癌症幸存者营养素养测评量表的编制及信效度检验

夏娟; 邵剑; 朱文宇; 孟欣雨; 吕霖; 怀逍展; 余金明

doi:10.16766/j.cnki.issn.1674-4152.003813

癌症幸存者营养素养测评量表的编制及信效度检验

doi: 10.16766/j.cnki.issn.1674-4152.003813

1.
首都医科大学公共卫生学院，北京 100069
2.
江苏省苏北人民医院临床营养科，江苏扬州 225001
3.
复旦大学公共卫生学院，上海 200032

基金项目:

国家自然科学基金项目 82103966

详细信息

通讯作者:
余金明，E-mail: jmy@fudan.edu.cn

中图分类号: R730.7 R151.42
计量
- 文章访问数: 14
- HTML全文浏览量: 10
- PDF下载量: 2
- 被引次数: 0
出版历程
- 收稿日期: 2024-07-29
- 网络出版日期: 2025-01-20

Development and validation of nutrition literacy assessment scale for cancer survivors

1.
Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, Beijing 100069, China

摘要

摘要: 目的膳食营养问题是影响我国癌症幸存者预后及生存质量的一个重要因素，目前的膳食评估方法因涉及内容繁多，在流行病学调查研究应用中存在诸多局限性，本研究拟编制适用于我国癌症幸存者的营养素养测评量表，为快速评估癌症幸存者存在的营养问题提供科学、适宜的工具。方法 2022年1月—2023年3月，通过文献回顾、专家咨询、预调查等形成初始量表。2023年3—7月基于课题组前期建立的癌症幸存者队列，招募了3 857名癌症幸存者进行调查，采用多维项目反应理论模型对量表条目进行筛选，并对筛选条目的结构效度进行验证。结果基于各条目的区分度、难度、信息量、因子负荷等信息，筛选形成包括4个维度、21个条目的癌症幸存者营养素养量表。量表的总Cronbach's α系数为0.83，二阶验证性因子分析结果亦显示模型拟合较好(χ²/df=1.769，TLI=0.986，CFI=0.988，RMSEA=0.026)。营养素养水平与癌症幸存者的生命质量相关。结论构建的癌症幸存者营养素养量表具有较好的信效度，可用于评估癌症幸存者营养素养水平及相关研究。
- 癌症幸存者 /
- 营养素养 /
- 多维项目反应理论 /
- 量表编制
Abstract: Objective Dietary nutrition is a crucial factor affecting the prognosis and quality of life of cancer survivors in China. Current dietary assessment methods have limitations in epidemiological research due to their extensive content. Therefore, this study aims to develop a nutritional literacy assessment scale suitable for cancer survivors in China and provide a scientific and appropriate tool for assessing their nutritional issues rapidly. Methods From January 2022 to March 2023, an initial scale was formed through the literature review, expert consultation, and preliminary surveys. From March to July 2023, a total of 3 857 cancer survivors were recruited based on the previously established cancer survivor cohort by the research group. The multidimensional item response theory (MIRT) model was used to select scale items, and the structural validity of the selected items was verified. Results Based on the discrimination, difficulty, information volume, and factor load of each item, the nutrition literacy scale for cancer survivors was developed, consisting of 4 dimensions and 21 items. The total Cronbach's α coefficient of the scale was 0.83, and the results of the second-order confirmatory factor analysis also indicated a good model fit (χ²/df=1.769, TLI=0.986, CFI=0.988, RMSEA=0.026). The level of nutrition literacy was significantly correlated with cancer survivors' quality of life. Conclusion The nutrition literacy scale for cancer survivors exhibits good reliability and validity, making it suitable for assessing the nutritional literacy level of cancer survivors and related research.
- Cancer survivors /
- Nutrition literacy /
- Multidimensional item response theory /
- Scale development

