臺灣博碩士論文加值系統

研究背景：目前本國缺乏以職能治療為理論依據，並具有良好心理計量特性之標準化社交技巧評估工具。溝通與互動技巧評估工具(the Assessment of Communication and Interaction Skills, ACIS)為一觀察型測驗，具有良好建構效度、信度及區辨力。但尚未使用於本國精神科患者，缺乏中文化版本及其心理計量特性驗證。
研究目的：檢驗中文版溝通與互動技巧評估工具應用於台灣精神科患者之信、效度。
研究方法：本研究的對象為北部和東部共四所醫學中心之日間病房之住院精神病患者，診斷根據DSM-IV標準診斷為精神分裂症及情感型疾患、教育程度具有國小畢業程度以上。藥酒癮患者，由於牽涉到腦傷影響，因此本研究不予收集。總共收案101位。個案經說明解釋研究內容及目的、同意並簽署同意書後，進行簡短式智能測驗(MMSE)，測驗得分大於24分以上者，繼續進行觀察與相關量表測驗。本研究使用ACIS-C評估個案參與合作性團體活動及標準化會談時，其社交與互動技巧之表現。以此檢驗ACIS-C之建構效度、區辨效度與再測信度。ACIS-C測驗結果並進一步與職能治療綜合評量表之社交行為、魏氏智力兩分測驗進行相關性分析，以驗證同時效度。研究資料以WINSTEP 3.56版本進行羅序模式分析，並以SPSS11.5版統計軟體進行描述性及推論性分析。
研究結果：101位個案平均年齡為38.56歲。55.4%為女性，44.6%為男性。診斷77.2%為精神分裂症，憂鬱症和躁鬱症佔少數。婚姻狀況未婚居多(70.3%)。教育程度以高中到大學居多。97%個案無全職工作。羅序分析結果顯示ACIS-C題項，除第七題外，其餘項項目符合羅序模式假設為單一建構效度。ICC=.93，而加權kappa值介於.365~1間，顯示再測信度良好。項目分離係數為.96，顯示項目內在一致性佳。測驗難易度可涵蓋所有個案不同程度的社交技巧。個案分離係數為4.64，可將個案分成至少6種不同程度之能力。項目難易度順序，最簡單為詢問，最困難為建立關係。
討論：中文版溝通與互動技巧評估工具經過嚴謹的翻譯過程，經過專家意見修正，建立中文版，適用在本國精神科患者以驗證其信效度，結果顯示中文版溝通與互動技巧評估工具具有適當之信效度，並可區分不同程度之個案能力，可供臨床治療師評估個案社交技巧問題。第七題發音不符合羅序模式假設，可能是因為藥物副作用影響個案口腔動作。臨床設計訓練活動，建議可先從肢體動作臉部表情開始，循序漸進地改善個案之社交技巧缺失。本研究發現可能因慢性化過程殘餘症狀趨於穩定，因此無法顯現台大症狀量表和憂鬱量表與ACIS-C之相關。未來研究應建立施測者間信度及增加團體觀察機會。

Background：There is a lack of standardized social skill assessments which are developed based on occupational therapy theories with good psychometric properties in Taiwan. The Assessment of Communication and Interaction Skills (ACIS) is an observational rating scale with acceptable construct validity, discriminative validity and reliability. However, the psychometric properties of the Chinese version are unclear.
Objective：The purpose of this study is to examine the reliability and validity of the Assessment Communication and Interaction Skills---Chinese version (ACIS-C) with psychiatric patients in Taiwan.
Methods：The subjects were recruited from 3 day care wards
in northern and eastern Taiwan. The minimal educational level is elementary school. Exclusion criteria for the subjects included diagnoses of organic brain injury and substance abuse. We recruited 101 patients. After explaining the process and purpose of the study to patients and obtaining their informed consent, each subject was tested on the Mini-Mental State Examination (MMSE). Only patients whose scores on MMSE were equal or larger than 24 were recruited. After securing the permission of the patient and ward staff, the researcher observed subjects’ performance during group session and a simulated social situation. The ACIS-C was used to assess the communication and interaction skills of the patients. Construct and discriminative validity as well as test-retest reliability were examined through Rasch measurement model and related inferential statistics.
Results: The mean age of the subjects are 38.6 years (SD=11.5years). 55.4% are female and 44.6% are male. The majority of the subjects are diagnosed as schizophrenia (77.2%). 70.3% of the patients were unmarried. Most of the educational level is at college or above. 97% of the subjects were unemployed. The results of the Rasch analysis showed that the items of the ACIS-C form a unidimensional construct except for one item (item 7). The test retest reliability is good (ICC=.93). The internal consistency of the scale is .96. The ACIS-C is a sensitive scale which could be used to differentiate social skills among psychiatric patients. The easiest item is ”ask” and the hardest item is”relate”.
Discussion：The ACIS was translated into Chinese through
careful two stage translation process. The ACIS-C has acceptable construct validity, discriminative validity and test-retest reliability. The reason for misfit item could be attributed to side effect of psychotropic medications. Therapists can utilize the level of difficulties of ACIS-C items from the study to design matching training programs. For example, a therapist could start the training focus from easier item such as body movement, then progress to harder items such as relates and respects. The results of the study also showed that the severity of symptoms did not influence the patients’ social skills. Future study needs to emphasize inter-rater and intra-rater reliability of the ACIS-C as well as ACIS-C’s validity in different context.

