Measurement And Application Research Of Working Alliance In Schizophrenia

Objective:1.To revise the Chinese version of Working Alliance Inventory-Short Form Revised(WAI-SR),make it conform to the cultural environment and language habit of Chinese people,and examine its reliability and validity in schizophrenia patients,and verify whether it is applicable to evaluate the quality of working alliance between schizophrenia patients and psychiatrists;2.To evaluate the quality of work alliance of schizophrenia patients by WAI-SR,a Chinese version of the reliability and validity test,to understand the characteristics of work alliance of schizophrenia patients,and to explore the influencing factors of work alliance of schizophrenia patients.Methods:1.The WAI-SR was translated into Chinese by means of the internationally acknowledged scale introduction method of translation-feedback,and the Chinese version of WAI-SR was further developed through the process of cultural adjustment,including expert committee and predictive test.A total of 132 patients with schizophrenia who received inpatient treatment in Shanghai Mental Health Center from April 2018 to July 2018 were selected as study objects.The reliability and validity of the Chinese Version of WAI-SR was evaluated through self-compiled demographic Questionnaire,Chinese Version of WAI-SR,Patient-Doctor Relationship Questionnaire(15-Item Version,PDRQ-15)and Wake Forest Physician Trust Scale(WFPTS).The entries of the Chinese version of WAI-SR were screened and analyzed by the item analysis method.The reliability of the Chinese version of WAI-SR was tested through internal consistency reliability and split reliability and the validity of WAI-SR in Chinese version was tested by structure validity and calibration validity.2.Through convenient sampling,206 patients with schizophrenia hospitalized in Shanghai Mental Health Center between May,2018 and October,2018 were selected as study objects.Self-compiled questionnaire,Chinese version WAI-SR scale and Global Assessment Function(GAF)were used as study tools.Through descriptive statistical analysis,one-way Anova and multivariate Anova,the current status of the work alliance of schizophrenia patients and the influencing factors were investigated.Results:1.The internal consistency of the scale(Cronbach alpha coefficient)was 0.864,split-half reliability was 0.919;the correlation coefficient method showed that all items were significantly correlated with the total score of the scale(r=0.587-0.839).The total samples were sorted according to the WAI-SR total score,with the top 27%as the high group,and the bottom 27%as the low group for the t test of each item,and the results showed that each item had a good degree of differentiation(P<0.01).Exploratory factor analysis shows that the KMO value of WAI-SR is 0.917,Bartlett's globular test degree?~2=0.823(P<0.01),which is suitable for factor analysis.Principal component analysis was used to extract common factors for the 12 entries of WAI-SR,and the maximum variance orthogonal rotation method was used to extract two common factors according to the principle of feature value above one,which labeled“goal-task”and“affective bond”and the cumulative variance contribution rate was 63.99%;confirmatory factor analysis showed the two-factor model had almost highest adjusted goodness of fit index.The scale and its two dimensions exhibited a strong significant positive correlation with doctor-patient relationship and physician trust(r=0.374-0.721,P<0.01).2.The total score of WAI-SR was 48.9±24.02,showing the average level of quality of work alliance.There was little difference between the score of the goal-task dimension(49.16±25.76)and the score of the affective bond dimension(48.50±24.73).There were significant differences on total score of Working alliance scale(WAI-SR)on patients'gender(?~2=6.980,P<6.980)and degree of culture(?~2=2.900,P<0.05);GAF score(r=0.156,P<0.156)and subjective overall health assessment(r=0.152,P<0.05)significantly correlated with the quality of working alliance,and the patient's medical decision-making position and degree showed no significant relationship.The results of multivariate analysis of variance showed that male with worse subjective health assessment and higher the GAF score establish the higher the quality of the work alliance.Conclusion:The Chinese version of WAI-SR is acceptable in terms of internal consistency,construct validity and criterion validity,and can be recommended for alliance assessment in inpatient of schizophrenia.The quality of working alliance of hospitalized schizophrenic patients was moderate,and gender,educational level,overall functional level of patients and subjective overall health evaluation were important factors influencing the quality of working alliance with psychiatrists.