HTML全文

表 1 癌症幸存者营养素养初始条目池涵盖内容

Table 1. The initial item pool of nutrition literacy for cancer survivors

条目内容		条目内容
1.对营养膳食相关信息或科普讲座的关注程度		18.食物的准备和烹调方式与营养损失的关系
2.查找、获取相关营养信息的困难程度		19.蔬菜水果每日推荐摄入量
3.辨别网络、朋友、食品销售员等提供的营养保健信息真实性及科学性的困难程度		20.食盐的推荐摄入量
4.从现有众多关于健康营养的信息中，选择适合自己健康需求的饮食搭配信息的困难程度		21.重度营养不良肿瘤患者蛋白质的推荐摄入量
5.对膳食宝塔内容的熟悉程度		22.不同食用方式与营养健康的关系
6.结合自身营养需要进行饮食搭配的能力		23.糖尿病患者的适宜食物选择
7.对肿瘤营养治疗、肿瘤膳食等内容的熟悉度		24.食用油的主要营养物质
8.对食品包装上营养成分表内容的理解程度		25.富含蛋白质的食物判断
9.对营养与肿瘤治疗及预后康复关系的认知		26.富含同类营养素的食物替换
10.对膳食补充剂的认知		27.食物分量大小估算能力
11.对食物富含主要营养成分的判断能力		28.富含饱和脂肪酸的食物判断
12.营养相关信息的分享能力		29.营养标签的识别和应用
13.购买食品时对配料及营养成分表的关注程度		30.食品主要配料成分的判断
14.关注营养搭配，调整饮食的行为能力		31.根据食品配料中提供的致敏原信息判断食用安全性
15.对膳食脂肪的认知		32.根据营养成分表计算摄入指定克重食品后，能量摄入量
16.主动咨询医生营养与健康相关问题的行为		33.根据营养成分表计算脂肪摄入量
17.健康食品选择的行为		34.根据营养成分表计算蛋白质摄入量

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表 2 保留条目质量及区分度和难度参数估计

Table 2. Estimation of discrimination, difficulty, and quality of selected items

条目序号	截距	斜率估计				MDISC	b	因子负荷				条目质量
条目序号	截距	A1	A2	A3	A4	MDISC	b	F1	F1	F3	F4	条目质量
1	-0.46	1.89	0.00	0.00	0.00	1.89	0.24	0.71	-0.07	0.07	0.07	优
2	0.44	0.20	2.55	0.00	0.00	2.56	-0.17	0.01	0.82	0.01	0.06	优
3	0.31	0.01	4.14	0.00	-0.31	4.15	-0.07	-0.04	0.93	0.02	-0.02	优
4	0.59	0.44	4.17	0.14	-0.27	4.20	-0.14	0.04	0.91	0.06	-0.01	优
5	-0.76	1.97	0.18	0.03	0.04	1.98	0.38	0.71	-0.01	0.08	0.09	优
6	-0.10	2.32	0.34	-0.25	-0.17	2.36	0.04	0.80	0.05	-0.02	0.05	优
7	-0.61	2.56	0.61	-0.31	-0.08	2.65	0.23	0.80	0.12	-0.03	0.09	优
8	-0.28	2.37	0.70	-0.06	-0.04	2.47	0.11	0.75	0.16	0.05	0.08	优
9	0.34	1.83	-0.06	0.31	-0.04	1.86	-0.18	0.67	-0.11	0.20	0.02	优
11	-0.63	-0.04	1.33	-0.15	0.07	1.34	0.47	-0.05	0.61	-0.08	0.09	良
12	-0.32	2.48	0.14	-0.01	-0.37	2.51	0.13	0.82	-0.01	0.08	-0.05	优
13	0.02	2.72	0.49	0.08	-0.01	2.76	-0.01	0.79	0.06	0.10	0.08	优
14	-0.13	2.31	0.33	0.03	0.00	2.33	0.06	0.76	0.03	0.08	0.08	优
18	1.05	0.71	0.30	0.97	0.48	1.33	-0.79	0.12	0.02	0.49	0.15	良
23	1.46	0.40	0.32	1.15	0.28	1.29	-1.13	-0.02	0.06	0.59	0.01	良
24	-1.65	0.55	0.30	1.21	0.70	1.53	1.08	-0.01	0.00	0.56	0.21	优
25	2.07	0.55	0.46	1.95	0.52	2.14	-0.97	-0.06	0.05	0.78	0.03	优
26	1.98	0.43	0.22	1.70	0.39	1.81	-1.09	-0.07	-0.02	0.75	-0.01	优
32	-2.50	0.35	0.21	0.13	1.18	1.26	1.99	-0.02	-0.03	0.01	0.59	良
33	-2.59	0.85	0.58	0.30	2.52	2.74	0.95	0.00	-0.01	0.03	0.84	优
34	-3.59	0.79	0.78	0.30	3.06	3.27	1.10	-0.06	0.02	0.01	0.89	优

