The development of a community resident questionnaire on children' s use of antimicrobial drugs: a study based on reliability and validity testing
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摘要:
目的 针对抗菌药物滥用对儿童健康的潜在危害，本研究旨在开发科学有效的问卷，评估社区居民对儿童使用抗菌药物的知识、态度和行为(知信行)，为制定健康教育策略提供依据。 方法 基于知信行理论，通过文献回顾和两轮德尔菲专家函询法构建初始问卷；采用便利抽样法，于2024年7—9月调查上海市青浦区398名儿童家长，进行项目分析、探索性因子分析(EFA)、验证性因子分析(CFA)和信效度检验，形成正式问卷。 结果 (1) 初始问卷：两轮专家咨询有效回收率均为100%，专家权威系数分别为0.75和0.79，第2轮肯德尔和谐系数为0.402(χ2=253.056，P＜0.001)，条目重要性评分为4.18~4.88分，变异系数均＜25%。初始量表包含3个维度、31个条目。(2)条目筛选：删除13个条目，最终量表包含18个条目。EFA提取3个主要因子，各条目因子载荷系数为0.592~0.838，累计方差贡献率为60.439%。(3)信效度：总量表的Cronbach's α系数为0.882，各维度Cronbach's α系数为0.762~0.903；CFA显示，χ2/df=2.78，RMSEA=0.091，NNFI=0.865，CFI=0.884，IFI=0.885，模型拟合基本良好。最终问卷包含3个维度、18个条目。 结论 本研究编制的问卷具有良好的信效度，能有效评估家长在儿童抗菌药物使用方面的知信行水平。 Abstract:Objective Antimicrobial drug misuse poses potential risks to children' s health. This study aimed to develop a scientifically valid questionnaire for assessing community residents' knowledge, attitudes, and practices (KAP) regarding children' s antimicrobial drug use, thereby providing a basis for targeted health education strategies. Methods The initial questionnaire was developed based on the Knowledge-Attitude-Practice (KAP) theory, informed by a literature review and two rounds of Delphi expert consultation. Using a convenience sampling method, we surveyed 398 parents of children in Qingpu District, Shanghai between July and September 2024. The collected data underwent item analysis, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA), alongside assessments of reliability and validity, to finalize the formal questionnaire. Results (1) Initial questionnaire: The effective response rate for both rounds of expert consultation was 100%. The expert authority coefficients were 0.75 and 0.79, respectively. Kendall' s W coefficient in the second round was 0.402 (χ2=253.056, P < 0.001). Item importance scores ranged from 4.18 to 4.88 with coefficients of variation < 25%. The preliminary scale included 3 dimensions and 31 items. (2) Item screening: after removing 13 items, the final scale comprised 18 items. EFA extracted 3 factors with loadings of 0.592-0.838, explaining 60.439% of the variance. (3) Reliability and validity: The total scale Cronbach' s α was 0.882, and the Cronbach' s α coefficients for the three dimensions ranged from 0.762 to 0.903. CFA results indicated a good model fit (χ2/df=2.78, RMSEA=0.091, NNFI=0.865, CFI=0.884, IFI=0.885). The final questionnaire included 3 dimensions and 18 items. Conclusion The developed questionnaire demonstrated satisfactory reliability and validity, and can effectively assess parents' KAP regarding children' s antimicrobial drug use. -
Key words:
- Antimicrobial drugs /
