The Chinesization And Application Of Community Client Need Classification System

Objective1.To translate the Community Client Need Classification System(CCNCS)into Chinese version and evaluate its reliability and validity in chronic patients.2.To explore the current condition of care needs of patients with chronic diseases(hypertension,II diabetes,heart disease and stroke)in the community.Methods1.To translate the CCNCS into Chinese and test its reliability and validity: The translation of CCNCS was carried out by Brislin model,and the items were carried out through expert consultation and pilot study.240 patients with chronic diseases in three community health service centers were selected for questionnaire survey,including general data questionnaire,Barthel Index and Chinese CCNCS(C-CCNCS)and the reliability and validity of the C-CCNCS were analyzed.IBM SPSS Statistics21.0 software was used to analyze the data.Pearson correlation analysis was used for item analysis.The validity was evaluated by content validity,calibration validity(predictive validity);the reliability was evaluated by internal consistency reliability,retest reliability and rater consistency;frequency,percentage and mean standarddeviation were used to describe the general data.2.The present status investigation: in this study,the 303 cases with chronic diseases(hypertension,diabetes,heart disease and stroke)in three community health service centers were investigated by convenient sampling,including general information questionnaire,Barthel Index,C-CCNCS,and we analyzed the influence factors of the care needs of chronic disease patients in community;Frequency,rate and percentage were used for the statistical description of qualitative data;mean standard deviation was used for the statistical description of quantitative data;t test or one-way analysis of variance was used for the comparison of data differences;multiple linear regression was used for regression analysis,α = 0.05.Results1.The results of translation the CCNCS into Chinese and its reliability and validity.C-CCNCS is an others-rating tool consisting of 7 dimensions,including nursing assessment,physiological care needs,health education and health promotion,caregiver and family support,psychosocial needs,case management,and environmental factors.If the driving time is >20min,the score is increased by 5points based on the above 7 dimensions.Pearson correlation analysis of the analysis dimensional-total score of C-CCNCS showed that the correlation coefficient r was 0.368~0.739,and the correlation analysis was statistically significant(P<0.05),and the r was >0.30 and <0.80,indicating good discrimination in each dimension.C-CCNCS validity test: Item-level content validity Index(I-CVI)was 0.80~1.00,and the average content validity index(s-cvi /Ave)was 0.97.Predictive validity(criterion related validity): the correlation and the impaction between the need level of the C-CCNCS and the direct/indirect nursing time.The direct nursing time(r=0.526)/indirect nursing time(r=0.570)was positively correlated with the need level(P<0.05),and the difference of the direct nursing time(F=31.343)/indirect nursing time(F=30.670)among the need level was statistically significant(P<0.05).Reliability test of C-CCNCS: Cronbach ’coefficient of C-CCNCS is 0.763;The test-retest reliability of C-CCNCS was 0.655,and the retest reliability of each dimension was between 0.86 and 0.694,both of which were statistically significant(P<0.05).The inter-rater reliability of C-CCNCS was 93.75%,and there was consistency among the evaluators.2.The total scores of C-CCNCS of patients with chronic diseases in the community is 15.45±5.79,and the scores of each dimension are 2.15±1.16,1.78±0.85,2.55±1.11,1.77±0.87,1.77±0.97,1.91±0.83,and 1.60±0.78.The need level of patients with chronic diseases in the community was 2.65±0.86,including 15 cases of need level 1,131 cases of need level 2,110 cases of need level3,39 cases of need level 4 and 8 cases of need level 5.The direct nursing time for patients with chronic diseases in the community was 14.00±8.72 min,and the indirect nursing time was 19.15±9.71 min.Multivariate linear regression analysis showed that:living conditions,main caregivers,and BI classification were the influencing factors of C-CCNCS scores in all dimensions and total scores of community patients with chronic diseases.Conclusions1.The C-CCNCS was good reliability and validity,which could be used for evaluating the level of care needs of community patients with chronic diseases.2.The level of care needs of community patients with chronic diseases was mostly at level 2 and level 3,and the need of the dimension of health education and health promotion are significant.Living conditions,main caregivers,and BI classification are the main factors affecting the demand level of chronic disease patients in the community.Targeted intervention strategies based on the above factors can effectively reduce their demand level and improve the efficiency of chronic disease management.