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表 3 量表条目验证性因子分析模型拟合指数汇总表

Table 3. Summary of the fit index of the confirmatory factor analysis model for the scale items

模型	χ²值	df	χ²/df	TLI	CFI	SRMR	RMSEA(90% CI)
一阶	311.675	182	1.713	0.987	0.989	0.048	0.025(0.020~0.029)
二阶	325.424	184	1.769	0.986	0.988	0.051	0.026(0.021~0.030)

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参考文献(22)

[1]	Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2021 (GBD 2021) Results[EB/OL]. (2024-05-16)[2024-07-16]. https://vizhub.healthdata.org/gbd-results/.
[2]	ROCK C L, THOMSON C A, SULLIVAN K R, et al. American Cancer Society nutrition and physical activity guideline for cancer survivors[J]. CA Cancer J Clin, 2022, 72(3): 230-262. doi: 10.3322/caac.21719
[3]	廖志军, 杨志勇, 黄英, 等. 个体化营养干预在老年肿瘤患者中的临床应用[J]. 中华全科医学, 2022, 20(12): 2019-2021. doi: 10.16766/j.cnki.issn.1674-4152.002759 LIAO Z J, YANG Z Y, HUANG Y, et al. Clinical study of individualized nutritional intervention in elderly patients with tumors[J]. Chinese Journal of General Practice, 2022, 20(12): 2019-2021. doi: 10.16766/j.cnki.issn.1674-4152.002759
[4]	MARTÍNEZ-GARAY C, DJOUDER N. Dietary interventions and precision nutrition in cancer therapy[J]. Trends Mol Med, 2023, 29(7): 489-511. doi: 10.1016/j.molmed.2023.04.004
[5]	SANFT T, HARRIGAN M, MCGOWAN C, et al. Randomized trial of exercise and nutrition on chemotherapy completion and pathologic complete response in women with breast cancer: the lifestyle, exercise, and nutrition early after diagnosis study[J]. J Clin Oncol, 2023, 41(34): 5285-5295. doi: 10.1200/JCO.23.00871
[6]	何艳, 唐莉, 陈恋. 认知行为干预对上消化道早癌行内镜下黏膜剥离术患者的效果研究[J]. 实用临床医药杂志, 2024, 28(7): 115-119. HE Y, TANG L, CHEN L. Effect of cognitive behavioral intervention in patients with endoscopic submucosal dissection for early upper gastrointestinal cancer[J]. Journal of Clinical Medicine in Practice, 2024, 28(7): 115-119.
[7]	梁玉杰, 张永琪, 陈梦杰, 等. 术前预后营养指数对前列腺根治性切除术患者的生存预测价值[J]. 中华全科医学, 2022, 20(2): 224-227. doi: 10.16766/j.cnki.issn.1674-4152.002318 LIANG Y J, ZHANG Y Q, CHEN M J, et al. Predictive value of the pre-operative prognostic nutrition index for the survival of patients undergoing radical prostatectomy[J]. Chinese Journal of General Practice, 2022, 20(2): 224-227. doi: 10.16766/j.cnki.issn.1674-4152.002318
[8]	夏娟, 张玲. 营养素养定义及其测评工具研究现状[J]. 卫生研究, 2021, 50(4): 698-704. XIA J, ZHANG L. Research status of the definition and assessment tools of nutrition literacy[J]. Journal of Hygiene Research, 2021, 50(4): 698-704.
[9]	KALKAN I. The impact of nutrition literacy on the food habits among young adults in Turkey[J]. Nutr Res Pract, 2019, 13(4): 352-357. doi: 10.4162/nrp.2019.13.4.352
[10]	PERUVEMBA S, GIENG J, CHEN S, et al. Diet quality, diet motives, and nutrition literacy of vegans, vegetarians, and semi-vegetarians[J]. Public Health Nutr, 2024: 1-19. DOI: 10.1017/S1368980024001241.
