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研究生:楊培筠
研究生(外文):Pei-Yun Yang
論文名稱:糖尿病同儕支持量表中文版之發展及驗證
論文名稱(外文):Instrument Development and Validation of theDiabetes Social Support Questionnaire-Friend(DSSQ-Friends) Chinese Version
指導教授:高碧霞高碧霞引用關係
指導教授(外文):Bih-Shya Gau
口試日期:2017-07-11
學位類別:博士
校院名稱:國立臺灣大學
系所名稱:護理學研究所
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2017
畢業學年度:105
語文別:中文
論文頁數:157
中文關鍵詞:第一型糖尿病青少年自我照顧同儕支持量表驗證
外文關鍵詞:Type 1 diabetesAdolescentSelf-carePeer supportInstrument Validation
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背景
第一型糖尿病青少年的盛行率比成年期高,罹病青少年必須長期執行血糖檢測、胰島素注射、規律運動與飲食監測,複雜的自我管理對病人極具挑戰性。青少年會非常在意自己於同儕眼中的樣子,不但會努力去扮演原有的角色,也會扮演能被同儕所接納的新角色。同儕支持對青少年在糖尿病自我照顧上是有顯著影響的。糖尿病的自我管理和同儕支持深受社會文化的影響,但目前並無中文版糖尿病青少年同儕支持的研究工具,華人地區糖尿病青少年在自我照顧時的同儕支持研究仍缺乏。
目的
本研究目的,主要於發展及驗證之糖尿病青少年同儕支持中文版量表,,進行工具之信、效度測試,以了解糖尿病青少年之同儕支持現況。。
方法
本研究分兩階段進行,第一階段為量表翻譯、回覆翻譯及質性研究驗證,第二階段為中文版問卷實地測試。第一階段先將英文問卷進行翻譯、回覆翻譯,經由兩次專家之內容效度審查,同時納入12位青少年個案質性訪談資料,增加本土性題目於英文版量表之中。第二階段收集123位符合收案條件青少年進行台灣版問卷的實地測試,及完成工具之建構效度與內在一致性等信效度驗證,以確立中文版糖尿病青少年同儕支持量表之臨床適用性。
本研究將進行翻譯之糖尿病青少年同儕支持量表(DSSQ-F),獲得原作者Berarman & La Greca授權同意,原始量表包含糖尿病所有自我照顧行為,共含28題(胰島素注射2題、血糖測試6題、飲食13題、運動4題與情緒支持3題),收集病童所感受到的支持度與支持行為發生的頻率資料。
結果
糖尿病青少年同儕支持原始量表之內容效度值為0.67,經由增加本土題目之後的CVI值為0.80。中文版量表之建構效度乃使用探索性因素分析,將33題項目粹取出5個因素,總解釋變異量為76.16%,此5個因素為:飲食14題(解釋23.97%的變異量)、胰島素注射與血糖測9題(解釋19.17%的變異量)、情緒3題(解釋12.03%的變異量)、緊急情況和症狀管理5題(解釋11.15%的變異量)與運動4題(解釋7.85%的變異量)。中文版糖尿病同儕支持量表總量表之Cronbach''s alpha為0.98,各分量表之Cronbach''s alpha介於0.88至0.96間,顯示中文版糖尿病同儕支持量表具有良好的內在一致性。
結論
研究結果顯示,中文版糖尿病支持同儕量表具有良好的信、效度,可運用於瞭解台灣地區糖尿病青少年的同儕支持現況使用,具體的察覺病童在校執行自我照顧行為時的同儕支持,協助糖尿病青少年在學校得到更完善的糖尿病自我照顧。本研究受限於橫斷式研究,為能使糖尿病同儕支持量表之適用範圍更擴大,未來的研究建議運用縱貫式研究設計,探討糖尿病青少年在不同罹病階段與不同區域醫療環境下的同儕支持與糖尿病自我照顧現況,以增加本研究之外推性。
Background
The prevalence of type 1 diabetes in adolescents is higher than that in adults. Adolescents with diabetes are required to undergo long-term blood glucose tests, receive insulin injections, exercise regularly, and be monitored for diet. The complex self-management process is extremely challenging to the patients. Because many adolescents are concerned about how they appear to their peers, those with diabetes strive to play their original roles (i.e., prior to being diagnosed with diabetes) as well as new roles that their peers deem acceptable. Peer support has a substantial effect on diabetes self-care among adolescents. However, despite these concepts being immensely influenced by social culture, no Chinese translations of the Diabetes Social Support Questionnaire-Friends Version (DSSQ-F) have been made for Taiwanese adolescents with diabetes. In addition, few studies on the peer support that is received by adolescents with diabetes when engaging in self-care have been conducted in the Greater China Region.
