Development And Empirical Study Of The Social Work Intervention Evaluation Scale For Elderly Patients With Pulmonary Tuberculosis

ObjectiveAccording to the goal of social work intervention,we are going to develop a scale suitable for elderly pulmonary tuberculosis patients in China.The social work intervention evaluation scale is mainly used to evaluate the elderly pulmonary tuberculosis patients'psychologic status,social support and beliefs,behavioral plans,self-efficacy in the face of tuberculosis.Using the Delphi method to select and evaluate the items in the scale,and evaluate the reliability and validity of the scale.Methods1.Build the item pool of the scale.Through extensively review of relevant literature,we had an in-depth understanding of the content of social work interventions for elderly pulmonary tuberculosis and the guidance of domestic and foreign authorities on the work of tuberculosis.Follow the principles of specificity,scientificity,applicability,availability,and importance of the content of the scale to collect the indicators that should be involved in China's current tuberculosis intervention work,and then through several rounds of group discussions and two rounds of expert meetings,initially build a pool of items for the evaluation scale of social work interventions for elderly pulmonary tuberculosis.2.The Delphi counseling.According to the purpose of the study and referring to the inclusion and exclusion criteria,15 experts from the relevant research fields of clinical tuberculosis,psychology and epidemiology were selected as the consultation objects.The initial scale and the expert consultation form were sent to each participating expert by e-mail or by mail,and the experts were asked to qualitatively and quantitatively evaluate the indicator items of the scale and feedback their familiarity with each item.Organize the experts'opinions,and then anonymously send the feedback information of the experts in the previous round to the experts,and solicit the new opinions again.In this study,two rounds of expert consultations were conducted.And the items were selected,modified,and improved according to the experts'feedback.So far this study has initially completed the development of the scale.The items of the scale are evaluated by the expert positive coefficient,the concentration and coordination degree of the expert opinions,and the index weight coefficient.3.The pilot study.32 cases of elderly pulmonary tuberculosis were randomly selected from the tuberculosis registration system of the Baibuting Community Health Service Center in Wuhan by systematic sampling method.A face-to-face questionnaire was conducted on these patients to assess the measurability of the scale.4.Reliability and validity test of scale.344 pulmonary tuberculosis patients aged65 years and older in the communities of Wuhan were selected as the survey respondents,and face-to-face questionnaire surveys were conducted by trained investigators.The reliability and validity of the scale were tested using the survey data.The reliability evaluation indicators are homogeneity reliability and split-half reliability;the validity evaluation indicators include content validity and construct validity.Results1.This study constructed a social work intervention evaluation scale for elderly pulmonary tuberculosis.The main contents of the scale assessment include anxiety,depression,social support and self-management.And self-management is divided into three parts including behavioral beliefs,behavioral planning and self-efficacy,so the scale contains a total of five subscales.Among them,(1)the mental state subscale continued to be divided into four dimensions:psychological barrier,physical disorder,psychomotor disorder,and emotional symptoms.The number of items in each dimension is 10,9,7,and 11;(2)the social support subscale is divided into three dimensions,including objective support,subjective support,and utilization of support.The number of items are 3,4,and 3 respectively;(3)the behavioral attitudes subscale is divided into five dimensions,including sources of infection,routes of transmission,close contacts,national policies,and treatments for tuberculosis,the number of items included are 5,6,8,2 and 4;(4)the behavioral plan subscale is divided into four dimensions of doctors'supervision and family supervision,self-control,and daily activities,the number of items are 2,1,3,and 3;(5)the four dimensions of the self-efficacy subscale are health maintenance,treatment confidence,persistence in nutrition,and persistence in exercise.And each dimension contains 3 items.2.After two rounds of expert consultation,a social work intervention evaluation scale for elderly pulmonary tuberculosis with 5 subscales,20 dimensions,and a total of93 items was finally established.Calculate the weight coefficient of each item,in which the weight coefficient is up to 0.0116 and the lowest is 0.0073.The experts of this expert consultation are highly motivated.The positive coefficient of the first round is73.33%,and the second round is 100%.The expert authority coefficients of each subscale are in the range of 0.86-0.94,all above 0.85.The coefficient of variation of the second round of expert consultation was significantly reduced,and the coefficient of variation ranged from 0.13 to 0.24.The coordination coefficient of the total scale is 0.56(?~2=540.83,p<0.001),and the consensus of experts is high.3.A small sample population pre-survey was conducted to investigate 32 elderly pulmonary tuberculosis patients.It took about 32.6 minutes for the respondents to complete the questionnaire,and the questionnaire recovery rate was 100%.After the pre-survey,the research team fine-tuned several items in the attitude and behavioral dimensions according to the survey results,and the rest items did not change.4.The results of the scale reliability and validity test show that the homogeneity reliability(Cronbach's?coefficient)of the scale and the half-fold reliability are above0.70.In the content validity evaluation,the correlation coefficients between each dimension with its subscale,and between the subscale with the whole scale,was statistically significant(P<0.05).The factor analysis results of construct validity showed that the scale extracted 9 common factors,the cumulative variance contribution rate was up to 67.0%,and the factor loadings for all items included were bigger than 0.40.ConclusionsIn the development of the social work intervention evaluation scale for elderly tuberculosis patients using the Delphi method,the Expert Positive Coefficient,expert authority coefficient and expert support for the scale are high,and the scale has good reliability and validity.