社區高關懷老人初篩量表之發展與信效度及診斷準確度建立

High-need Community Older Adults Screening Scale: Scale Development, Psychometric Testing, and Diagnostic Accuracy Establishment

陳孟勤(Meng-Chin Chen)

指導教授 ： 陳桂敏

高雄醫學大學/護理學院/護理學系博士班/博士(2019年)

摘要

目的：本研究目的為發展「社區高關懷老人初篩量表」並建立此篩檢量表的信效度及診斷準確度。
方法：研究分為三階段，第一階段以修正式德爾菲法，邀請10位專家評估初擬量表。第二階段以描述性研究設計，詢問社區志工在使用量表時，對量表各構面之10分量表評值，且依其回饋進一步修訂量表。第三階段以描述性研究設計，進行818位個案的調查，進而分析信效度及診斷準確度。
結果：第一階段進行兩輪之修正式德爾菲法，量表的指標構面與題項內容適切性、敘述明確性及權重計分適切性得分皆為1.0。第二階段量表各構面及內容之明確性平均得分9.23±1.00、適切性9.08±1.05及助益性8.95±1.40。第三階段再測信度為良好，ICC=.94，庫李信度(KR-20)α值為.75，探索性因素分析可解釋56.41%的變異量，驗證性因素分析整體配適度指標皆在標準之上，AUC =.90，量表為4/5切分，敏感性= .95，特異性= .70，Youden’s index=.65，陽性預測值= .64，陰性預測值= .96，陽性相似比=3.19，陰性相似比= 0.07，總體診斷準確度= .79。
結論：此量表相較於其他相關量表之信、效度及診斷準確度為中上。量表題目內容簡單、易懂、無須專業背景即可使用，能提供社區相關單位及社區志工作為篩選社區高關懷老人的指引。

關鍵字

社區 ； 高關懷老人 ； 量表 ； 信效度 ； 診斷準確度

並列摘要

Background: Human’s life expectancy has elongated globally, and most of older adults live in communities. Therefore, the health of community-dwelling older adults is a topic requiring serious attention. If community-dwelling older adults who are in need can be identified at the early stage and be provided with subsequently professional services and referrals, their degeneration can be delayed, and the later medical-care costs can be reduced. To discover High-need Community Older Adults at an early stage, people must provide care and pay visits to these older adults. Community volunteers are critical assets of a community, and they play an optimal role in early discovery of older adults who are in need. However, existing evaluation tools are complex and people who use them must have professional background; so community volunteers are not suitable for using them. If there were an easily-understood and easily-used evaluation tool, volunteers could not only provide care verbally to older adults but also understand the situation of these older adults, referring high-need older adults to subsequently professionals and arranging adequate counseling and care services.
Objectives: The purpose of this study was to develop a High-need Community Older Adults Screening Scale as well as to establish the reliability, validity, and diagnostic precision of the scale.
Methods: This study comprised three stages. During the first stage, the Modified Delphi Process was adopted, and 10 experts were invited to evaluate a drafted scale. During the second stage, a descriptive research design was adopted. Community volunteers were asked to use the scale and evaluate each dimension of the scale on a 10-point scale. Subsequently, we revised the scale based on the feedback. During the third stage, we used the descriptive research design to investigate 818 cases and to analyze the reliability, validity, and diagnostic precision of the scale.
Results: During the first stage, two-round Modified Delphi Method was conducted. The score for the scale’s index dimension, the adequateness of item content, the clearness of description, and the adequacy of weighted scoring were all 1.0. During the second stage, for each dimension and its content, the average scores on clearness, adequacy, and helpfulness were 9.23±1.00, 9.08±1.05, and 8.95±1.40, respectively. During the third stage, we observed that the reliability was satisfactory: ICC=.94 and KR-20 α = .75. Exploratory factor analysis explained 56.41% of the variance. Confirmatory factor analysis found overall model fit indexes were all above the criteria. AUC = .90. The cut off point for the scale was 4/5. Sensitivity = .95. Specificity = .70. Youden’s index = .65. Positive predictive value = 0.64. Negative predictive value = 0.96. Positive likelihood ratio = 3.19. Negative likelihood ratio = 0.07. Overall diagnostic precision = 0.79.
Conclusion: Compared to other relevant scales, this scale has medium to favorable reliability, validity, and diagnostic precision. The questions and contents of the scale are simple, easily to understand, and do not require professional background to administer. The scale can serve as a guide for community relevant units and community volunteers to screen High-need Community Older Adults.

並列關鍵字

Community ； High-need Older Adults ； Screening scale ； Reliability and Validity ； Diagnostic accuracy

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內政部統計處（2017，3月）．106年第10週內政統計通報(我國老年人口數首次超過幼年人口數)．取自http://www.moi.gov.tw/stat/news_content.aspx?sn=11735