Objective
The main objectives of this study were to develop and validate the DSSQ-F (Chinese version) for adolescents with diabetes. The reliability and validity of the DSSQ-F (Chinese version) were tested to determine the peer support situations experienced by adolescents with diabetes.
Methods
This study was divided into two stages. The first stage involved translating the scale and performing a qualitative assessment of the scale to verify its effectiveness. The second stage entailed performing field tests using the translated scale. For the first stage, the questionnaire was translated from English to Chinese and then back-translated from Chinese to English before two expert reviews were performed to determine its content validity. Qualitative data obtained from interviews with 12 adolescents were also incorporated. Furthermore, local-based (i.e., Taiwan-based) items were added to the questionnaire after approval was received from the authors of the English questionnaire. For the second stage, a purposive sampling method was adopted to recruit 123 adolescent participants who met the study criteria. Field tests were performed using the DSSQ-F (Chinese version), and the construct validity and internal consistency of the scale were subsequently tested to validate the applicability of the scale in clinical practice.
The DSSQ-F (Chinese version) for adolescents with diabetes was authorized and approved by Bearman and La Greca, the authors of the original English version of the questionnaire. The original scale focused on diabetes self-care behavior and contained 28 items that measured the support felt by adolescents who were sick and the frequency at which supportive behavior occurred. Specifically, 2, 6, 13, 4, and 3 items addressed insulin injection, blood glucose testing, diet, exercise, and emotional support, respectively. The Type 1 Diabetes Self-care behavior scale was later used to test the criterion-related validity of the DSSQ-F (Chinese version).
Results
The results showed that the original scale and the revised scale (which included additional local-based items) produced a content validity index CVI of 0.67 and 0.80, respectively. To measure the constructive validity of the scale, an exploratory factor analysis and confirmatory factor analysis was performed. The analysis extracted five factors that explained 76.16% of the total variance among 35 items of the DSSQ-F (Chinese version); these factors were diet (14 items, explained 23.97% of variance), insulin injection and blood glucose test (9 items, explained 19.17% of variance), emotional support (3 items, explained 12.03% of variance), emergency and symptom management (5 items, explained 11.15% of variance), and exercise (4 items, explained 7.85% of variance). Finally, the DSSQ-F (Chinese version) displayed a Cronbach’s alpha of 0.98 and its subscales yielded Cronbach’s alphas between 0.88 and 0.96, highlighting the favorable internal consistency of the scale.
Conclusion
The study results showed that the DSSQ-F (Chinese version) features outstanding reliability and validity and can be used to understand the current peer support situation of adolescents with diabetes in Taiwan. The scale helps identify the peer support received by adolescents with diabetes when they engage in self-care practices in school and helps them achieve more complete diabetes self-care in school. Because this study adopted a cross-sectional study method, future studies are suggested to utilize a longitudinal study design to more thoroughly investigate the current diabetes self-care and peer support situations of adolescents with diabetes who are at different diabetes stages, as well as those who are treated in different regions. Such research will expand the current scope of application of the DSSQ-F (Chinese version) scale.
