「台灣版有意義的活動參與量表」之跨文化調整與心理計量特質研究

Cross-Cultural Adaptation and Psychometric Properties of the Taiwanese version of the Meaningul Activity Participation Assessment

葉雅欽(Ya-Chin Yeh)

指導教授 ： 郭昶志

共同指導教授 ： 蘇純瑩(Chwen-Yng Su)

高雄醫學大學/健康科學院/職能治療學研究所/碩士(2014年)

摘要

前言
有意義的活動參與經研究證實和成功老化有關，並可作為臨床上正向成效的指標；因此，評估個體活動參與的主觀意義很重要。使用數種理論與模式所形成之選擇標準來檢視數種與活動參與有關的評估工具，發現含有28個活動項目之「有意義的活動參與量表」 (Meaningful Activity Participation Assessment, MAPA) 為其中最理想的評估工具。MAPA有良好的信度與效度，評估內容包含活動之參與頻率與個體主觀感受之活動意義。將每個活動項目之頻率與意義得分相乘後再一一加總，即得出總分。由於活動意義具文化特殊性，因此本研究的目的為：首先將MAPA做跨文化調整，接著使用羅序分析建立具有單向度特性之「台灣版有意義的活動參與量表」 (台灣版MAPA)，最後檢驗其再測信度與效度。
研究方法
本研究共分成三期。第一期之主要任務為對原版進行翻譯與跨文化調整，含五個主要階段與一個過渡階段。目的在於達成兩個版本間的同等 (等義)。主要階段含正翻、翻譯合成、反翻、專家會議，以及前驅測試；過渡階段含專家諮詢、焦點團體，以及原量表發展者諮詢。第二期之受試者共含146名年齡介於56至87歲、男女比例1：1，且居住於社區之健康年長者。為了建立「台灣版MAPA」之單向度與信度，使用羅序分析之「Andrich 評等量尺模式」來評估「台灣有意義的活動參與量表預試版」(預試版MAPA) 之類別效能、題目適配度、差別試題函數、測驗訊息函數、受試者分離指數，以及題目標定。第三期則使用 「生活滿意度量表」、「流行病學研究中心憂鬱量表」與「SF-36 台灣版」於120名由總樣本中隨機選取之受試者，以檢驗效標關聯效度。在填寫「預試版MAPA」後的1至2周內，由總樣本中隨機選取之49名受試者再填寫「台灣版MAPA」，以檢驗再測信度。
研究結果
在跨文化調整後產生一含29個活動項目之「預試版MAPA」。調整包括：增加、刪除、重新命名，以及重新定義活動項目，並將頻率評等與意義評等置於同一活動項目之下。在將頻率分量表之反應類別數量合併為4點評等之後，預試版獲得最佳之類別效能。在刪除3個不適配之活動項目與1個在教育程度之分組間分數有顯著差別的題目之後， 產生具有單向度特性的 「台灣版MAPA」。亦可由高受試者信度與極優之測驗訊息函數證實台灣版具良好之信度。由於受試者信度指數達2.79，因此本量表可將樣本區分為4種具不同活動參與意義程度之受試者。此外，「台灣版有意義的活動參與量表」和效標關聯量表間有中度至高度之顯著相關性 (r = .46 ~ .53, p < .0001)；其1至2周之再測信度亦呈現 「極優」 (組內相關係數 = .94, p < .0001)。
討論與結論
本研究結果證實「台灣版MAPA」為一適用於台灣年長者、具單向度、有良好內在一致性、良好效度與再測信度之評估工具。經羅序分析轉換之總分可精確估算個體參與活動之意義程度。此量表亦可量測出4種具不同意義程度之受試者。量表格式之調整與施測手冊的建立則有助於信度之提升。基於以上種種優點， 「台灣版MAPA」是一個可用來量測職能治療成效之優質評估工具。在臨床上，活動項目難易之排序有助於治療者設計漸進式的職能活動計畫。除此之外，由於「台灣版MAPA」 與心理安適感、情緒調節，以及健康相關之生活品質皆有顯著相關性，因此可作為成功老化的指標。未來之研究將進一步檢驗此量表於不同族群屬性之台灣人，如中風患者、精神疾病患者、青少年等，使更多不同特性的族群受益。