- Parents of children /
- Questionnaire /
- Reliability /
- Validity
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图 1 验证性因子分析模型
Figure 1. Confirmatory factor analysis (CFA) model of the KAP questionnaire
表 1 家长对儿童使用抗菌药物知信行初始问卷项目分析结果
Table 1. Item analysis of a preliminary KAP questionnaire on parental use of antimicrobial drugs in children
维度 临界比值法 条目与总分相关 CR值 P值 K1抗菌药物=消炎药 9.122 ＜0.001 0.622 K2抗菌药物可有效治疗感冒(如咳嗽、流鼻涕等) 13.531 ＜0.001 0.695 K3抗菌药物越新越贵疗效越好 5.870 ＜0.001 0.666 K4静脉输液抗菌药物比口服用药效果更好、风险更小 12.039 ＜0.001 0.679 K5抗菌药物可随意购买 5.431 ＜0.001 0.662 K6可自行根据说明书给孩子使用抗菌药物 5.839 ＜0.001 0.708 K7孩子病情好转或症状消失时可自行停药 13.531 ＜0.001 0.693 A1赞同孩子出现轻度不适时，自行使用抗菌药物 10.099 ＜0.001 0.784 A2赞同小孩就医时首选静脉滴注抗菌药物而非口服 6.965 ＜0.001 0.832 A3赞同使用昂贵的抗菌药物效果好、不良反应少 10.831 ＜0.001 0.753 A4赞同联合使用多种抗菌药物以尽快治愈孩子疾病 10.551 ＜0.001 0.854 A5赞同孩子漏服后，将两次剂量一次性服用 5.365 ＜0.001 0.747 P1曾根据经验自主给孩子服用过抗菌药物 9.233 ＜0.001 0.732 P2就诊时主动要求医生开具抗菌药物 12.458 ＜0.001 0.828 P3医生因主动要求而开具抗菌药物的次数较多 10.133 ＜0.001 0.825 P4曾联合使用多种抗菌药物以尽快治愈疾病 8.592 ＜0.001 0.848 P5未按医嘱或说明书自行调整抗菌药物剂量 8.403 ＜0.001 0.832 P6曾自行改变抗菌药物种类，未按医生处方用药 6.591 ＜0.001 0.872 
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表 2 家长对儿童抗菌药物知信行初始问卷因子结构
Table 2. Exploratory factor analysis of the preliminary antimicrobial drug KAP questionnaire: rotated factor loadings, communalities, and total variance explained
维度 因子载荷系数 共同度 因子1 因子2 因子3 K1 0.620 0.406 K2 0.639 0.481 K3 0.656 0.516 K4 0.638 0.462 K5 0.647 0.683 K6 0.704 0.648 K7 0.631 0.474 A1 0.677 0.583 A2 0.686 0.713 A3 0.742 0.598 A4 0.785 0.749 A5 0.592 0.582 P1 0.674 0.500 P2 0.799 0.665 P3 0.771 0.642 P4 0.801 0.710 P5 0.806 0.692 P6 0.838 0.773 特征根值(旋转前) 6.847 2.541 1.491 方差解释率%(旋转前) 38.041% 14.115% 8.283% 累积方差解释率%(旋转前) 38.041% 52.156% 60.439% 特征根值(旋转后) 4.733 3.214 2.932 方差解释率%(旋转后) 26.294% 17.855% 16.289% 累积方差解释率%(旋转后) 26.294% 44.150% 60.439%
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表 3 家长对儿童抗菌药物知信行问卷验证性因子分析各个因子载荷系数
Table 3. Factor loadings from the confirmatory factor analysis of the antimicrobial drug KAP questionnaire
维度 因子1 因子2 因子3 K1 0.575 K2 0.610 K3 0.605 K4 0.528 K5 0.739 K6 0.787 K7 0.724 A1 0.786 A2 0.805 A3 0.758 A4 0.796 A5 0.695 P1 0.681 P2 0.814 P3 0.840 P4 0.771 P5 0.736 P6 0.818
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表 4 家长对儿童抗菌药物知信行问卷的信度系数(n=218)
Table 4. Internal consistency reliability of the KAP questionnaire subscales(n=218)
维度 题目数量 n Cronbach's α系数 认知水平 7 218 0.762 态度情况 5 218 0.883 行为情况 6 218 0.903 总量表 18 218 0.882
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表 5 家长对儿童抗菌药物知信行问卷三维度及其与总量表相关性分析
Table 5. Intercorrelations among KAP dimensions and total scale scores
项目 认知总分 态度总分 行为总分 认知总分 1 态度总分 0.279 1 行为总分 0.231 0.598 1 量表总分 0.510 0.851 0.880
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