临床情境评估量表的汉化及在高血压患者服药管理循证实践中的初步应用

doi:10.3761/j.issn.0254-1769.2025.10.012

摘要/Abstract

摘要：

目的汉化临床情境评估量表（Context Assessment for Community Health，COACH），并在高血压患者服药管理循证实践中初步应用，为循证实践中临床情境的评估提供规范化测量工具。方法按照Brislin翻译模型对量表进行汉化，形成中文版COACH。采用便利抽样法，于2024年5月—9月选取河南省、江西省、辽宁省3所三级甲等医院以及辽宁省2所社区医院的584名医护人员进行调查，以检验量表的信效度；于2024年10月，对辽宁省某三级甲等医院高血压专科病房44名医护人员进行调查，以指导高血压患者服药管理循证实践方案的制订。结果回收有效问卷519份，有效问卷回收率为88.87%。中文版COACH包括7个维度，共42个条目。量表总的Cronbach’s α系数为0.975，McDonald’s Omega系数为0.979，折半信度为0.808，重测信度为0.917。量表水平的平均内容效度为0.950，全体一致内容效度为0.980，条目水平的内容效度为0.775~1.000。探索性因子分析中，累计方差贡献率为79.260%，各条目的因子载荷值为0.569~0.954。验证性因子分析结果显示，模型拟合较好。初步应用结果显示，量表得分为（185.18±17.82）分，各维度得分与量表总分的相关系数为0.116~0.905。结论中文版COACH具有良好的信效度，具有临床适用性，能客观反映循证实践中的临床情境，有助于指导循证实践方案的制订。

关键词: 临床情境, 量表, 信度, 效度, 循证实践, 护理

Abstract:

Objective To translate the Context Assessment for Community Health（COACH） scale into Chinese，thereby providing a standardized measurement tool for context assessment in clinical evidence-based practice. Methods The scale was translated following the Brislin translation model，ultimately forming the Chinese version of the COACH scale. Using convenience sampling，584 healthcare professionals were recruited from 3 tertiary hospitals in Jiangxi，Henan，and Liaoning provinces and 2 community hospitals in Liaoning province from May to September 2024 to evaluate the reliability and validity of the scale. In October 2024，the Chinese version of COACH was applied to 44 healthcare professionals in a hypertension specialist ward of a provincial tertiary hospital. Results Of the 584 distributed questionnaires，519 valid questionnaires were collected（the effective response rate of 88.87%）. The Chinese version consists of 7 dimensions with 42 items. The overall Cronbach’s α coefficient was 0.975；the McDonald’s omega coefficient was 0.979；split-half reliability was 0.808，and the test-retest reliability was 0.917. The scale-content validity index/average was 0.950，and the scale-content validity index/universal agreement was 0.980，with item-content validity index ranging from 0.775 to 1.000. Exploratory factor analysis extracted 7 factors，accounting for 79.260% of the cumulative variance，with factor loadings ranging from 0.569 to 0.954. Confirmatory factor analysis showed good model fit. The preliminary application results showed that the total score of the scale was 185.18±17.82. The correlation coefficients between dimensions and total score ranged from 0.116 to 0.905. Conclusion The Chinese version of the COACH scale demonstrates good reliability and validity，making it suitable as a context measurement tool for implementation research at different stages in clinical and public health settings.

Key words: Clinical Context, Scale, Reliability, Validity, Evidence-Based Practice, Nursing Care

张敬颖, 张凤佩, 涂惠, 赵艳红, 宋英茜, 欧敏行, 杨振, 张秀杰. 临床情境评估量表的汉化及在高血压患者服药管理循证实践中的初步应用[J]. 中华护理杂志, 2025, 60(10): 1230-1236.

ZHANG Jingying, ZHANG Fengpei, TU Hui, ZHAO Yanhong, SONG Yingqian, OU Minxing, YANG Zhen, ZHANG Xiujie. Validation and application of Chinese Clinical Context Assessment for Community Health in evidence-based hypertension medication management[J]. Chinese Journal of Nursing, 2025, 60(10): 1230-1236.

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