關鍵字

有意義的活動參與 ； 跨文化調整 ； 羅序分析 ； 成功老化

並列摘要

Introduction
Meaningful activity participation has been documented to be associated with successful aging and an indicator of positive outcome in practice; therefore, evaluating subjective meaningfulness in activity participation for the individual is crucial. The Meaningful Activity Participation Assessment (MAPA), which is a checklist survey with 28 activity items, was found to be the most appropriate instrument through selection criteria formulated by theories and models. The MAPA appeared to be a reliable and valid measure of meaningful activity participation, encompassing the frequency of participation and the meaningfulness of each activity experienced. The total MAPA score involved the sum of the frequency rating multiplied by the meaning rating for each item. Considering the meanings of activities are culturally specific, the purpose of the study is to cross-culturally adapt the MAPA and to investigate the psychometric properties of this adapted version in Taiwanese older adults.
Methods
This study consisted of 3 phases. In Phase I, 5 main stages and 1 transition stage were employed to cross-culturally adapt the original MAPA. It was purported to reach equivalences between the Original version and the Taiwanese version. The main stages included forward translation, synthesis of the translations, back translation, committee review, and pilot testing. The transition stage included expert consultation, focus groups, and developer consultation. 146 independent community dwellers aged 56 to 87 years with equal proportion of female and male were included in Phase II. To establish the unidimensionality and reliability of the Taiwanese version of the MAPA, a Rasch-Andrich rating scale model was applied to evaluate category effectiveness, item fit, differential item functioning (DIF), test information function (TIF), person separation index (PSI), and item targeting of the pre-final Taiwanese version of the MAPA. In Phase III, criterion-related validity was tested on randomly selected 120 of 146 participants using the Life Satisfaction Index-Z, the Center for Epidemiologic Studies Depression Scale, and the SF-36 Health Survey. Test-retest reliability was examined in a 1-2 week interval on 49 participants randomly selected from the whole sample (N=146).
Results
A 29-item Pre-final Taiwanese version of the MAPA was produced after the cross-cultural adaptation. The adaptation included addition, deletion, renaming and re-definition on several activity items and changes of the format. Optimal category effectiveness of the Pre-final Taiwanese version of the MAPA was improved by reducing item responses of the frequency subscale to 4 categories. After the removal of 3 misfit items and 1 item with significant DIF, the formal Taiwanese version of the MAPA demonstrated unidimensionality. High reliability was also evidenced with high person reliability (alpha = 0.89), and excellent TIF with small standard deviation (≦0.5) and large information (≧4) when the meaningfulness of individual participation ranged from －2.0 to 1.8 logits. With a PSI of 2.79, the scale is able to distinguish four strata of meaningfulness of activity participation in this sample. The Taiwanese version of the MAPA showed moderate to high correlations to theoretically related constructs with significance (r = .46 ~ .53, p < .0001). The test-retest reliability was excellent as well (intraclass correlation coefficient = .94, p < .0001).
Discussions/ Conclusions
The results presented that the Taiwanese version of the MAPA was culturally specific for Taiwanese older adults and a unidimensional questionnaire with high internal consistency, validity and test-retest reliability. The total score of the Taiwanese version of the MAPA using Rasch transformed logit scores precisely represents the degree of meaningfulness of activity participation for each individual. Four levels of individual degree of meaningfulness in this sample can be differentiated by this scale. The placement of frequency and meaning ratings under the same activity item and the construction of a Test Administration Manual of the Taiwan version also contribute to the enhancement of reliability. Taking into account the aforementioned merits, the Taiwanese version of the MAPA can be an excellent instrument for measuring transformative effects of occupational therapy. For clinical application, the activity hierarchy presented in this study can help the design of progressive occupation-based intervention programs. In addition, the Taiwanese version of the MAPA has great potential as an indicator of successful aging according to its prominent correlations with psychological well-being, positive emotional regulation and health related quality of life. Future studies require the examination of the Taiwanese version of the MAPA on diverse populations of Taiwanese for extensive use.

並列關鍵字

Meaninful Activity Participation ； Cross-Cultual Adaptation ； Rasch Analysis ； Successful Aging

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