【作者】 余静；

【导师】 张先红；

【作者基本信息】 重庆医科大学 ， 护理（专业学位）， 2020， 硕士

【摘要】 目的:编制《早产儿出院后父母应对能力问卷》,并对问卷进行测评与检验,考量该问卷在早产儿父母人群中的适用性,为后期进一步研究早产儿出院后父母应对能力现状及相关因素提供科学的测量工具。方法:1.形成初始问卷:首先,采用文献回顾法,检索与早产儿出院后父母应对能力主题相关的文献,经过对文献的筛选与评价后对文献主题进行汇总,初步确定《早产儿出院后父母应对能力问卷》的主要维度。其次,采用目的抽样法对13名出院后的早产儿父母进行电话访谈,根据访谈结果对问卷维度进行验证与完善。最后,结合文献回顾、电话访谈、课题组讨论的结果,参考相关书籍与量表拟定问卷初始条目池,形成初始问卷。2.形成正式问卷:采用德尔菲专家函询法对17名相关领域的专家进行函询,计算专家的权威系数、积极系数、及意见协调系数,根据条目筛选原则:条目相关性赋值均值(MJ)>4、条目满分率(KJ)>20%、变异系数(CV)<0.25对条目进行筛选,并参考专家意见对初始问卷内容进行修订与完善,形成正式问卷。3.问卷的测评与检验:采用方便抽样法,根据样本量为问卷条目数的5-10倍,选取300位早产儿父母作为基础人群对问卷进行测评,采用临界比值法、Pearson相关系数法进行项目分析,探索性因素分析检验问卷的构建效度,剔除无统计学意义的条目,形成最终问卷。采用条目水平的内容效度指数与量表水平的内容效度指数评定问卷内容效度,Cronbach’sɑ系数、折半系数分析问卷信度。结果:1.初始问卷结果:(1)经筛选与评价后纳入文献24篇,其中质性研究13篇,描述性研究11篇,文献质量均为B级,提炼出5个主题作为问卷的主要维度,分别是早产儿照护知识与技能、压力与应对、亲职状态、外界支持及家庭功能。(2)根据访谈资料提炼出2个主题,主题一“早产儿父母的主要应对问题”包括喂养不顺利、照护知识与技能欠缺、普遍的焦虑与不确定感、育儿信息支持不足几个方面,这与问卷维度“早产儿照护知识与技能”、“压力与应对”、“外界支持”具有一定的契合性;主题二“早产儿父母的适应性变化”包括早产儿父母照护知识与技能的成熟、父母角色的成长,这与问卷维度“亲职状态”、“外界支持”有一定的关联。2位早产儿母亲表示在照护问题上与家人存在分歧,带来了一定程度的情绪焦虑,这说明良好的家庭支持对有利于缓解早产儿母亲的焦虑,因而,“家庭功能”维度的设立是可行的。(3)结合文献回顾、电话访谈、课题组讨论的结果,参考相关书籍与量表初步拟定了包括5个一级条目、17个二级条目,74个三级条目的初始问卷。2.德尔菲函询结果:完成了2轮专家函询,2轮函询中专家的应答率均为100%,专家权威系数均为0.840,提出建议率分别为76.47%、52.94%,第一轮函询中专家意见协调系数分别为0.488、0.266、0.274,第二轮函询中专家意见协调系数分别为0.250、0.122、0.221。经修订与完善后形成了包含5个一级条目,14个二级条目,55个三级条目的正式问卷。3.问卷测评结果:共发放293份问卷,获得有效问卷257份,有效回收率为87.71%,各条目的临界比值为0.135-13.010,各条目得分与问卷总分的相关系数r为0.038-0.886。删除5个无效条目后进行探索性因子分析,提取了8个共同因素作为问卷维度,累积解释变异量为59.864%,各因素的权重值为0.044-0.429。最终形成的问卷包含8个维度,分别为早产儿照护技能、父母角色适应、亲子关系、家庭功能、积极应对、消极应对、外界支持、早产儿保健知识,共40个条目。4.问卷的信效度结果:整个问卷的Cronbach’sɑ系数为0.916、折半信度为0.845,各维度的Cronbach’sɑ系数为0.724-0.906,折半信度为0.712-0.897。问卷整体的内容效度(S-CVI)为0.946,问卷各条目的内容效度(I-CVI)为0.824-1.000,校正后的Kappa值为0.823-1.000。结论:1.《早产儿出院后父母应对能力问卷》包含八个基本维度,分别是早产儿照护技能、父母角色适应、亲子关系、家庭功能、积极应对、消极应对、外界支持、早产儿保健知识,共40个条目。经验证,该问卷具有良好的信度、效度。2.《早产儿出院后父母应对能力问卷》的编制过程规范、内容合理,适用于早产儿出院后父母应对能力的评估。更多还原

