肝癌免疫治疗患者营养及免疫相关不良事件管理知信行问卷编制及信效度检验  

Development and validation of a questionnaire for the management of nutrition and immune-related adverse events in patients with liver cancer who received immunotherapy

作　　者：文雯 陈英爽 刘春玲 童丽灵 张华 Wen Wen;Chen Yingshuang;Liu Chunling;Tong Liling;Zhang Hua(Department of Hepatobiliary and Pancreatic Surgery,Haikou Hospital Afiliated of Xiangya Medical College,Central South University,Haikou 570208,China;School of International Nursing,Hainan Medical University,Haikou 571199,China)

机构地区：[1]中南大学湘雅医学院附属海口医院肝胆外科,海口570208 [2]海南医科大学国际护理学院,海口571199

出　　处：《中华消化杂志》2024年第10期693-701,共9页Chinese Journal of Digestion

基　　金：海南省自然科学基金(823MS169);海南省卫生健康行业科研项目(22A200123)。

摘　　要：目的编制肝癌免疫治疗患者营养及免疫不良事件知信行问卷并检验其信效度,为有针对性地开展健康教育、提高依从性、改善生活质量提供调查及评估工具。方法基于知信行理论(KAP),通过检索文献确定初步调查问卷,选取海口市人民医院30例肝癌免疫治疗的患者进行预调查。组织肝胆外科、肿瘤内科副主任医师,营养师,消化专科护士进行专家函询,根据函询结果修改得到测试版问卷。估算结构效度评价所需最小样本量为322例。采用便利抽样法招募海口市人民医院就诊的接受肝癌免疫治疗的患者填写测试版问卷,按随机数字表法均分为两组,分别进行问卷的探索性和验证性因子分析。以Cronbach′sα系数、折半信度、重测信度评价问卷信度。结果预调查问卷完成时间为(9.57±7.57)min。共发放407份测试版问卷,回收400份有效问卷,回收率98.28%。最终形成的问卷包含了知识、态度、行为3个维度,共27个条目,其中知识维度(9个条目),态度维度(10个条目),行为维度(8个条目)。探索性因子分析显示,共提取3个公因子,累计方差贡献率为65.265%。验证性因子分析显示,卡方自由度比为3.956,渐进残差均方和平方根为0.086,残差均方和平方根为0.076,适配度指数为0.871,增值适配指数为0.872。模型拟合度主要指标均在可接受范围内。本次调查问卷总的Cronbach′sα系数、折半信度、重测信度分别为0.935、0.834、0.933。结论肝癌免疫治疗患者营养及免疫不良事件知信行问卷,信效度良好,可以作为初步了解相关患者营养及不良事件知信行现状的测评工具。Objective To develop and verify the validity of a questionnaire on nutrition and immunerelated adverse events in patients with liver cancer and received immune therapy.To provide a survey and evaluation tool for targeted health education,improving compliance and quality of life.Methods Based on the knowledge attitude practice(KAP)theory,the preliminary draft of questionnaire was determined by literature search and 30 patients with liver cancer who received immunotherapy at Haikou People's Hospital were selected for pre survey.The expert consultation was conducted by associate chief physicians from the department of hepatobiliary surgery and the department of oncology,the nutritionists and specialist nurses from the department of gastroenterology.According to the consultation results,the questionnaire was modified into the test version.It was estimated that the minimum sample size required for structural validity evaluation was 322 cases.Patients with liver cancer who received immunotherapy at Haikou People's Hospital were recruited by convenience sampling,and the test version questionnaire were filled in.According to random number table method,the patients were divided into 2 groups.Exploratory and confirmatory factors analysis of the questionnaire were conducted respectively.The reliability of the questionnaire was evaluated by Cronbach'sαcoefficient,split half reliability and retest reliability.Results The completion time of the pre-survey questionnairein was(9.57±7.57)min.A total of 407 test questionnaires were distributed,and 400 were recovered,and the recovery rate of test questionnaire was 98.28%.The final questionnaire consisted of 27 items in 3 dimensions(knowledge,attitude,and practice),including 9 items of knowledge dimension,10 items of attitude dimension and 8 items of practice dimension.Three factors were extracted in exploratory factors analysis with a cumulative variance contribution rate of 65.265%.In validation factor analysis,the chi-square freedom ratio was 3.956,the root mean square error of

关 键 词：肝肿瘤 免疫疗法 营养 免疫相关不良事件 健康知识、态度、实践 

分 类 号：R73[医药卫生—肿瘤]