精神障礙者身體活動參與阻礙因素以及促進因素量表編製及信效度

前言：精神障礙者(精障者)普遍健康狀態較差，規律的中等到高強度之身體活動可幫助精障者達到健康效益，然而，精障者大多缺乏身體活動量，與其多從事靜態活動以及不健康的生活型態有關。為了促進精障者從事身體活動，找出其中關鍵的影響因素為首要任務。本研究目的是，發展精神障礙者身體活動參與阻礙因素以及促進因素量表，並驗證其應用於臺灣精障者族群之信度與效度。研究方法：本研究使用混合研究法，首先，進行焦點團體找出關鍵因素，由研究者編製題項後，經5位精神領域專家審查題項，完成施測量表，並建立內容效度。本研究資料蒐集來源為南台灣10所社區復健中心，共有147位參與者，(男性74位、女性73位)。平均年齡為40.27±10.68歲。使用AMOS 7.0版執行驗證性因素分析以驗證本量表之建構效度與內在一致性，以及SPSS 19.0版統計軟體進行再測信度、同時效度以及描述性統計等分析。研究結果：驗證性因素分析中，精障者身體活動參與阻礙因素量表包含「個人因素」構念5題、「社會支持」構念3題以及「物理環境」構念3題，整體適配度為良好(χ2=56.003，p=.088，χ2/df=1.302，TLI=.976, CFI=.981，RMSEA=.046)，潛在變項的成分信度為.9442，潛在變項的平均變異抽取為.8495，顯示內在一致性為佳。其再測信度良好(ICC=.676)，同時效度與自覺運動參與益處及阻礙量表中阻礙量表部分呈現中度顯著相關(r=.576, p=.000)。精障者身體活動參與促進因素量表，包含「個人因素」構念4題、「社會支持」構念3題以及「物理環境」構念3題，整體適配度為良好(χ2=35.845，p=.278，χ2/df=1.052，TLI=.954，CFI=.983，RMSEA=.025)，潛在變項的成分信度為.9012，潛在變項的平均變異抽取為.7533，顯示內在一致性為佳，其再測信度良好(ICC=.676)。結論：本研究發展並驗證精神障礙者身體活動參與阻礙因素以及促進因素量表為一份可信且有效的評估工具，可提供臨床專業人員，擬訂個別化身體活動介入計畫之參考依據。

關鍵字

身體活動；精神障礙者；阻礙因素；促進因素；驗證性因素分析；信度；效度

並列摘要

Introduction： Persons with serious mental illness (SMI) have poor health status. Although, it has been claimed that moderate to vigorous physical activity has positive effect on health, the leve of physical activity is insufficient for most people with SMI, which might due to their unhealthy and sedentary lifestyle. To facilitate the physical activity participation, it’s critical to find the key factors. The puposes of this study were to develop the scales of barriers and facilitators to physical activity in people with SMI and validate the psychometric properties. Methods： This study used a mixed-methodology. First, the researcher constructed the instrument which was according to the focus groups findings, and five professionals in mental health field revised the instrument to establish content validity. There were 147 clients (74 men and 73 women) recruited from ten community-based psychiatric rehabilitation institutes in southern Taiwan. The average age of the clients was 40.27±10.68 years old. Finally, this study applied confirmatory factor analysis (CFA) using AMOS 7.0 to analyze construct validity and internal consistency, and SPSS 19.0 to analyze test-retest reliability, concurrent validity and descriptive statistics. Results： The scale of Barriers to Physical Activity with Mental Illness (BPAMI), consisting of personal construct (5 items), social support construct (3 items), and physical environment construct (3 items). Results of the CFA showed thatχ2=56.003, p=.088, χ2/df=1.302, TLI=.976, CFI=.981 and RMSEA=.046, suggesting good overall fit of this model. The composite reliability=.9442 and average variance extracted=.8495, revealing a good internal consistency. In addition, the test-retest reliability was good (ICC=.676). There was moderate correlation (r=.576, p=.000) between BPAMI and Exercise Barriers Scale, suggesting good concurrent validity. In the scale of Facilitators to Physical Activity with Mental Illness (FPAMI), consisting of personal construct (4 items), social support construct (3 items), and physical environment construct (3 items). Results of the CFA showed thatχ2=35.845, p=.278, χ2/df=1.052, TLI=.954, CFI=.983 and RMSEA=.025, suggesting good overall fit of this model. The composite reliability=.9012 and average variance extracted=.7533, revealing a good internal consistency. In addition, the test-retest reliability was good (ICC=.602). Conclusions： This study developed and confirmed that both of the scales of barriers and facilitators to physical activity in people with mental illness are reliable and effective assessment tools, which can provide useful information to clinical practitioners about the factors affect the physical activity as references in developing the individualized physical activity program.