目 錄
誌 謝……………………………………………………………………………………………i
中文摘要……………………………………………………………………………………iii
英文摘要…………………………………………………………………………………………v
目 錄………………………………………………………………………………………viii
圖目錄……………………………………………………………………………………………xi
表目錄…………………………………………………………………………………………xii
第一章 緒論…………………………………………………………………………………1
第一節 研究背景與動機…………………………………………………………1
第二節 研究重要性……………………………………………………………………3
第三節 研究問題…………………………………………………………………………4
第四節 研究目的…………………………………………………………………………5
第五節 名詞界定…………………………………………………………………………6
第二章 文獻探討…………………………………………………………………………7
第一節 第1型糖尿病之相關概念…………………………………………7
第二節 第1型糖尿病青少年之自我照顧…………………………10
第三節 糖尿病青少年之同儕支持………………………………………20
第四節 文獻總結…………………………………………………………………………25
第三章 研究方法…………………………………………………………………………26
第一節 研究設計…………………………………………………………………………26
第二節 研究對象及場所……………………………………………………………27
第三節 研究工具……………………………………………………………………………28
第四節 研究步驟……………………………………………………………………………30
第五節 資料分析方法…………………………………………………………………33
第六節 研究倫理……………………………………………………………………………35
第四章 研究結果……………………………………………………………………………36
第一節 研究對象基本特性…………………………………………………………36
第二節 研究工具的修正與發展…………………………………………………43
第三節 研究工具的驗證與信效度檢定……………………………………51
第四節 糖尿病青少年同儕支持現況…………………………………………62
第五章 討論…………………………………………………………………………………………65
第一節 中文版糖尿病同儕支持量表心理計量特性……………65
第二節 台灣糖尿病同儕支持特性………………………………………………67
第三節 研究方法的考量…………………………………………………………………71
第六章 結論與建議……………………………………………………………………………75
第一節 結論……………………………………………………………………………………………75
第二節 護理應用與建議……………………………………………………………………76
第三節 研究限制與建議……………………………………………………………………78
參考文獻……………………………………………………………………………………………………79
中文部份……………………………………………………………………………………………………79
英文部分……………………………………………………………………………………………………81
附錄……………………………………………………………………………………………………………93
附錄一 自我照顧測量工具比較……………………………………………………93
附錄二 同儕支持測量工具比較……………………………………………………98
附錄三 質性訪談指引……………………………………………………………………100
附錄四 資本資料表…………………………………………………………………………101
附錄五 糖尿病學童自我照顧行為量表……………………………………105
附錄六 研究倫理委員會審查同意書…………………………………………108
附錄七 訪談同意書……………………………………………………………………………110
附錄八 糖尿病同儕支持量表翻譯步驟………………………………………111
附錄九 質性資料歸類至各題目……………………………………………………123
附錄十 質性資料歸納新題………………………………………………………………137
附錄十一 糖尿病同儕支持量表翻譯Chinese-2C…………………140
附錄十二 糖尿病同儕支持量表翻譯Chinese-3C…………………142
附錄十三 驗證性因素分析模型………………………………………………………145

圖目錄
圖3-1 研究工具驗證過程與資料收集流程圖………………………………32
圖4-1 因素模型架構圖……………………………………………………………………………58

表目錄
表3-1糖尿病學童自我照顧行為量表之效度……………………………………29
表4-1質性研究對象基本資料…………………………………………………………………38
表4-2研究對象基本資料……………………………………………………………………………39
表4-3研究對象家庭相關資料……………………………………………………………………40
表4-4糖尿病學童自我照顧行為量表題目得分……………………………………41
表4-5第一次內容效度題目評分…………………………………………………………………44
表4-6 中文版量表(Chinese-1C)內容修正……………………………………45
表4-7第二次內容效度題目評分…………………………………………………………………48
表4-8 中文版量表(Chinese-2C)內容修正……………………………………50
表4-9中文版糖尿病同儕支持量表題目分析…………………………………………52
表4-10中文版糖尿病同儕支持量表因素分析………………………………………56
表4-11各題項迴歸決定係數與顯著相關值……………………………………………59
表4-12研究模式的整體配適度分析……………………………………………………………60
表4-13中文版糖尿病同儕支持量表的內在一致性………………………………61
表4-14中文版糖尿病同儕支持量表題目得分………………………………………63
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