| purpose:Based on the target population of health policies,this study constructs a theoretical framework to evaluate the sense of gain of residents in health policies.Develop a residents’ sense of achievement evaluation scale for the comprehensive prevention and control of chronic diseases demonstration zone policy and test its reliability and validity.It serves as an important supplementary for evaluating the construction effect of the comprehensive prevention and control demonstration area for chronic diseases,which could provide a reference for other similar health policy evaluations.Method:1.Preparation of predictive test scaleBased on the public policy cycle theory and the "customer oriented model",combined with the concept definition of sense of gain,and drawing on the analytical framework of policy sense of gain from relevant scholars,the theoretical framework for evaluating health policy residents’ sense of gain is constructed.To collect policy texts at the national/provincial level of the Comprehensive Prevention and Control of Chronic Diseases Demonstration Zone from 2010 to 2022,and to analyze its policy objectives and work priorities at different policy stages using policy bibliometrics.Using the policy text content analysis method,to summarize and sort out the main policy goals and evaluation points of the policy.Using the Delphi expert consultation method,a preliminary screening of policy evaluation points was conducted to provide an important basis for constructing the initial entry pool of the residents’ sense of achievement evaluation scale for the comprehensive prevention and control of chronic diseases demonstration zone policy.The permanent residents in Qingyang District were selected to conduct a pre survey to investigate whether the research objects could understand the content of the item description and whether there was ambiguity in the expression of the item.The items were initially adjusted and modified to form a pre-test scale for the evaluation of residents’ sense of gain in the comprehensive prevention and control of chronic diseases in the demonstration area.2.Formation and reliability and validity testing of formal scalesConvenient sampling was used to select adult permanent residents in Qingyang District of Chengdu City in two stages as predictive test samples and reliability and validity evaluation samples.Pre test scale was used for the first stage of investigation.Discrete trend method,critical ratio method,correlation coefficient method,factor analysis method were comprehensively used to screen the items of the pre test scale,and exploratory factor analysis was used to construct the dimensions of the scale,Form a formal evaluation scale for residents’ sense of achievement in the comprehensive prevention and control demonstration zone for chronic diseases.Conduct the second phase of the survey using a formal scale to test the reliability and validity of the scale.Evaluate the validity of the scale from both subjective and objective perspectives based on content validity,structural validity,convergent validity,and discriminative validity;Cronbach’s α coefficient and half reliability are used as reliability evaluation indicators for the scale,which in turn forms the final scale.Result:1.Preparation of predictive test scaleThe theoretical framework for evaluating residents’ sense of gain in health policies includes four aspects: residents’ awareness and participation in the content of health policies during the policy formulation stage(sense of entitlement);The degree of recognition of health policy promotion,government service quality,and service attitude among residents during the policy implementation stage(sense of service acquisition);The degree of satisfaction of residents with health policy outcomes such as infrastructure construction and public health services during the policy outcome stage(sense of benefit acquisition);At the policy outcome stage,residents perceive and evaluate the fairness of health policy allocation(sense of value acquisition).Collate and analyze the six core documents related to the implementation of policies in the Comprehensive Prevention and Control of Chronic Diseases Demonstration Zone,and sort out 40 policy evaluation points in eight dimensions,including policy development,environmental support,health education and health promotion,and chronic disease overall management.15 experts were invited for two rounds of consultation,with a positive coefficient of 100% and an authoritative coefficient of 0.917.The Kendall’s W coefficients for the two rounds were 0.292 and0.341 respectively(P<0.001),resulting in 21 policy evaluation points from five dimensions.After pre investigation,a predictive test scale with 85 items was formed,among which the evaluation scale for sense of entitlement includes 5 dimensions and 22items;The evaluation scales for service acquisition,benefit acquisition,and value acquisition all contain 5 dimensions and 21 items.2.Formation and reliability and validity testing of formal scalesIn October 2022,a predictive test scale was used to collect 249 valid samples for item screening,forming a formal scale with 77 items.Among them,one item was removed from the evaluation scale of sense of entitlement,which includes 21 items from four dimensions: health supportive environment,fitness exercise,healthy lifestyle promotion and education,and chronic disease management throughout the process;The three satisfaction evaluation scales for service,benefit,and value were deleted with 2,2,and 3 items,including 19,19,and 18 items,all of which included 5 dimensions of health supportive environment,fitness exercise,promotion of healthy lifestyle,health education and promotion,and full process management of chronic diseases.In January 2023,249 valid samples were collected using a formal scale for reliability and validity evaluation.Validity analysis showed that all four satisfaction evaluation scales had good content validity,with cumulative variance contribution rates exceeding 80%,commonality of each item greater than 0.7,and factor load values greater than 0.5.The first order confirmatory factor analysis showed a high correlation among all dimensions,and the second order confirmatory factor analysis was used to simplify the model.Most of the model adaptation indicators of the two models were in the ideal range,indicating good structural validity;The AVE values were all greater than0.5,and the CR values were all higher than 0.7.The standardized load coefficients of all entries in both models were higher than 0.7(P<0.001),indicating good aggregation validity;The scale also has good discriminant validity.Reliability analysis shows that Cronbach’s of four perceived gain evaluation scales α coefficient is 0.979～0.983,and the half reliability is 0.945～0.963,indicating good internal consistency.Conclusion:The evaluation scale for residents’ sense of achievement in the comprehensive prevention and control demonstration zone policy for chronic diseases developed in this study has good reliability and validity,and can be used as a measurement tool for residents’ sense of achievement evaluation in the comprehensive prevention and control demonstration zone policy for chronic diseases,as an important supplement to the evaluation of the construction effect of the demonstration area. |
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