內文目錄 頁次
中文摘要 Ⅰ
英文摘要 Ⅱ
內文目錄 Ⅲ
表目錄 Ⅳ
第一章 緒論 研究背景與動 1
第二章 文獻回顧 3
一、 特質模式 3
二、 微行模式 5
三、 兩特質綜合模式 5
第二節 人類職能模式之社交互動技巧 6
第三節 社交技巧定義比較分析 10
第四節 精神疾病患者之社交技巧缺失 11
一、 精神分裂症 11
二、 憂鬱症 14
第五節 社交技巧評估工具 17
第三章 研究假設 23
第四章 研究方法 24
第一節 研究對象 24
第二節 研究工具 26
第三節 研究過程 32
第四節 資料處理與分析 34
第五章 研究結果 37
第一節 中文版溝通與互動技巧評估工具翻譯過程 37
第二節 人口學資料分析 37
第三節 中文版溝通與互動技巧評估工具之建構效度 39
第四節 中文版溝通與互動技巧評估工具之區辨效度及同時效度 40
第五節 中文版溝通與互動技巧評估工具之內在一致性和再測信度 42
第六章 討論 44
第一節 中文版溝通與互動技巧之完成 44
第二節 中文版溝通與互動技巧評估工具之建構效度 44
第三節 中文版溝通與互動技巧評估工具之區辨效度和同時效度 47
第四節 中文版溝通與互動技巧評估工具之內在一致性和再測信度 48
第七章 結論與建議 51
第一節 結論與臨床涵義 51
第二節 研究限制與建議 52
參考文獻 54
表圖目次-表
表一 社交技巧模式比較 67
表二 社交技巧定義比較 68
表三 社交技巧評估工具比較 69
表四 101位個案之人口學資料 70
表五 各測驗之分數分佈情形 71
表六 中文版溝通與互動技巧評估工具項目合適度值 72
表七 中文版與英文版溝通與互動技巧難易度排序比較 73
表八 One-way ANOVA 74
表九 Independent sample t-test 75
表十 中文版溝通與互動評估工具與各測驗之斯皮爾曼相關性檢定 76
表十一 30位再測個案基本資料 77
表十二 中文版溝通與互動技巧項目加權kappa值 78
表圖目次-圖
圖一 中文版溝通與互動技巧分數機率分布 79
圖二 項目難易度與個案能力對照圖 80
圖三 發音再測分數人數分配圖 81
圖四 態度肯定再測分數人數分配圖 82
圖五 詢問再測分數人數分配圖 83
圖六 尊重再測分數人數分配圖 84
圖七 30位個案之再測分數折散圖 85
圖八 中文版溝通與互動評估工具與英文原文版量表研究之項目難易度XY分布圖 86
圖九 中文版和英文版項目難易度順序比較示意圖 87
附錄
附錄一 受試者同意書 88
附錄二 MMSE中文版使用同意書 89
附錄三 簡短式智能測驗題目與評分表 90
附錄四 個案基本資料表 91
附錄五 台大症狀量表 92
附錄六 貝氏憂鬱量表中文版第二
版題目範例 93
附錄七 溝通與互動技巧測驗中文版量表 94
附錄八 魏氏智力測驗成人版之詞彙測驗量表題目範例 95
附錄九 魏氏智力測驗成人版之記
憶廣度測驗量表題目範例 96
附錄十 職能治療綜合評量表(取自台大精神部) 97
附錄十一 溝通與互動技巧評量表翻譯同意書 98

參考文獻
中文參考書目
1.王秀枝、王若蘭 (2000)。臨床心理與臨床神經心理衡鑑。李明濱，實用精神醫學。頁89-106。台北：國立台灣大學醫學院。
2.劉智民(2000)。精神分裂症。李明濱，實用精神醫學。頁129-142。台北：國立台灣大學醫學院。
3.蔡茂堂、文榮光、林信男、宋維村、陳珠彰(1978)。精神科門診病人自填症狀量表之應用經驗。中華民國神經精神醫學會會刊，4(2)，頁47-65。
4.陳榮華、陳心怡 (2000)。魏氏智力測驗量表第三版(中文版)。臺北：中國行為科社。
5.郭乃文、劉秀枝、王佩芳、廖光淦、甄瑞興、林恭平、陳祖裕、徐道昌(民84)。「簡短氏智能評估」之中文施測與常模建立。復健醫學雜誌，19，頁52-58。
6.高麗芷、劉運康、周美華(1981)。台北市立療養院社區工作職能方實驗報告。台北市立療養院年報。頁115-124。
7.王文中(1997)。測驗的建構：因素分析還是Rasch分析?。調查研究，3，頁129-166。
8.劉麗婷、陳詞章、鍾麗英、潘璦琬(2004)。角色量表於台灣精神病患之信度與效度測試。台灣醫學，8(5)，頁630-638。
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