【作者】 任慧；

【导师】 张振香；

【作者基本信息】 郑州大学 ， 护理学， 2023， 硕士

【摘要】 目的1.研制《脑卒中高危人群发病风险感知问卷》,并进行信效度检验,为脑卒中高危人群发病风险感知测评和干预效果的评价提供评估工具。2.探索脑卒中高危人群发病风险感知的现状、影响因素及作用路径,为开展脑卒中高危人群发病风险感知干预策略和方案提供参考依据。方法1.《脑卒中高危人群发病风险感知问卷》的研制及信效度检验。在心理测量范式和健康信念模式的指导下,通过文献回顾和半结构化访谈,形成《脑卒中高危人群发病风险感知问卷》初稿;通过两轮Delphi专家咨询(16位专家)和小样本(30例)预调查,形成问卷施测稿;于2022年9月～11月选取214例脑卒中高危人群为研究对象,使用IBM SPSS Statistics 21.0进行项目分析、探索性因子分析和信度检验;于2022年12月～2023年2月选取326例脑卒中高危人群为研究对象,使用IBM SPSS Amos 24.0进行验证性因子分析、聚敛效度和区分效度计算。2.脑卒中高危人群发病风险感知现状、影响因素及其作用路径。采用一般资料调查表、脑卒中高危人群发病风险感知问卷、担忧、自评健康、广泛焦虑障碍量表、患者健康问卷-9和社会支持评定量表调查326例脑卒中高危人群发病风险感知现状及影响因素。使用IBM SPSS Statistics 21.0进行描述性统计、独立样本t检验、单因素方差分析、Pearson相关分析、多重线性逐步回归分析,使用PROCESS程序插件的Model 6进行链式中介效应检验,探索脑卒中高危人群发病风险感知现状、影响因素及作用路径。结果1.研制形成《脑卒中高危人群发病风险感知问卷》。问卷总内容效度指数(S-CVI)为0.996,各条目内容效度指数(I-CVI)为0.875～1.000。探索性因子分析共提取出5个公因子,累积方差贡献率为57.98%,载荷范围在0.406～0.927;问卷总Cronbach’sa系数为0.878,各维度Cronbach’sa系数在0.803～0.906,总折半信度Guttman Spilt系数为0.722,重测信度为0.936,各维度重测信度在0.774～0.953;验证性因子分析结果显示,修正后模型拟合指标卡方自由度之比(χ~2/df)=2.200,近似均方根误差(RMSEA)=0.061,拟合优度指数(GFI)=0.858,相对拟合指数(CFI)=0.919,常规拟合指数(NFI)=0.862,增值拟合指数(IFI)=0.920,处于可接受范围内。各维度的平均方差抽取量为0.501～0.602,组合信度为0.795～0.914,两因子间平均方差抽取量的平方根均大于其相关系数的绝对值。最终形成包括感知易感性、感知发病症状、感知危险因素、感知风险控制和感知严重性,共5个维度30个条目的脑卒中高危人群发病风险感知问卷。2.脑卒中高危人群发病风险感知总分为(109.50±14.205)分,五个维度条目均分从低至高依次为:感知易感性(2.43±0.955)分,感知风险控制(2.89±1.131)分,感知危险因素(3.69±0.744)分,感知发病症状(3.92±0.680)分,感知严重性(4.38±0.697)分。多重线性逐步回归分析结果显示:文化程度(B=1.890,P=0.005)、运动缺乏(B=-3.994,P=0.010)、脑卒中危险因素数量(B=3.302,P=0.015)、担忧(B=2.251,P(27)0.001)、自评健康(B=1.966,P=0.025)和社会支持(B=0.266,P=0.009)是脑卒中高危人群发病风险感知的影响因素。中介效应分析结果显示:社会支持除直接影响脑卒中高危人群发病风险感知(B=0.265,95%CI:0.066～0.465)外,还可通过其他变量对风险感知产生间接影响:一方面可分别通过担忧、自评健康对脑卒中高危人群发病风险感知产生间接效应(B=0.064,95%CI:0.019～0.128;B=-0.053,95%CI:-0.113～-0.009);另一方面还可通过担忧和自评健康对脑卒中高危人群发病风险感知产生链式中介效应(B=0.006,95%CI:0.001～0.016)。结论1.《脑卒中高危人群发病风险感知问卷》包括感知易感性、感知发病症状、感知危险因素、感知风险控制及感知严重性共5个维度30个条目,问卷信效度良好,可用于评估脑卒中高危人群发病风险感知水平。2.脑卒中高危人群发病风险感知处于中等水平,感知易感性维度条目均分最低。文化程度越高、无运动缺乏、脑卒中危险因素数量越多、担忧程度越高、自评健康状况越差和社会支持水平越高的脑卒中高危人群发病风险感知水平越高。担忧和自评健康是社会支持和脑卒中高危人群发病风险感知间的独立和链式中介,启示提高社会支持或可对改变脑卒中高危人群发病风险感知产生多重作用路径;也可从脑卒中高危人群发病担忧和自评健康切入,制定更具针对性的干预方案。更多还原