【Abstract】 Objective:The questionnaire of parents’ coping ability of premature infants after discharge was developed,and the questionnaire was evaluated and tested to consider the applicability of the questionnaire in the population of parents of premature infants.The purpose of this study is to provide a basis for further study on the current situation of parents’ coping ability and related factors of premature infants after discharge.Methods:1.Form the initial questionnaire: first of all,the literature review method was used to search the literature related to the topic of parents’ coping ability of premature infants after discharge,and the topics were summarized after screening and evaluation.the main dimensions of the questionnaire on parents’ coping ability of premature infants after discharge were preliminarily determined.Secondly,the purpose sampling method was used to conduct a telephone interview with the parents of 13 premature infants after discharge,and the questionnaire dimension was verified and improved according to the interview results.Finally,combined with the results of literature review,telephone interview and research group discussion,we draw up the initial item pool of the questionnaire with reference to relevant books and scales to form the initial questionnaire.2.Form a formal questionnaire: 17 experts in related fields were consulted by Delphi expert letter method,and the authority coefficient,positive coefficient and opinion coordination coefficient of experts were calculated.Items were screened according to the principles of item selection: mean value of item correlation((Mj)> 4),full score rate of item((Kj)> 20%),coefficient of variation((CV)< 0.25),and the content of the initial questionnaire was revised and improved with reference to expert opinions.Form a formal questionnaire.3.Evaluation and test of the questionnaire: using convenient sampling method,according to the sample size of 5-10 times the number of items of the questionnaire,selecting 300 parents of premature infants as the basic population to evaluate the questionnaire,using critical ratio method and Pearson correlation coefficient method for item analysis,exploratory factor analysis to test the construction validity of the questionnaire,excluding items without statistical significance to form the final questionnaire.The content validity of the questionnaire was evaluated by the content validity index of item level and the content validity index of scale level,and the reliability of the questionnaire was analyzed by Cronbach’s coefficient and half coefficient.Results:1.Initial questionnaire results:(1)after screening and evaluation,24 articles were included,including 13 qualitative studies and 11 descriptive studies,all of which were grade B.five topics were extracted as the main dimensions of the questionnaire,which were premature infants’ care knowledge and skills,stress and coping,parental status,external support and family function.(2)according to the interview data,two themes were extracted.The theme one,"main coping problems for parents of premature infants",included unsmooth feeding,lack of nursing knowledge and skills,general anxiety and uncertainty,and lack of parenting information support.this is consistent with the questionnaire dimensions of "knowledge and skills of premature care","stress and coping" and "external support".The second theme,"Adaptive change of parents of premature infants",includes the maturity of parents’ care knowledge and skills and the growth of parents’ role,which is related to the questionnaire dimension "parenting status" and "external support".Two mothers of premature infants said that they had differences with their families on the issue of care,which brought about a certain degree of emotional anxiety,indicating that good family support is conducive to alleviating the anxiety of mothers of premature infants.therefore,the establishment of the dimension of "family function" is of practical significance.(3)based on the results of literature review,telephone interview and research group discussion,and referring to relevant books and scales,a questionnaire item pool including 5 first-level items,17 second-level items and 74 third-level items was preliminarily drawn up.2.Results of Delphi letter inquiry: two rounds of expert letter inquiries were completed,in which the expert response rate was 100%,the expert authority coefficient was 0.840,and the proposal rate was 76.47% and52.94%,respectively.the coordination coefficients of expert opinions in the first round of letter inquiry were 0.488,0.266 and 0.274 respectively,and the coordination coefficients of expert opinions in the second round of letter inquiry were 0.250,0.122 and 0.221,respectively.After revision and improvement,the initial questionnaire consists of 5 first-level items,14second-level items and 55 third-level items.3.Questionnaire evaluation results: a total of 293 questionnaires were sent out,257 valid questionnaires were obtained,the effective recovery rate was 87.71%,the critical ratio of each item was 0.135-13.010,and the correlation coefficient between the score of each item and the total score of the questionnaire was 0.038-0.886.After deleting 5 invalid items,exploratory factor analysis was carried out,8 common factors were extracted as questionnaire dimensions,and the cumulative explanatory variation was 59.864%.The final formal questionnaire consists of eight dimensions,namely,care skills of premature infants,parental role adaptation,parent-child relationship,family function,positive coping,negative coping,external support,and health care knowledge of premature infants.There are 40 entries in total.The Cronbach’s coefficient of the whole questionnaire is 0.916,the half reliability is 0.845,the Cronbach’s coefficient of each dimension is 0.724-0.906,the half-reliability is0.712-0.897.The overall content validity(S-CVI)of the questionnaire was0.946,the content validity(I-CVI)of each item of the questionnaire was0.824-1.000,and the corrected Kappa value was 0.823-1.000.Conclusion:1.The questionnaire on parents’ coping ability of premature infants after discharge contains eight basic dimensions,namely,care skills of premature infants,role adaptation of parents,parent-child relationship,family function,positive coping,negative coping,external support,and health care knowledge of premature infants,a total of 40 items.It is proved that the questionnaire has good reliability and validity.2.The process of compiling the questionnaire of parents’ coping ability of premature infants after discharge is standardized and the content is reasonable,which is suitable for the evaluation of parents’ coping ability of premature infants after discharge.更多还原