[11]	LI Z, ZHEN T, ZHAO Y, et al. Development and assessment of a nutrition literacy scale for patients with end-stage kidney disease undergoing dialysis and its correlation with quality of life[J]. Ren Fail, 2023, 45(1): 2162417. DOI: 10.1080/0886022X.2022.2162417.
[12]	陶敏洁, 雷宇, 金俊, 等. 个体化饮食指导对肝癌患者肝动脉灌注化疗栓塞术后营养状况和生活质量的影响[J]. 中华全科医学, 2022, 20(3): 507-510. doi: 10.16766/j.cnki.issn.1674-4152.002388 TAO M J, LEI Y, JIN J, et al. Effect of individualised dietary guidance on nutritional status and quality of life of liver cancer patients after TACE[J]. Chinese Journal of General Practice, 2022, 20(3): 507-510. doi: 10.16766/j.cnki.issn.1674-4152.002388
[13]	陈秀, 余建平, 翁芳芳, 等. 授权教育饮食联合心理干预在病毒性肝炎后肝硬化中的应用[J]. 中华全科医学, 2022, 20(9): 1535-1537. doi: 10.16766/j.cnki.issn.1674-4152.002642 CHEN X, YU J P, WENG F F, et al. Authorised educational diet combined with psychological intervention in viral post-hepatitis cirrhosis[J]. Chinese Journal of General Practice, 2022, 20(9): 1535-1537. doi: 10.16766/j.cnki.issn.1674-4152.002642
[14]	PITUCH K A, STEVENS J P. Applied multivariate statistics for the social sciences: analyses with SAS and IBM ' s SPSS[M]. Sixth Edition (6th ed. ), Routledge, 2015: 339-390.
[15]	王孟成. 潜变量建模与Mplus应用·基础篇[M]. 重庆: 重庆大学出版社, 2014: 105-126. WANG M C. Latent variable modeling using Mplus[M]. 1st Edition. Chongqing: Chongqing University Press, 2014: 105-126.
[16]	LI C. flexMIRT^Ⓡ version 3.65: Flexible multilevel multidimensional item analysis and test scoring[Computer software][CP]. Chapel Hill: NC: Vector Psychometric Group, 2022.
[17]	WORLD HEALTH ORGANIZATION. Ambition and Action in Nutrition 2016-2025[EB/OL]. (2017-05-18)[2024-07-16]. https://www.who.int/publications/i/item/9789241512435.
[18]	国务院办公厅. 国民营养计划(2017—2030年)[EB/OL]. (2017-06-30)[2024-07-16]. http://www.gov.cn/zhengce/content/2017-07/13/content_5210134.htm. General Office of the State Council. National Nutrition Plan (2017-2030)[EB/OL]. (2017-06-30)[2024-07-16]. http://www.gov.cn/zhengce/content/2017-07/13/content_5210134.htm.
[19]	ROSENBAUM D L, CLARK M H, CONVERTINO A D, et al. Examination of nutrition literacy and quality of self-monitoring in behavioral weight loss[J]. Ann Behav Med, 2018, 52(9): 809-816. doi: 10.1093/abm/kax052
[20]	HAKAMI R, GILLIS D E, POURESLAMI I, et al. Patient and professional perspectives on nutrition in chronic respiratory disease self-management: reflections on nutrition and food literacies[J]. Health Lit Res Pract, 2018, 2(3): e166-e174.
[21]	LI Z, ZHOU Y, TAN Y, et al. Development and validation of nutrition literacy assessment instrument for Chinese Lactating Women: a preliminary study[J]. Nutrients, 2023, 15(15): 3488. DOI: 10.3390/nu15153488.
[22]	ZHANG Y, SUN Q, ZHANG M, et al. Nutrition literacy measurement tool with multiple features for Chinese adults[J]. Food Nutr Bull, 2022, 43(2): 189-200.