妊娠期糖尿病孕妇血糖管理行为决策量表的编制及信效度检验

doi:10.3761/j.issn.0254-1769.2024.22.012

摘要/Abstract

摘要：

目的编制妊娠期糖尿病（gestational diabetes mellitus，GDM）孕妇血糖管理行为决策量表，并检验其信效度。方法基于跨理论模型和行为决策理论，通过文献分析、半结构式访谈法、头脑风暴法、2轮专家咨询及认知性访谈法形成测试版量表。采用便利抽样法，于2023年7月21日—11月选取福建省泉州市10所医院的560例GDM孕妇进行调查，运用随机数字法将数据分为2个部分，进行探索性因子分析和验证性因子分析。结果 GDM孕妇血糖管理行为决策量表包括行为决策动机、行为决策影响因素、行为决策意向、行为决策有效性4个维度，34个条目。量表总的Cronbach’s α系数为0.971，折半信度为0.919，重测信度为0.863，内容效度指数为0.853。探索性因子分析提取4个公因子，累计方差贡献率为78.28%；验证性因子分析结果显示，量表因子结构稳定。结论 GDM孕妇血糖管理行为决策量表信效度良好，可用于对GDM孕妇血糖管理行为决策水平的评估。

关键词: 妊娠期糖尿病, 血糖管理, 自我管理, 行为决策, 量表, 信度, 效度, 护理评估

Abstract:

Objective To develop a Behavioral Decision-making Scale for Glycemic Management in pregnant women with gestational diabetes and to test its reliability and validity. Methods Based on the trans-theoretical model and behavioral decision theory，the test version of the scale was formed through literature review，semi-structured interview，brainstorming，2 rounds of expert consultation and cognitive interview. A total of 560 pregnant women with gestational diabetes mellitus were recruited from 10 hospitals in Quanzhou，Fujian Province by convenience sampling method from 21 July to November 2023. The data were divided into 2 parts by random number method for exploratory factor analysis and confirmatory factor analysis. Results The scale included 4 dimensions of “behavioral decision-making motivation”“behavioral decision-making influencing factors”“behavioral decision-making intention” and “behavioral decision-making effectiveness” with 34 items. The Cronbach’s α coefficient of the total scale was 0.971；the split-half reliability was 0.919；the test-retest reliability was 0.863；the content validity index of the scale was 0.853. The exploratory factor analysis extracted 4 common factors，and the cumulative variance contribution rate was 78.28%. The confirmatory factor analysis showed that the factor structure of the scale was stable. Conclusion The scale has ideal reliability and validity，which can be used to measure the level of glycemic management behavior decision-making of pregnant women with gestational diabetes mellitus.

Key words: Gestational Diabetes Mellitus, Blood Glucose Management, Self-Management, Behavioral Decision-Making, Scale, Reliability, Validity, Nursing Assessment

彭玉美, 柯慧莹, 赵梅晶, 刘丽丽, 谢宝缘, 陈钰妹, 谢雅萍, 赵惠芬. 妊娠期糖尿病孕妇血糖管理行为决策量表的编制及信效度检验[J]. 中华护理杂志, 2024, 59(22): 2766-2773.

PENG Yumei, KE Huiying, ZHAO Meijing, LIU Lili, XIE Baoyuan, CHEN Yumei, XIE Yaping, ZHAO Huifen. Development and validation of a Behavioral Decision-making Scale for Glycemic Management in Pregnant Women with Gestational Diabetes[J]. Chinese Journal of Nursing, 2024, 59(22): 2766-2773.