【Abstract】 Objectives1.To develop the risk perception questionnaire for people at high risk of stroke and test its reliability and validity,to provide an assessment tool for perceived stroke risk assessment and evaluation of intervention effects in high-risk groups.2.To explore the current status,influencing factors,and pathway of risk perception in people at high risk of stroke,and to provide a reference for the development of intervention strategies and programs for perceived risk of stroke in high-risk groups..Methods1.Development and reliability testing of the risk perception questionnaire for people at high risk of stroke.Based on the psychometric paradigm and health belief model,the first draft of the risk perception questionnaire for people at high risk of stroke was developed through literature review and semi-structured interviews;the questionnaire administration draft was developed through two rounds of Delphi expert consultation(16 experts)and a small sample pre-survey(30 cases).Investigate 214 people at high risk of stroke from September to November 2022,using IBM SPSS Statistics 21.0 for item analysis,exploratory factor analysis,and reliability testing;investigate 326 people at high risk of stroke from December 2022 to February 2023,using IBM SPSS Amos24.0 for confirmatory factor analysis,convergent validity,and discriminant validity.2.Analysis of the current status of risk perception for people at high risk of stroke and influencing factors.The General Information Questionnaire,Risk Perception Questionnaire for People at High Risk of Stroke,Worry,Self-rated Health,Generalized Anxiety Disorder Scale,Patient Health Questionnaire-9,and Social Support Rate Scale were used to investigate the current status of risk perception of stroke and the factors influencing it in 326 high-risk stroke patients.Descriptive statistics,independent samples t-test,one-way ANOVA,Pearson correlation analysis,and multiple linear stepwise regression analysis were performed using IBM SPSS Statistics 21.0,and chain-mediating effect was performed using the PROCESS program to explore the current status,influencing factors,and pathways of risk perception in people at high risk of stroke.Results1.The risk perception questionnaire for people at high risk of stroke consisted of 5domains and 30 items.The scale-level content validity index(S-CVI)was 0.996,and each item’s content validity index(I-CVI)ranged from 0.875 to 1.000.Exploratory factor analysis extracted five common factors with a cumulative variance contribution rate of 57.98%and a loading range of 0.406 to 0.927;the total Cronbach’sacoefficient was 0.878,the Cronbach’sacoefficient for each dimension was in the range of0.803～0.906,the total fold-half reliability Guttman Spilt coefficient was 0.722,the retest reliability was 0.936,and the retest reliability for each dimension was in the range of 0.774～0.953.The results of the confirmative factor analysis showed that the modified fit index cardinality ratio of freedom(χ~2/df)=2.220,Root Mean Square Error of Approximation(RMSEA)=0.061,Goodness Fit Index(GFI)=0.858,Comparative Fit Index(CFI)=0.919,Normal Fit Index(NFI)=0.862,and Incremental Fit Index(IFI)=0.920,which are basically within the acceptable range.The Average Variance Extracted for each dimension ranged from 0.501 to 0.602,and the Composite Reliability ranged from 0.795 to 0.914.The square root of the Average Variance Extracted between the two factors was greater than the absolute value of their correlation coefficients.2.The actual score of risk perception in people at high risk of stroke was(109.50±14.205).The average score of items in the five dimensions,in descending order,are perceived susceptibility(2.43±0.955),perceived risk control(2.89±0.1.131),perceived risk factors(3.69±0.744),perceived disease symptoms(3.92±0.680),and perceived severity(4.38±0.697).Education levels(B=1.890,P=0.005),physical inactivity(B=-3.994,P=0.010),number of stroke risk factors(B=3.302,P=0.015),worry about stroke(B=2.251,P(27)0.001),self-rated health(B=-1.966,P=0.05)and social support(B=0.266,P=0.009)were the influencing factors of risk perception of people at high risk of stroke.The results of the mediating effects analysis showed that social support,in addition to directly influencing the risk perception of stroke in high-risk groups(B=0.265,95%CI:0.066～0.465),could also have an indirect effect on risk perception through other variables:on the one hand,there were indirect effects of worry and self-rated health on the risk perception of stroke in high-risk groups(B=0.064,95%CI:0.019～0.128;B=-0.053,95%CI:-0.113～-0.009),and on the other hand,there were chain mediating effects of worry and self-rated health on the risk perception of stroke in high-risk groups(B=0.006,95%CI:0.001～0.016).Conclusion1.The risk perception questionnaire for people at high risk of stroke includes 30 items in 5 dimensions,including perceived susceptibility,perceived disease symptoms,perceived risk factors,perceived risk control,and perceived severity.2.The risk perception of people at high risk of stroke was moderate,with the lowest standardized score for the perceived susceptibility dimension.Education levels,physical inactivity,number of stroke risk factors,worry,self-rated health,and social support were influencing factors.Worry and self-rated health were independent and chained mediators between social support and risk perception of stroke in high-risk groups.更多还原