- 學位論文
四份中文版失眠認知行為因素量表於長期血液透析患者之信效度建構
Psychometric Testing of Four Instruments of Insomnia-Related Cognitive and Behavioral Factors in Long Term Hemodialysis Patients
摘要
在國外研究中，患者潛在的生理特性可能是導致慢性失眠的決定因素，而認知行為因素在失眠的發生與延續上可能是一重要的誘發因素與惡化因素。此外，焦慮及憂鬱也會伴隨著這些失眠者，形成一惡性循環。因此要確實了解影響長期血液透析患者失眠的因素，必須選擇一個靈敏的、可信賴的和有效的評估工具。 本研究主要的目的在建構中文版「監測睡眠相關的威脅量表」、「過度評估睡眠的需要量表」、「睡前的思緒量表」、「睡眠相關功能失常的信念及態度量表」( SAMI、GSES、GCTI、DBAS-10-Taiwan version )等四份量表用於長期血液透析患者的信效度。本研究為描述性相關性研究，採結構式問卷調查，以方便取樣方式，選取接受長期血液透析的病患為研究對象，有效樣本為89位。量表的信度檢定採內在一致性 Cronbach’s α 及再測信度，效度檢定採建構效度、外在關聯效度；以因素分析檢定「中文版監測睡眠相關的威脅量表」有幾個構面，另以受試者作業特徵曲線圖(ROC curve)檢定此四份量表於失眠與非失眠的區辨力，同時找出長期血液透析患者「中文版監測睡眠相關的威脅量表」、「中文版睡前的思緒量表」之最佳臨界值。 SAMI、GSES、GCTI 及DBAS-10等四份量表的 Cronbach’s α 值分別為 .98、.92、.96、.91，前測與後測呈顯著相關(r = .43, .48, .44, .58, P< .001)，而四份量表的分數在失眠組與非失眠組兩組間有統計上顯著差異(all p< .05)，與中文版匹茲堡睡眠品質量表(r = .62, .68, .61, .25, p< .001)、中文版貝克憂鬱量表(r = .65, .67, .66, .26, p< .001)及中文版貝克焦慮量表總分呈顯著相關(r = .72, .71, .69, .22, p< .001)，因此，四份量表具有良好的內在一致性，是一個穩定可重複測試的工具，且有良好的建構效度及外在關聯效度，在區辨失眠與非失眠具有中度至中度以上的鑑別力。 長期血液透析患者的睡眠品質越差其睡眠相關認知行為因素的分數越高，而憂鬱和焦慮的程度也和睡眠相關的認知行為因素有顯著相關。此研究結果可提供醫護人員在照護失眠長期血液透析患者之臨床實務 及未來研究方向之參考。
並列摘要
Title of Thesis: Psychometric Testing of Four Instruments of Insomnia- Related Cognitive and Behavioral Factors in Long- Term Hemodialysis Patients Institution: Graduate Institute of Nursing, Taipei Medical University Author: Shu-Fen Chan Thesis directed by: Pei-Shan Tsai, Taipei Medical University Associate Professor Although patient's physiological characteristics may be decisive factors that cause chronic insomnia, cognitive and behavioral factors may very likely be precipitating factors in the development and maintenance of the insomnia. In addition, anxiety and depression often accompany insomnia and form a vicious circle. A simple, reliable, sensitive and efficacious instrument to accurately assess the associated factors of insomnia in long-term hemodialysis patients is needed. The main purpose of this research was to validate the Taiwanese versions of the Sleep Associated Monitoring Index (SAMI), Glasgow Sleep Effort Scale (GSES), Glasgow Content of Thoughts Inventory (GCTI), Dysfunctional Beliefs, and Attitudes About Sleep Scale (DBAS-10). A cross-sectional descriptive correlational design was adopted for the study. Eighty-night eligible subjects were recruited by convenience sampling from five dialysis centers in northern Taiwan. Reliability of the instruments were determined by assessing internal consistency (Cronbach’s α) and test-retest reliability. Construct validity and external validity for these four instruments were also established. Exploratory factor analysis was performed to examine the constructs of the SAMI. Receiver-operating characteristics (ROC) curve was used to determine the cutoff value for the SAMI and GCTI. The four instruments’ Cronbach’s α were high ( .98, .92, .96, and .91, respectively). The test-retest reliability were moderate ( r = .43, .48, .44, and .58 ; all p< .001). The correlation coefficients with the CPSQI were significant ( r = .62, .68, .61, and .25 ; all p< .001). The correlation coefficients with the BDI-II were significant ( r = .65、.67、.66、and .26 ; all p< .001). The correlation coefficients with the BAI were also significant ( r = .72, .71, .69, and .22 ; all p< .001 ). The four instruments have good internal consistency, test-retest reliability, construct validity and external validity. The results of the study provide useful information to clinicians who are interested in the insomnia epidemic of the hemodialysis patients.
參考文獻
延伸閱讀
- 蔣世光、譚偉象、潘能靜、張勤金、陳永誠、平烈勇、林知遠（2007）。檢驗魏氏成人智力測驗第三版(WAIS-Ⅲ)的Blyler和四個分測驗組成的簡式版本在住院慢性精神分裂症病患的適用性。臺灣精神醫學，21(1)，26-36。https://doi.org/10.29478/TJP.200703.0004
- 鍾麗娟、高紀惠（1995）。血液透析患者疲憊定義特徵及相關因素之臨床效度測定。長庚護理，6(2)，13-25。https://www.airitilibrary.com/Article/Detail?DocID=10267301-199512-6-2-13-25-a
- Yang, Z. Y. (2008). 利用4-[18F]-ADAM 在CT / PET立體影像量測血清素轉運體變化並搭配漢式憂鬱量表做重度憂鬱症的關聯分析 [master's thesis, National Taipei University of Technology]. Airiti Library. https://doi.org/10.6841/NTUT.2008.00303
- 劉月敏、葉美玲、鍾玉珠（2013）。Improving Physiological and Psychological Status in a Hemodialysis Patient: A Nursing Experience Using an Exercise Training Program。護理雜誌，60(5)，104-110。https://doi.org/10.6224/JN.60.5.104
- Chen, H. M., Tsai, L. J., Chao, S. Y., & Clark, M. J. (2016). Study on the Effects of Individualized Learning Therapy on Cognitive Function and Behavioral and Psychological Symptoms of Dementia in the Institutionalized Older Adults. The Journal of Nursing Research, 24(4), 300-310. https://doi.org/10.1097/jnr.0000000000000118