臺灣博碩士論文加值系統

前言：「參與」在學齡前孩童的發展中佔有相當重要的地位，學齡前孩童透過日常生活活動參與來累積其生活經驗，並擴充其各個發展面向的能力，在此階段所習得的各項技能與知識，亦被視為是奠定孩童發展及未來成功的重要基礎。隨著國際健康功能與身心障礙分類系統帶來「健康」及「障礙」的新概念，學齡前孩童在活動「參與」上之全面性評估，已愈來愈被各專業所強調且做為療育介入之目標基礎。有鑒於國內目前少有以學齡前孩童為主之參與評估工具，故本研究將針對國外一套學齡前孩童之活動參與評估量表，即「學前活動卡片組（Preschool Activity Card Sort；PACS）」進行翻譯及其信效度檢驗。

研究方法：研究者遵照跨文化翻譯流程將中文版PACS翻譯完成，並徵求全台灣北、中、南三地區共五十八名之一般正常發展孩童接受訪視，訪視結果做為學前活動卡片組題項內容調整與修定之基礎。修定完後之預試版本，再徵求全台灣北、中、南三地區共五十四名之動作發展遲緩孩童進行訪視，並以電腦統計軟體SPSS 17.0進行中文版PACS之信度（內部一致性信度、施測者間信度及重測信度）和效度檢驗（內容效度及建構效度：聚歛效度或區辨效度、內部一致性分析及已知族群效度）。

研究結果：中文版PACS經由跨文化翻譯流程翻譯完成後，共五十八名一般正常發展孩童及五十四名動作發展緩孩童家庭接受訪視，訪視結果經專家會議討論後，依據學者建議進行修訂，並於研究進行期間撰寫各活動題項定義及評判標準，以建立中文版PACS指導手冊。在信度檢驗方面，中文版PACS之內部一致性係數Cronbach α值為0.86；施測者間信度，各分量表及全量表之信度，ICC（3, 1）介於0.91至0.99 （p<0.01）之間；重測信度方面，ICC（3, 1）值介在0.66至0.95 （p<0.01）之間，顯示出中文版PACS有中等至極佳的信度。在效度檢驗方面，中文版PACS組與中文版兒童生活功能評估量表以Pearson係數進行檢驗，中文版PACS之自我照顧及居家生活領域與兒童生活功能評估量表之自我照顧領域相關度最高（γ = 0.54, p<0.01; γ = 0.73, p<0.01），其於分量表及總量表則與兒童生活功能評估量表之社會功能領域相關度最高（γ = 0.35至0.77, p<0.01）；在內部一致性分析方面，中文版PACS各分量表與全量表呈現中度至高度的相關（γ = 0.58至0.88, p<0.01）；而在已知族群效度檢驗方面，一般正常發展孩童於中文版PACS各領域之平均分數均顯著高於動作發展遲緩孩童（p<0.05），以上結果均顯現出中文版PACS具有適當的建構效度。

結論：隨著中文版PACS的建立，其在信效度檢驗方面的初步結果，也支持了中文版PACS在台灣學齡前孩童身上之應用。中文版PACS之建立除了可以與未來ICF／ICF-CY之運用相搭配外，也能協助家長及各早療專業人員了解學齡前孩童們在參與日常生活活動上之情況與限制，進而規劃出更適切的療育計畫。

Introduction: Participation had played an important role in preschoolers’ life. They learned how to interact, work, and live with others through their participation in real-life situations and activities, and what they’ve learned during this time was also seen as the foundation of child development and future success. Since the new concepts for health and disability that International Classification of Functioning, Disability and Health (ICF) had bring, participation had gradually been emphasized by every professions in early intervention. And for the reason that there were few assessment tools in Taiwan, especiaaly for preschoolers, the purposes of this study were to develop an Chinese version of assessment tool for measuring participation adapted from the Preschool Activity Card Sort (PACS-C) and to examined its reliability and validity.

Methods: The study was contained three steps. First, translating the　PACS based on the guidelines of cross-cultural adaptation process with the author’s authorization. Second, interviewing with 58 parents of typically developed children aged 3-6 years. The findings of the interviews and the suggestions obtained from the parents provided the basis for item revising on PACS-C. Third, examining the reliability and validity of PACS-C with 54 children with motor delay. All data was analyzed with SPSS 17.0. The tests of reliability included internal consistency, reliability, inter-rater reliability, and test-retest reliability, and the tests of validity were namely content validity, convergent validity/discriminant validity, construct validity and known group method.

