台灣版失智症家屬汙名量表之發展

背景：失智症家屬之汙名感受，會影響其照顧負荷與心理健康，然而，目前仍缺乏針對台灣失智症照顧者所設計之家屬汙名量表。本研究翻譯英文版阿茲海默症家屬汙名量表(Family Stigma in Alzheimer's disease Scale, FS-ADS)，發展台灣版失智症家屬汙名量表(Taiwanese version of Family Stigma in Dementia Scale，TWFS-DS)，此量表包括連帶汙名(courtesy stigma)與附屬汙名(affiliate stigma)兩子量表，並驗證其信效度。方法：本研究為橫斷性調查研究。首先經回復翻譯確認TWFS-DS中文版量表；之後使用羅序分析確認量表建構效度、內部一致性信度、不變性與再測信度；以連帶內化烙印量表(Affiliate Stigma Scale，ASS)驗證TWFS-DS之共時效度；以家屬汙名模型為架構，使用線性回歸模型探討TWFS-DS量表分數與照顧者負荷(Chinese Zarit Burden Interview, CZBI)、負向情緒(Depression Anxiety Stress Scale-21, DASS-21)之關聯以驗證外部效度。結果：共401人納入羅序分析，結果顯示在刪除10題不適配題目，並將七點李克氏量表換算為五分後，TWFS-DS兩子量表(16題連帶汙名、16題附屬汙名)均符合羅序模式單一向度特徵具建構效度，有良好內部一致性（Cronbach's α = .90/ .92），無明顯天花板效應且有良好再測信度(n=28, ICC=.758/ .829 )，在照顧者性別與親屬關係測量維持不變性。TWFS-DS之附屬汙名子量表與關聯汙名量表(ASS)具共時效度(n=332, 衰減校正相關係數=.652)。TWFS-DS兩子量表在控制控制照顧者特徵與失智者症狀後，仍與負荷(n=294, β=.361 p<.001/ .376, p<.001)與負向情緒(n=294, β=.130, p=.019/ .328, p<.001)相關，具外部效度。結論：TWFS-DS量表之連帶與附屬汙名子量表經驗證均符合羅序模型，其單一向度與等距量尺特性可靠並有效測量失智症照顧者汙名感受，且證實家屬汙名與照顧者之負荷與負向情緒相關，可用於未來台灣失智症家屬汙名調查與介入研究之測量工具。

關鍵字

失智症照顧者；家屬汙名；連帶汙名；附屬汙名；羅序分析；量表信效度驗證

並列摘要

Background:Family caregiver’s stigma belief would adversely affect their perceived burden and mental health. However, there is a lack of tools to measure family stigma specifically among Taiwan’s caregivers for people with dementia. This study aimed to develop the Taiwanese version of Family Stigma in Dementia Scale (TWFS-DS), translated from the English version of Family Stigma in Alzheimer's disease Scale (FS-ADS); TWFS-DS would include two subscales to measure courtesy stigma and affiliate stigma, respectively. We aimed to verify the reliability and validity of TWFS-DS. Method:The is a cross-sectional survey study. First, back-translation was used to develop the Taiwanese version of scale. Second, Rasch analysis was used to verify the construct validity, internal consistency reliability, invariance, and test-retest reliability of the scale. Affiliate Stigma Scale (ASS) was used to verify concurrent validity of TWFS-DS. The external validity was verified by examing the association between TWFS-DS and the Chinese Zarit Burden Interview (CZBI) as well as Depression Anxiety Stress Scale-21 (DASS-21). Results:Data collected from 401 participants were used in Rasch analysis. After dropping 10 misfit items and rescored from the 7-point Likert scale to 5-point scale, the two subscales (16 items for courtesy stigma subscale and 16 items for affiliate stigma subscale) fitted the unidimensionality property of Rasch model. The scales had good construct validity, good internal consistency (Cronbach's α = .90/ .92), no ceiling or floor effects, good test-retest reliability (ICC=.758/ .829), and consistent invariant property between sex and kinship. The affiliate stigma subscale of TWFS-DS correlated with ASS, indicating concurrent validity (n=332; disattenuated correlations=.652). The associations were found between family stigma and negative consequences (burden and negative emotion) in the regression model analyses, after adjusting for caregiver characteristics and patients’ behavior and psychological symptoms of dementia (BPSD), indicating external validity (burden: n=294, β=.361 p<.001/ .376, p<.001 and negative emotion: n=294, β=.130, p=.019/ .328, p<.001). Conclusion:The two subscales of TWFS-DS fitted the Rasch model. Their unidimensional and interval properties indicated that the two subscales can be reliable and valid instruments for measuring family stigma among caregivers of patients with dementia. Family stigma measured using TWFS-DS correlated well with care burden and negative emotions among caregiviers. TWFS-DS could be a useful tool for future investigations and interventions of family stigma in dementia in Taiwan.

並列關鍵字

caregiver of people with dementia ； family stigma ； courtesy stigma ； affiliate stigma ； Rasch analysis ； validity and reliability of scale

參考文獻

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台灣版失智症家屬汙名量表之發展

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