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参考文献 27

[1]	杨慧霞. 妊娠合并糖尿病实用手册[M]. 2版. 北京: 人民卫生出版社, 2018.
	Yang HX. Practical handbook of pregnancy complicated with diabetes mellitus[M]. 2nd ed. Beijing: People’s Medical Publish-ing House, 2018.
[2]	Johns EC, Denison FC, Norman JE, et al. Gestational diabetes mellitus:mechanisms,treatment,and complications[J]. Trends Endo-crinol Metab, 2018, 29(11):743-754.
[3]	Gao CH, Sun X, Lu L, et al. Prevalence of gestational diabetes mellitus in mainland China:a systematic review and meta-analysis[J]. J Diabetes Investig, 2019, 10(1):154-162.
[4]	Saravanan P, Diabetes in Pregnancy Working Group, Maternal Medicine Clinical Study Group, et al. Gestational diabetes:opportunities for improving maternal and child health[J]. Lan-cet Diabetes Endocrinol, 2020, 8(9):793-800.
[5]	Zhang CH, Zhang PL. Adverse perinatal outcomes complicated with gestational diabetes mellitus in preterm mothers and preterm infants[J]. Exp Ther Med, 2023, 26(3):425.
[6]	Farrar D, Simmonds M, Bryant M, et al. Treatments for gestatio-nal diabetes:a systematic review and meta-analysis[J]. BMJ Open, 2017, 7(6):e015557.
[7]	章孟星, 周英凤, 钟婕, 等. 妊娠期糖尿病临床护理实践指南的整合研究[J]. 中华护理杂志, 2019, 54(1):104-113.
	Zhang MX, Zhou YF, Zhong J, et al. The adaptation of clinical nursing practice guideline for gestational diabetes mellitus[J]. Chin J Nurs, 2019, 54(1):104-113.
[8]	查慧贤, 蒋英, 蒋玲, 等. 妊娠期糖尿病患者血糖自我管理教育及支持的最佳证据总结[J]. 中华护理杂志, 2023, 58(11):1308-1315. DOI URL
	Zha HX, Jiang Y, Jiang L, et al. Best evidence summary on glycemic self-management education and support for patients with gestational diabetes mellitus[J]. Chin J Nurs, 2023, 58(11):1308-1315. DOI URL
[9]	Nielsen KK, Kapur A, Damm P, et al. From screening to post-partum follow-up the determinants and barriers for gestational diabetes mellitus(GDM) services,a systematic review[J]. BMC Pregnancy Childbirth, 2014, 14:41.
[10]	Kelly MP, Barker M. Why is changing health-related beha-viour so difficult?[J]. Public Health, 2016, 136:109-116.
[11]	林蓓蕾, 张振香, 梅永霞, 等. 脑卒中患者行为决策评估量表的编制及信效度检验[J]. 中华护理杂志, 2022, 57(13):1605-1610. DOI URL
	Lin BL, Zhang ZX, Mei YX, et al. Development and psycho-metric test of the Behavioral Decision-making Scale for Stroke Patients[J]. Chin J Nurs, 2022, 57(13):1605-1610.
[12]	黄娜, 周英凤, 李丽, 等. 妊娠期糖尿病孕妇血糖管理决策行为及影响因素的研究[J]. 中华护理杂志, 2021, 56(9):1312-1317. DOI URL
	Huang N, Zhou YF, Li L, et al. The decision-making behavior and influencing factors of blood glucose management in pregnant women with gestational diabetes mellitus[J]. Chin J Nurs, 2021, 56(9):1312-1317. DOI URL
[13]	Prochaska J. Systems of psycho therapy:a trans-theoretical ana-lysis[M]. Pacific, CA:Brooks-Cole, 1979.
[14]	田向阳. 行为决策的评估理论构建研究[J]. 健康教育与健康促进, 2020, 15(2):167-172.
	Tian XY. A study on construction of assessment theory on behavioral decision-making[J]. Health Educ Health Promot, 2020, 15(2):167-172.
[15]	Hashemzadeh M, Rahimi A, Zare-Farashbandi F, et al. Trans-theoretical model of health behavioral change:a systematic review[J]. Iran J Nurs Midwifery Res, 2019, 24(2):83-90. DOI PMID
[16]	Assarroudi A, Heshmati Nabavi F, Armat MR, et al. Directed qualitative content analysis:the description and elaboration of its underpinning methods and data analysis process[J]. J Res Nurs, 2018, 23(1):42-55.
[17]	德威利斯RF. 量表编制理论与应用[M]. 3版. 重庆: 重庆大学出版社, 2016:61,167.
	Devellis RF. Scale development:theory and applications[M]. 3rd ed. Chongqing: Chongqing University Press, 2016:61,167.
[18]	李月仪, 陈伟菊. 德尔菲法在护理管理学中的应用现状[J]. 护理研究, 2018, 32(21):3339-3341.
	Li YY, Chen WJ. Application status quo of Delphy method in nursing management[J]. Chin Nurs Res, 2018, 32(21):3339-3341.
[19]	谢幸, 孔北华, 段涛. 妇产科学[M]. 9版. 北京: 人民卫生出版社, 2018.
	Xie X, Kong BH, Duan T. Obstetrics and gynecology[M]. 9th ed. Beijing: People’s Medical Publishing House, 2018.
[20]	李峥, 刘宇. 护理学研究方法[M]. 2版. 北京: 人民卫生出版社, 2018.
	Li Z, Liu Y. Nursing research methods[M]. 2nd ed. Beijing: People’s Medical Publishing House, 2018.
[21]	秦浩, 陈景武. 医学量表条目的筛选考评方法及其应用[J]. 中国行为医学科学, 2006(4):375-376.
	Qin H, Chen JW. Screening and evaluation method of medical scale items and its application[J]. Chin J Behav Med Sci, 2006(4):375-376.
[22]	张晨, 周云仙. 我国护理测量工具文献中内容效度指数应用误区分析[J]. 护理学杂志, 2020, 35(4):86-88,92.
	Zhang C, Zhou YX. Analysis on errors regarding content vali-dity index used in evaluation of measurement tools in Chinese nursing literature[J]. J Nurs Sci, 2020, 35(4):86-88,92.
[23]	吴明隆. 问卷统计分析实务:SPSS操作与应用[M]. 重庆: 重庆大学出版社, 2010.
	Wu ML. Practice of questionnaire statistical analysis:SPSS operation and application[M]. Chongqing: Chongqing Univer-sity Press, 2010.
[24]	孙振球, 徐勇勇. 医学统计学[M]. 4版. 北京: 人民卫生出版社, 2014.
	Sun ZQ, Xu YY. Medical statistics[M]. 4th ed. Beijing: People’s Medical Publishing House, 2014.
[25]	吴明隆. 结构方程模型:Amos实务进阶[M]. 重庆: 重庆大学出版社, 2013.
	Wu ML. Structural equation model:advanced Amos practice[M]. Chongqing: Chongqing University Press, 2013.
[26]	陈维, 黄程琰, 毛天欣, 等. 多维测评工具聚敛和区分效度的SEM分析:以领悟社会支持量表为例[J]. 西南师范大学学报(自然科学版), 2016, 41(2):136-140.
	Chen W, Huang CY, Mao TX, et al. On analysis of convergent and discriminant validity of multidimensional measurement tools with the perceived social support scale as an example[J]. J Southwest China Norm Univ Nat Sci Ed, 2016, 41(2):136-140.
[27]	Grieve S, Adams J, McCabe C. ‘What I really needed was the truth’ exploring the information needs of people with complex regional pain syndrome[J]. Musculoskeletal Care, 2016, 14(1):15-25.