Result: PACS-C was finalized by well cross-culture adapation processes. Two items were added and five items were revised in PACS-C according to interviewee’s suggestion and the openions of expert committee for the cultural appropriateness in PACS-C. The results of the reliability and validity studies indicated high internal consistency (Cronbach α = 0.86), and moderate to excellent inter-rater reliability (ICC(3, 1) = 0.91 ~ 0.99, p<0.01) and test-retest reliability (ICC(3, 1) = 0.66 ~ 0.95, p<0.01) of the PACS-C. In addition, low to high correlation between the domains of PACS-C and Pediatric Evaluation of Disability Inventory　indicated convergent and discriminative validity (p<0.01) of PACS-C with PEDI. The construct validity was also supported by the correlation of subscale scores and full scale scores of PACS (p<0.01) and known group method comparing the domain scores between typically developed children and children with motor delay (p<0.05).

Conclusion: The PACS-C has been developed for measuring participation for Children aged 3-6 years in Taiwan and part of its psychometric property has been established. The PACS-C is now expected to be applicable in Taiwan and could help family and interventionists to clearly understand the children’s participation and to make an explicit and comprehensive plan for early intervention based on the International Classification of Functioning, Disability and Health (ICF) model in the future.

目 錄
指導教授推薦書
論文口試委員會審定書
長庚大學授權書 iii
誌謝 iv
中文摘要 v
英文摘要 vii
目　錄 ix
第一章 緒論 1
第一節 研究背景及動機 1
第二節 研究目的 4
第三節 研究假設 4
第二章 文獻回顧 5
第一節 ICF／ICF-CY中之參與意義及其評估 5
第二節 學齡前孩童之日常生活活動 8
第三節 學齡前孩童之參與評估工具 15
第四節 「學前活動卡片組」之發展 24
第五節 量表翻譯及信效度檢驗 28
第三章 研究方法 32
第一節 研究對象 32
第二節 研究工具 33
第三節 研究程序 35
第四節 資料處理及分析 39
第四章 研究結果 42
第一節 中文版學前活動卡片組之建立 42
第二節 研究對象之基本人口學資料 47
第三節 中文版學前活動卡片組信度檢定 50
第四節 中文版學前活動卡片組效度檢定 51
第五章 討論 68
第一節 中文版學前活動卡片組之建立 68
第二節 基本人口學資料 69
第三節 中文版學前活動卡片組之信度 70
第四節 中文版學前活動卡片組之效度 71
第六章 結論與建議 75
第一節 結論 75
第二節 研究限制及建議 75
參考文獻 77
附錄 777
附錄一　受試者同意書 86
附錄二　個案家庭基本人口資料表 90
附錄三　照片使用同意書 92
附錄四　人體試驗倫理委員會同意臨床試驗證明書 93
附錄五　翻譯者背景資料表 94
附錄六　專家背景資料表（按姓氏比畫排序） 95
附錄七　中文版學前活動卡片組問卷 96
附錄八　中文版學前活動卡片組活動卡片 100
附錄九　中文版學前活動卡片組指導手冊 122

圖 目 錄
圖3-3-1「學前活動卡片組」之中文化過程 37
圖3-3-2 信效度檢測流程 38

表 目 錄
表2-2-1 學齡前孩童之日常生活活動蒐集方式 9
表2-2-2 3至5歲之學齡前孩童之日常生活活動型態 10
表2-2-3　ICF-CY中之活動與參與新增題項 12
表2-3-1　國內外之學齡前階段（3至6歲）參與評估工具 20
表2-4-1　PACS與ICF之類別對應 25
表2-5-1 跨文化量表翻譯步驟 29
表4-1-1　學前活動卡片組之研究流程表 43
表4-1-2 中文版學前活動卡片組題項名稱翻譯修定流程 44
表4-1-3 中文版學前活動卡片組預試版_V85題項名稱修定 46
表4-2-1 一般正常發展孩童之基本資料（Ｖ87版）（n=37） 48
表4-2-2 一般正常發展孩童之基本資料（Ｖ85版）（n=58） 49
表4-2-3 動作發展遲緩孩童之基本資料（n=54） 50
表4-3-1 動作發展遲緩孩童（n=54）於「學前活動卡片組」之答題分配比率 53
表4-3-2 「學前活動卡片組」單題題項之測試者間信度（動作發展遲緩兒童n=54） 61
表4-3-3 「學前活動卡片組」各分量表之測試者間信度（動作發展遲緩兒童：V85，n=54；V87，n=54） 63
表4-3-4 「學前活動卡片組」之重測信度（動作發展遲緩兒童：V85，n=27；V87，n=27） 64
表4-4-1 動作發展遲緩孩童（n=54）於兒童生活功能評估量表得分之平均值與標準差 65
表4-4-2 動作發展遲緩兒童（V87，n=54；V85，n=54）於中文版學前活動卡片組與兒童生活功能評估量表各分量表之相關 65
表4-4-3 中文版學前活動卡片組各分量表與全量表間之相關（動作發展遲緩兒童：V87，n=54；V85，n=54） 66
表4-4-4 一般正常發展孩童（V85，n=58；V87，n=37）及動作發展遲緩孩童（n=54）於中文版學前活動卡片組之各項度得分平均值與標準差 67

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