BACKGROUND
Early identification of infants at-risk is imperative for proper referral to intervention programs. The Alarm Distress Baby Scale (ADBB) is an eight-item observer-rated screening tool detecting social withdrawal in infants. Previously, a shortened five-item version of the scale (m-ADBB) has been proposed. To date, few studies have examined the validity of the two scales, and no studies have examined the validity of the ADBB after implementation as a universal screening tool in primary care.
OBJECTIVE
The aim of this study is to use Item Response Theory (IRT) to examine the construct validity of the ADBB when used by public health visitors in primary care.
METHODS
Participants were 24,752 infants (aged: 2-12.9 months) screened by public health visitors using the ADBB. Screenings were categorized into three waves according to the infant's age at the screening time (2-3.9 months, 4-7.9 months, and 8-12.9 months). Analyses were conducted separately on each wave. We checked IRT assumptions: (a) Unidimensionality, (b) Monotonicity, (c) Local independence, and (d) No DIF in relation to infant sex and gestational age. The 2PLM was used to assess model fit and estimate model parameters.
RESULTS
Items fulfilled assumptions regarding unidimensionality, monotonicity, and no clinical and significant DIF. Local independence was not present for all items (i.e. 2, 7, and 8). The items showed moderate to good discriminatory abilities (alpha values ≥ 1.11) and discriminated best above average levels of social withdrawal (theta values ≥ 1.33). Items 7 and 8 showed nearly identical ICC suggesting that the two items discriminate equally well at the same level of social withdrawal. In addition, items 4 and 6 discriminated best at very high levels of social withdrawal, which might be of limited interest for screening purposes. Finally, the items showed similar patterns in terms of discrimination and location parameters across the three waves.
CONCLUSIONS
The ADBB shows several psychometric strengths when used by public health visitors in primary care, and the items show good discriminatory abilities at the levels of social withdrawal of interest for screening purposes. Yet, the results also suggest that for first-line screening, the validity of the scale might be improved with the removal of items 4, 6, and 8 as suggested in the m-ADBB. However, before recommending implementation of the m-ADBB, studies comparing the criterion-related validity of the two scales are needed.
背景
早期识别高危婴儿对于将其恰当转介至干预项目至关重要。警报性苦恼婴儿量表（ADBB）是一种由观察者评分的八项筛查工具，用于检测婴儿的社交退缩情况。此前，有人提出了该量表的一个缩短版五项量表（m - ADBB）。迄今为止，很少有研究检验这两种量表的效度，且尚无研究检验ADBB在初级保健中作为通用筛查工具实施后的效度。
目的
本研究旨在运用项目反应理论（IRT）检验公共卫生访视员在初级保健中使用ADBB时的结构效度。
方法
参与者为24752名婴儿（年龄：2至12.9个月），由公共卫生访视员使用ADBB进行筛查。筛查根据婴儿筛查时的年龄分为三个阶段（2至3.9个月、4至7.9个月、8至12.9个月）。对每个阶段分别进行分析。我们检验了IRT假设：（a）单维性，（b）单调性，（c）局部独立性，以及（d）与婴儿性别和胎龄无关的差异性项目功能（DIF）。使用二参数逻辑斯蒂模型（2PLM）评估模型拟合度并估计模型参数。
结果
各项目满足关于单维性、单调性以及无临床显著DIF的假设。并非所有项目都满足局部独立性（即项目2、7和8）。这些项目显示出中等至良好的区分能力（α值≥1.11），并且在社交退缩平均水平以上（θ值≥1.33）时区分效果最佳。项目7和8显示出几乎相同的组内相关系数（ICC），表明这两个项目在相同社交退缩水平下区分效果相同。此外，项目4和6在社交退缩水平极高时区分效果最佳，但这对于筛查目的而言可能意义有限。最后，这些项目在三个阶段的区分度和位置参数方面呈现出相似的模式。
结论
公共卫生访视员在初级保健中使用ADBB时，该量表显示出若干心理测量学优势，且这些项目在筛查所关注的社交退缩水平上具有良好的区分能力。然而，结果也表明，对于一线筛查，按照m - ADBB的建议去除项目4、6和8可能会提高该量表的效度。不过，在推荐实施m - ADBB之前，需要进行比较这两种量表与标准相关效度的研究。
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